背景:丙型肝炎(HCV)是一种导致慢性肝病的病毒,终末期肝硬化,和肝癌,然而,大多数感染者仍未被诊断或未经治疗。肯尼亚是一个位于撒哈拉以南非洲(SSA)的国家,HCV的流行率仍然很高,但由于基于人群的流行证据很少,疾病负担不确定。我们旨在通过总结现有数据来强调肯尼亚的HCV疾病负担。
方法:本研究按照系统评价和荟萃分析(PRISMA)指南的首选报告项目进行。我们检索了2000年1月至2022年12月在肯尼亚报告HCV流行和基因型的出版物。效果大小,即,HCV患病率,定义为HCV抗体检测阳性的样本比例。研究质量由JoannaBriggs研究所(JBI)关键评估清单评估。由于研究异质性高,这些研究被归类为低,中介-,和HCV感染的高风险。每个类别的汇总估计患病率由随机效应模型确定。本综述已在国际前瞻性系统评价登记册(PROSPERO)(ID:CRD42023401892)中注册。
结果:共有29项研究,样本量为90,668项,符合我们的纳入标准。其中三分之一来自首都内罗毕(34.5%)。一半的研究包括艾滋病毒感染者(31%)或注射吸毒者(20.7%)。HCV基因型1是最常见的,基因型4只稍微不常见,他们总共占了94%的病例。低人群的合并患病率,中危和高危人群为2.0%,3.4%,和15.5%,分别。超过80%的研究在JBI量表上得分>6,表明在研究设计方面存在低偏倚风险,进行和分析。
结论:我们的研究结果表明,在肯尼亚,HIV感染者和吸毒者等关键人群中,HCV的流行率高于一般人群。我们发现HCV基因型1和4是最常见的基因型。为了建立肯尼亚HCV流行率和基因型的基线数据,需要更多来自普通人群的数据。
BACKGROUND: Hepatitis C (HCV) is a virus that causes chronic liver disease, end-stage cirrhosis, and liver cancer, yet most infected individuals remain undiagnosed or untreated. Kenya is a country located in Sub-Saharan Africa (SSA) where the prevalence of HCV remains high but with uncertain disease burden due to little population-based evidence of the epidemic. We aimed to highlight the HCV disease burden in Kenya with a summary of the available data.
METHODS: The study was performed as per the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. We searched publications reporting HCV prevalence and genotypes in Kenya between January 2000 to December 2022. The effect size, i.e., the HCV prevalence, was defined as the proportion of samples testing positive for HCV antibody. Study quality was assessed by the Joanna Briggs Institute (JBI) critical appraisal checklist. Due to high study heterogeneity, the studies were categorized into low-, intermediate-, and high-risk for HCV infection. The pooled estimate prevalence per category was determined by the random effects model. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023401892).
RESULTS: A total of 29 studies with a sample size of 90,668 met our inclusion criteria, a third of which were from the capital city Nairobi (34.5%). Half of the studies included HIV-infected individuals (31%) or injection drug users (20.7%). HCV genotype 1 was the most common, with genotype 4 only slightly less common, and together they accounted for 94% of cases. The pooled prevalence for the low-, intermediate- and high-risk groups were 2.0%, 3.4%, and 15.5%, respectively. Over 80% of the studies had a score of > 6 on the JBI scale, indicating a low risk of bias in terms of study design, conduct and analysis.
CONCLUSIONS: Our findings demonstrate that there is a higher prevalence of HCV in key populations such as HIV-infected individuals and drug users than in the general population in Kenya. We found that HCV genotypes 1 and 4 were the most common genotypes. More data from the general population is required in order to establish baseline data on the prevalence and genotypes of HCV in Kenya.