Prevalence of hepatitis C virus seropositivity and active infection in a Rohingya refugee population in Cox's Bazar camps, Bangladesh: a cross-sectional study

Background

Hepatitis C virus (HCV) infection is a significant public health concern. Limited data have shown unusually high HCV seroprevalence among Rohingya refugees residing in camps in Cox's Bazar, Bangladesh. We aimed to assess the prevalence of HCV seropositivity and active infection and identify risk factors to inform the HCV response.

Methods

A cross-sectional survey was conducted between May 10 and June 14, 2023, in adult (≥18 years) residents of seven camps in Cox's Bazar. Households were selected by simple random geosampling and one participant per household was selected at random. Participants were screened for HCV antibodies with a rapid finger prick blood test and, if seropositive, venous samples were tested for HCV viral load. A structured questionnaire collected information about demographics, HCV knowledge, and exposure risks. Survey-adjusted prevalence estimates of HCV seropositivity and active infection were generated by applying sampling weights. Factors associated with HCV seropositivity were identified using univariable and multivariable current status analysis and those associated with active infection via logistic regression.

Findings

The survey included 641 participants, of whom 425 (66%) were women and for whom the median age was 34 years (IQR 28–46). 191 individuals tested positive for HCV antibodies. 187 of these individuals were tested for active infection and 124 had a detectable HCV viral load. The survey-adjusted prevalence estimate of HCV seropositivity was 30·4% (95% CI 26·5–34·5), and that of active infection 19·8% (95% CI 16·5–23·4). Current status analysis identified higher odds of HCV seropositivity among individuals reporting medical injection(s) (adjusted odds ratio 1·8 [95% CI 1·2–2·8]) or surgery (5·9 [1·9–18·4]), and among women (2·1 [1·3–3·2]). 328 (51%) of 641 participants had never heard of hepatitis C. Five (4%) of 124 participants with HCV viraemia reported previous HCV treatment.

Interpretation

There is a substantial burden of active HCV infection among adult Rohingya camp residents, highlighting the urgent need to scale up testing and treatment capacities. The survey had constraints in identifying risk factors and could not provide data on HCV incidence. Reassessing infection prevalence after mass interventions and prospective surveillance are recommended to monitor ongoing transmission. A well-concerted multi-stakeholder action plan is needed to prevent future large-scale burden of severe liver disease and halt ongoing transmission.

Funding

Médecins Sans Frontières.