Prevalence and trends of hepatitis B and C virus biomarkers in Zimbabwe: comparative analyses of a nation’s blood-donor surveillance data and meta-analyses of population studies

Abstract

Background The disproportionate burden of viral hepatitis, particularly hepatitis B virus (HBV) is experienced by people living in low-resourced sub-Saharan Africa, where the estimated prevalence is 3–7 times the global average. Therefore to inform policy, we describe the seroprevalence and trends of hepatitis C (HCV) and HBV biomarkers: anti-HCV antibody and hepatitis B surface antigen (HBsAg), respectively, in Zimbabwe. Methods We analysed data from 181,248 consecutive blood-donors, examined between January 2015 through December 2018. Additionally, we conducted a comprehensive literature review using PubMed and African Journals Online databases, meta-analysing selected papers from Zimbabwe, published between 1970 and 2020, that met specific criteria. Results Overall age-standardized prevalence rate (ASPR) for anti-HCV was 8.67 (95%CI, 0.25–17.09) per 100,000, while that for HBsAg was 2.26 (95%, 1.89–2.63) per 1000 blood-donors, per year. Meta-analysis of 9 studies comprising 220,127 persons tested for anti-HCV revealed ASPR of 0.05% (95% 0%–0.19%) in blood-donors and 1.78% (95%CI, 0.01%–5.55%) in the general population, for an overall pooled ASPR of 0.44 (95%CI, 0.19%–0.76%). 21 studies comprising 291,784 persons tested for HBsAg revealed ASPR of 0.65% (95%CI, 0.31%–1.00%) in blood-donors and 4.31% (95%CI, 1.77%–6.50%) in the general population for an overall pooled ASPR of 4.02% (95%CI, 3.55%–4.48%), after HBV vaccine introduction. HBsAg prevalence was significantly higher before HBV vaccine introductions. Conclusions The prevalence of HBV is decreasing, consistent with the introduction of HBV vaccination, while HCV prevalence is increasing in Zimbabwe. This highlights the need for Improved blood-donor screening and more informative biomarker studies, particularly among repeat donors and children.