Bridging the data gaps in the epidemiology of hepatitis C virus infection in Malaysia using multi-parameter evidence synthesis.
BACKGROUND
Collecting adequate information on key epidemiological indicators is a prerequisite to informing a public health response to reduce the impact of hepatitis C virus (HCV) infection in Malaysia. Our goal was to overcome the acute data shortage typical of low/middle income countries using statistical modelling to estimate the national HCV prevalence and the distribution over transmission pathways as of the end of 2009.


METHODS
Multi-parameter evidence synthesis methods were applied to combine all available relevant data sources - both direct and indirect - that inform the epidemiological parameters of interest.


RESULTS
An estimated 454,000 (95% credible interval [CrI]: 392,000 to 535,000) HCV antibody-positive individuals were living in Malaysia in 2009; this represents 2.5% (95% CrI: 2.2-3.0%) of the population aged 15-64 years. Among males of Malay ethnicity, for 77% (95% CrI: 69-85%) the route of probable transmission was active or a previous history of injecting drugs. The corresponding proportions were smaller for male Chinese and Indian/other ethnic groups (40% and 71%, respectively). The estimated prevalence in females of all ethnicities was 1% (95% CrI: 0.6 to 1.4%); 92% (95% CrI: 88 to 95%) of infections were attributable to non-drug injecting routes of transmission.


CONCLUSIONS
The prevalent number of persons living with HCV infection in Malaysia is estimated to be very high. Low/middle income countries often lack a comprehensive evidence base; however, evidence synthesis methods can assist in filling the data gaps required for the development of effective policy to address the future public health and economic burden due to HCV.
Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia. scott.mcdonald@rivm.nl.|Centre for Infectious Disease Control, National Institute for Public Health and the Environment, PO Box 1, 3720BA, Bilthoven, The Netherlands. scott.mcdonald@rivm.nl.|School of Health & Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland. scott.mcdonald@rivm.nl.
Scott A
SA
McDonald
Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. ros@ummc.edu.my.
Rosmawati
R
Mohamed
Julius Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. maznahd@ummc.edu.my.
Maznah
M
Dahlui
Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia. dobie.herlianna@gmail.com.
Herlianna
H
Naning
Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia. adeeba@ummc.edu.my.|Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. adeeba@ummc.edu.my.
Adeeba
A
Kamarulzaman
D000293:Adolescent; D000328:Adult; D005006:Ethnicity; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015995:Prevalence; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology