Pre-elimination Plan Seroprevalence Epidemiological Study of Hepatitis C Infection in General Population in Tunisia

Background: Viral Hepatitis C (VHC) is a major public health concern. The global prevalence of VHC infection is estimated to more than 170 million people, nearly 3% world's population. In Tunisia, the latest prevalence estimates date back to the nineties with most studies on small populations and specific regions. This study aimed to estimate the national seroprevalence of VHC infection in Tunisia and to identify the associated risk factors in order to guide prevention and management measures. Methods: We conducted a cross-sectional survey in the general population from January to December 2015, using a two-stage cluster sampling design based on 2014 national census. The expected sample size was 22 275 participants. Data collection was based on standardized questionnaires administered by trained doctors, blood samples were collected in the nearest healthcare centre and tested for antiVHC IgG antibodies in the same reference laboratory. Data were entered using EpiData and analysed with SPSS-20. Results were adjusted to the 2014 population. Ethical considerations were respected. Results: Anti-VHC antibodies prevalence was 0.88% [0.78% – 0.99%]. Prevalence did not vary with the gender but increased significantly with age (p<10-3). Rates ranged from 0.13% in the centereast region to 2.57% in the northwest region (p<10-3). Univariate analysis revealed that associated risk factors were marital status, profession, blood transfusion before 1992, diabetes, hypertension, hospitalization, invasive procedures, drug use and scarification. Multivariable analysis showed that age (adjusted OR= 1.04 [1.03–1.06]); region (adjusted OR= 3.15 [1.11–8.99] Center vs South and adjusted OR= 12.53 [4.56–34.45] North vs South); rural area (adjusted OR=1.57 CI95% [1.15–2.14]); hospitalization (adjusted OR= 1.51 [1.06–2.15]); drug use (adjusted OR= 11.1 [4.94–24.9]) and having a VHC chronic carrier relative (adjusted OR = 3.99 [2.17-7.36]) were independently associated with VHC infection. Conclusions: While overall VHC prevalence can be considered low in Tunisia, some areas are at high risk, probably related to predominance of some risk factors. Prevalence increased with age and higher rates were registered in rural areas and the north region. Our results suggest that besides socio-demographic factors, the main risk factors of VHC transmission in Tunisia were healthcare-related factors, drug use and having VHC infected relatives. Thus the need to strengthen standard precautions of hygiene in healthcare settings, harm reduction programmes as well as screening among those at risk populations.