title: The epidemiology of hepatitis C virus in the Maghreb region: systematic review and meta-analyses.
abstract: OBJECTIVE
  To systematically review and synthesize available epidemiological data on hepatitis C virus (HCV) prevalence and incidence in the Maghreb region and to estimate the country-specific population-level HCV prevalence.
  
  
  METHODS
  We conducted a systematic review of HCV antibody prevalence and incidence in the Maghreb countries as outlined by the PRISMA guidelines. Meta-analyses were conducted using DerSimonian-Laird random-effect models with inverse variance weighting to pool HCV prevalence estimates among general population groups.
  
  
  RESULTS
  We identified 133 HCV prevalence measures and two HCV incidence measures. Among high risk groups, HCV prevalence ranged between 22% and 94% among people who inject drugs, 20% and 76% among dialysis patients, and 2% and 51% among hemophiliacs. Among intermediate-risk groups, considerable but widely variable HCV prevalence was found. Most common risk factors cited across studies were the duration of dialysis, number of transfusions, and having a history of surgery or dental work. The national HCV prevalence in Algeria was estimated at 0.3% (95%CI: 0.1-0.5), Libya 1.2% (95%CI: 1.1-1.3), Mauritania 1.1% (95%CI: 0-2.3), Morocco 0.8% (95%CI: 0.5-1.2), and Tunisia 0.6% (95%CI: 0.5-0.8).
  
  
  CONCLUSIONS
  HCV prevalence in the Maghreb region of the Middle East and North Africa is comparable to that in developed countries of about 1%. HCV exposures appear often to be linked to medical care and are suggestive of ongoing transmission in such settings. Injecting drug use appears also to be a major, though not dominant, contributor to HCV transmission. Further research is needed to draw a more thorough understanding of HCV epidemiology, especially in the countries with limited number of studies. HCV prevention policy and programming in these countries should focus on the settings of exposure.
authors: Infectious Disease Epidemiology Group, Weill Cornell Medical College, Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar; College of Medicine, University of Toledo, Toledo, Ohio, United States of America.
authors: Fatima A
authors: FA
authors: Fadlalla
authors: Infectious Disease Epidemiology Group, Weill Cornell Medical College, Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.
authors: Yousra A
authors: YA
authors: Mohamoud
authors: Infectious Disease Epidemiology Group, Weill Cornell Medical College, Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar.
authors: Ghina R
authors: GR
authors: Mumtaz
authors: Infectious Disease Epidemiology Group, Weill Cornell Medical College, Qatar, Cornell University, Qatar Foundation, Education City, Doha, Qatar; Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, New York, United States of America; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America.
authors: Laith J
authors: LJ
authors: Abu-Raddad
mesh_terms: D000352:Africa, Northern / Q000453:epidemiology; D000914:Antibodies, Viral / Q000097:blood; D016174:Hepacivirus / Q000276:immunology*; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D015233:Models, Statistical; D015995:Prevalence
chemical_list: D000914:Antibodies, Viral