oa The Epidemiology Of Hepatitis C Virus In Yemen: A Systematic Review And Meta-analysis

Background and Objective: In the Middle East and North Africa, hepatitis C virus (HCV) infection distribution appears to present a wide range of prevalence. The scale and nature of HCV infection exposure in Yemen is poorly known. The objective of this study was to establish the national population-level HCV prevalence in Yemen and to characterize the epidemiology of this infection in the Yemeni population. Methods: We conducted a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Sources of data included PubMed and Embase databases. Our analysis included all primary studies reporting HCV antibody prevalence or incidence measures in Yemen. Extracted measures were then classified and analyzed on the basis of the study population's risk of acquiring HCV. Meta-analyses were conducted incorporating inverse variance weighting and using a random-effects model to pool summary estimates of HCV prevalence among general population groups. Results: We identified 28 studies providing a total of 46 measures on HCV prevalence and none on incidence in Yemen. Pooled HCV prevalence in the general population was 1.8% (95% confidence interval (CI): 1.05-2.75). Among blood donors the prevalence ranged from 0.2 to 3.0% depending on governorate of origin. The highest prevalence within the general population groups was reported among pregnant women in one study (8.5%) followed by a study of African migrant community living in a Shanty town in Sana'a (5.2%). Among high risk populations, HCV prevalence among hemodialysis patients was 40.0% in 1999 and 62.7% in 2007. Among patients with acute and chronic liver disease it was 74.1%. Conclusions: National-level HCV prevalence in Yemen is slightly higher than that in developed countries, but comparable to several other countries in the Middle East and North Africa. The high prevalence found among high risk groups may indicate limitations in implementation of infection control and blood screening protocols, or possibly dates back to exposures before these measures were expanded. These findings are of particular relevance for resource allocation and HCV public health programming in Yemen. HCV prevention policy in Yemen should focus mainly on prevention and infection control in settings of exposure such as in medical care and among people who inject drugs.