Epidemiology and control of hepatitis C virus infection in Brunei Darussalam: a retrospective cohort study

Objectives: We describe the epidemiology of hepatitis C virus (HCV) cases in Brunei Darussalam and evaluate factors associated with its treatment outcomes. Methods: A retrospective cohort study was conducted using data from two national databases between January 2013 and December 2022. Results: We identified 801 anti-HCV-positive cases. Although incidence remained relatively stable, prevalence rates increased from 10.1 to 48.7 per 100,00 population. Among those with detectable HCV RNA, treatment was initiated in 52.3% (n = 239). Locals (adjusted odds ratio [aOR] = 2.42, 95% confidence interval [CI] 1.16, 5.36) and age (30-39 years [aOR = 2.41, 95% CI 1.17, 5.07], 40-44 years [aOR = 2.55, 95% CI 1.19, 5.58], and 50-54 years [aOR = 2.76, 95% CI 1.25, 6.24) were associated with treatment initiation. Among those who completed treatment (69.5%, n = 166), 64.5% (n = 107) achieved sustained virologic response. HCV-related complications at baseline were recorded in 7.4% (n = 59) of all cases, particularly among those aged ≥50 years (aOR = 3.32, 95% CI 1.93, 5.79). HCV-related deaths occurred in 36.4% (n = 47), among which 44.7% (n = 21) had HCV-related complications at baseline. Conclusions: An increasing HCV prevalence (likely due to case management processes and patient-related factors) and the high proportion of deaths with baseline HCV-related complications suggest the need to strengthen HCV screening and management in Brunei.