Hepatitis C Virus Infection in Eastern Libya: Efforts Needed to Improve HCV Testing and Linkage to Care in the Resource-Limited Setting.

Faisal Ismail,Eman Abdelsameea,Soghra Haq,Islam El-Garawani

doi:10.3390/tropicalmed7020014

Abstract

Hepatitis C virus (HCV) is a significant public health problem, and the elimination of its infection by 2031 is a global goal. However, due to insufficient testing, lack of linkage to care (LTC) and treatment, Libya may be far from achieving this goal. This study aimed to explore HCV testing, the care and treatment of infected people, and to assess the burden of the infection among individuals who visited the main Medical Centre in Tobruk region, eastern Libya, for various medical and surgical conditions. A research team interviewed public health officials in Tobruk Medical Center, inspected available equipment, and obtained data available for people who were positive for antibodies to HCV (anti-HCV) as part of their routine pre-invasive procedures and pre-donation screening tests from January 2005 to April 2020. HCV antibody tests were positive for 612 cases out of 368,392 (0.17%). Of those who tested positive for anti-HCV antibodies, no one had followed up by RNA test for identifying individuals with chronic HCV infection, and there are no links to outpatient care and treatment. Our findings highlight the critical need for an up-to-date HCV diagnosis and linkage to care guidelines, which includes a follow-up RNA test for anti-HCV positive patients and early linkage to care for confirmed cases to accelerate the elimination of HCV infection from the community.

Highlights

Hepatitis C virus is a blood-borne viral infection that causes substantial morbidity and mortality rate in the world mainly due to liver cirrhosis and hepatocellular carcinoma, and remains a potential cause of morbidity and mortality in the future [1].Globally, an estimated 71 million people have chronic HCV infection
A total of 612 out of 368,392 (0.17%) individuals were found positive for anti-HCV antibodies over the study period
The frequency of anti-HCV positive individuals according to geographical regions was varied; the majority of cases being from Tobruk region (506, 82.7%), followed by Darnah city (53, 8.7%), Al-Bayda city (27, 4.4%), Banghazi (14, 2.3%), and sporadic cases from other nearby cities (12, 1.9%)

Summary

Introduction

Hepatitis C virus is a blood-borne viral infection that causes substantial morbidity and mortality rate in the world mainly due to liver cirrhosis and hepatocellular carcinoma, and remains a potential cause of morbidity and mortality in the future [1]. An estimated 71 million people have chronic HCV infection. HCV can cause both acute and chronic infection. New HCV infections are usually asymptomatic [2]. Around 30% (15–45%) of infected persons spontaneously clear the virus within 6 months of infection; different HCV genotypes may exhibit different spontaneous clearance rates [3]. The remaining 70% (55–85%) of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis ranges between 15% and 30% within 20 years [4]

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