Prevalence, trends, and distribution of hepatitis C virus among the general population in sub-Saharan Africa: A systematic review and meta-analysis

Background and Aims: Although the evidence is uncertain, existing estimates for hepatitis C virus (HCV) in sub- Saharan Africa (SSA) indicate a high burden. We estimated HCV seroprevalence and viraemic prevalence among the general population in SSA. Methods: We searched Medline, Embase, Web of Science, APA PsycINFO, and World Health Organization Africa Index Medicus for community- based studies. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool, and heterogeneity using the index of heterogeneity (I-2). Two approaches were deployed. First, we used random- effects meta- analysis to pool prevalence. Second, to derive representative estimates, we weighted each country's HCV seroprevalence using 2021 United Nations country population sizes. Results: We synthesized 130 studies. Overall, SSA HCV seroprevalence from the random- effects model was 4.17% (95% confidence interval [CI]: 3.71-4.66, I-2 = 99.30%). There were no differences between males (4.31%) and females (4.03%). Seroprevalence was 2.25%, 3.31%, and 16.23% for ages <= 20, 21-64, and >= 65 years, respectively, and was higher in rural (6.63%) versus urban (2.93%). There was indication of decrement overtime from 5.74% to 4.35% to 3.03% in the years 1984-2000, 2001-2014, and 2015-2023, respectively. The weighted overall SSA HCV seroprevalence was estimated to be 2.30% (95% CI: 1.59-3.00) with regional variation: Africa- Southern (.79%), Africa- Central (1.47%), Africa- Eastern (2.71%), and Africa- Western (2.88%). HCV viremia among HCV seropositives was 54.77% (95% CI: 47.80-61.66). Conclusions: HCV seroprevalence in SSA remains high. Populations aged >= 65 years, rural communities, Africa- Western, and some countries in Africa- Central and Africa- Eastern appear disproportionately affected. These results underline the need for governmental commitment to achieve the 2030 global HCV elimination targets.