title: Hepatitis C seroprevalence and HIV co-infection in sub-Saharan Africa: a systematic review and meta-analysis.
abstract: BACKGROUND
  An estimated 150 million people worldwide are infected with hepatitis C virus (HCV). HIV co-infection accelerates the progression of HCV and represents a major public health challenge. We aimed to determine the epidemiology of HCV and the prevalence of HIV co-infection in sub-Saharan Africa.
  
  
  METHODS
  We searched Medline and Embase (Ovid) from Jan 1, 2002, to Dec 31, 2014, for studies containing data for HCV seroprevalence in different population groups in WHO-defined regions of sub-Saharan Africa. We estimated pooled regional prevalence estimates with a DerSimonian-Laird random-effects model. Data were further stratified by risk factor and HIV status.
  
  
  RESULTS
  We included 213 studies from 33 countries in sub-Saharan Africa, comprising 287 separate cohorts with 1 198 167 individuals. The pooled HCV seroprevalence from all cohorts was 2·98% (95% CI 2·86-3·10). The pooled HCV seroprevalence was 2·65% (95% CI 2·53-2·78) across all 185 low-risk cohorts, 3·04% (2·23-3·84) in antenatal clinic groups, 1·99% (1·86-2·12) in blood donors, but 6·9% (6·1-7·5) in other general population cohorts. The pooled seroprevalence of HCV was 11·87% (95% CI 7·05-16·70) across all high-risk groups and 9·95% (6·79-13·11) in patients with liver disease. 101 cohorts included HIV-positive samples tested for HCV (42 648 individuals), with a pooled seroprevalence of 5·73% (95% CI 4·90-6·56).
  
  
  CONCLUSIONS
  We recorded a high seroprevalence of HCV across populations of sub-Saharan Africa, including in HIV-positive adults, with evidence of regional variation in the general population. Monitoring of antenatal HCV prevalence might be a helpful indicator of population trends in HCV infection; however, larger population surveys are needed to monitor these trends. Access to prevention and treatment needs to be improved for both monoinfected and co-infected individuals.
  
  
  BACKGROUND
  None.
authors.affiliation: Manson Unit, Médecins Sans Frontières, London, UK; Division of Infectious Diseases, Imperial College London, London, UK.
authors.forename: V Bhargavi
authors.initials: VB
authors.lastname: Rao
authors.affiliation: Division of Infectious Diseases, Imperial College London, London, UK.
authors.forename: Nur
authors.initials: N
authors.lastname: Johari
authors.affiliation: Manson Unit, Médecins Sans Frontières, London, UK.
authors.forename: Philipp
authors.initials: P
authors.lastname: du Cros
authors.affiliation: Spatial Epidemiology and Ecology Group, Department of Zoology, University of Oxford, Oxford, UK.
authors.forename: Janey
authors.initials: J
authors.lastname: Messina
authors.affiliation: Division of Infectious Diseases, Imperial College London, London, UK; Médecins Sans Frontières, Geneva, Switzerland; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: Division of Infectious Diseases, Imperial College London, London, UK. Electronic address: g.cooke@imperial.ac.uk.
authors.forename: Graham S
authors.initials: GS
authors.lastname: Cooke
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D060085:Coinfection / Q000453:epidemiology*; D015658:HIV Infections / Q000453:epidemiology*; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D012307:Risk Factors; D016036:Seroepidemiologic Studies