Hepatitis C burden in rural and periurban Sindh, Pakistan: insights into prevalence and the urgent need for targeted health services

Introduction Hepatitis C virus (HCV) affects 50 million people globally, with Pakistan contributing 17.8% of the burden. Despite elimination efforts, national estimates overlook high-risk underserved populations, necessitating region-specific data. This study evaluates HCV seroprevalence and viraemic burden in rural and periurban Sindh, Pakistan, highlighting the urgency for targeted interventions. Methods A cross-sectional survey (May–July 2023) was conducted in Mirpurkhas, Tando Allahyar, and Sukkur districts using two-stage PPS sampling at public and public-private sector health facilities. Individuals (≥10 years) were screened for anti-HCV antibodies using rapid diagnostic tests and confirmed for viraemia via PCR. Sociodemographic and risk factor data were collected through structured questionnaires. Survey-adjusted seroprevalence and viraemic prevalence were estimated, with multivariable logistic regression identifying risk factors. Prevalence estimates were extrapolated to the entire Sindh population aged ≥10 years to estimate the absolute number of exposed and infected individuals. Results Among 3380 participants, the weighted prevalence of anti-HCV positivity was 17.1% (95% CI 11.9 to 24.1). Of those who screened anti-HCV positive, 44.8% (95% CI 39.4 to 50.3) were viraemic, corresponding to a weighted viraemic prevalence of 7.7% (95% CI 5.5 to 10.6). Extrapolated estimates suggest 4.5–10.4 million Sindh residents may have been exposed to HCV. Women aged ≥30 years, individuals with limited education and rural residents were disproportionately affected, with healthcare access disparities posing service barriers. Conclusion Rural and periurban Sindh faces a significant HCV burden due to healthcare access limitations, low health literacy, stigma and socioeconomic constraints. Targeted, community-based care models are essential. The Prime Minister’s Hepatitis Elimination Program (2024–2030) offers an opportunity for expanded screening and treatment, but success requires improving healthcare access, workforce capacity, surveillance and public awareness to prevent infections and promote safer health practices.