Introduction: hepatitis C virus (HCV) screening efficiency in resource-limited settings is compromised by variable ribonucleic acid (RNA) detectability among seropositive individuals. Understanding the demographic predictors of RNA positivity is crucial for optimizing testing algorithms in high-burden populations such as Ethiopia. Methods: we conducted a retrospective analysis of 792 anti-HCV seropositive treatment-naive individuals in Ethiopia. Multivariate logistic regression with comprehensive diagnostics was used to assess the independent associations of age and sex with HCV RNA status. Assay specificity was enhanced through duplicate testing and elevated signal-to-cutoff thresholds (S/CO ≥5.0). Results: the overall RNA positivity rate was 69.7% (552/792). Multivariate analysis revealed that each additional year of age increased the odds of RNA positivity by 3.1% (aOR = 1.031, 95% CI: 1.019-1.042, P <0.001), whereas female sex was independently associated with 44.6% greater odds (aOR = 1.446, 95% CI: 1.060-1.973, P = 0.020). Subgroup analysis revealed that young males (<30 years) had lower RNA positivity (37.8%, 95% CI: 24.1-53.9%) than young females did (50.0%, 95% CI: 36.6-63.4%). RNA positivity was 1.6-fold greater in adults ≥30 years (72.8%) than in younger individuals <30 years (44.8%). Genotype 4 predominated (49.6%) among the RNA-positive cases. Conclusion: both age and sex independently predict HCV RNA detectability in Ethiopia. The substantially lower RNA positivity among young males suggests that this subgroup may benefit from differentiated testing approaches. Demographic-informed algorithms could optimize resource allocation in HCV elimination programs in low- and middle-income countries (LMICs).
Nigussie et al. (Thu,) studied this question.