Prevalence and trends of hepatitis B and C virus biomarkers in Zimbabwe: comparative analyses of a nation’s blood-donor surveillance data and meta-analyses of population studies

Abstract

Background

The disproportionate burden of viral hepatitis, particularly hepatitis B virus (HBV) is experienced by people living in low-resourced sub-Saharan Africa, where the estimated prevalence is 3–7 times the global average. Therefore to inform policy, we describe the seroprevalence and trends of hepatitis C (HCV) and HBV biomarkers: anti-HCV antibody and hepatitis B surface antigen (HBsAg), respectively, in Zimbabwe.

Methods

We analysed data from 181,248 consecutive blood-donors, examined between January 2015 through December 2018. Additionally, we conducted a comprehensive literature review using PubMed and African Journals Online databases, meta-analysing selected papers from Zimbabwe, published between 1970 and 2020, that met specific criteria.

Results

Overall age-standardized prevalence rate (ASPR) for anti-HCV was 8.67 (95%CI, 0.25–17.09) per 100,000, while that for HBsAg was 2.26 (95%, 1.89–2.63) per 1000 blood-donors, per year. Meta-analysis of 9 studies comprising 220,127 persons tested for anti-HCV revealed ASPR of 0.05% (95% 0%–0.19%) in blood-donors and 1.78% (95%CI, 0.01%–5.55%) in the general population, for an overall pooled ASPR of 0.44 (95%CI, 0.19%–0.76%). 21 studies comprising 291,784 persons tested for HBsAg revealed ASPR of 0.65% (95%CI, 0.31%–1.00%) in blood-donors and 4.31% (95%CI, 1.77%–6.50%) in the general population for an overall pooled ASPR of 4.02% (95%CI, 3.55%–4.48%), after HBV vaccine introduction. HBsAg prevalence was significantly higher before HBV vaccine introductions.

Conclusions

The prevalence of HBV is decreasing, consistent with the introduction of HBV vaccination, while HCV prevalence is increasing in Zimbabwe. This highlights the need for Improved blood-donor screening and more informative biomarker studies, particularly among repeat donors and children.

Keywords:

• Hepatitis B vaccine
• age-standardized prevalence
• crude prevalence
• anti-hepatitis C virus
• hepatitis B surface antigen
• Zimbabwe blood transfusion screening
• hepatitis B virus/hepatitis C virus co-infection

Acknowledgments

Research effort and time for JGP was supported by the National Institute of General Medical Sciences of National Institutes of Health fellowship under award T32 GM007569

Authors contributions

SM wrote the first draft; SM, EM, MM and JGP conceptualised and designed the study; SM, MM and JGP performed the systematic review; JGP performed the meta-analysis; SM and JGP analysed data; SM, EM, MM, TM, LM, MM and JGP reviewed the results and verified the underlying data. All authors contributed to the final manuscript and approved the final version.

Ethical approval

Ethical approval was not required for the meta-analysis. However, for the observational retrospective analysis of the blood donors data, ethical approval was obtained from NBSZ (NBSZ006/2019) and Medical Research Council of Zimbabwe (MRCZ/E/261).

Disclosure statement

The authors have no competing interests to declare. Some authors were paid salaries by the WHO; however, they did not receive specific funding for this study. Some data in this study are collected and managed by NBSZ; however, the authors were responsible for study design, analysis, interpretation, and writing of this Article. The corresponding author (MM) had full access to all the data and had final responsibility for the decision to submit for publication

Data availability statements

Data inputs and analytic code available upon request to the corresponding authors (MM) or (JGP).

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Some authors were paid salaries by the WHO; however, they did not receive specific funding for this study. Some data in this study are collected and managed by NBSZ; however, the authors were responsible for study design, analysis, interpretation, and writing of this Article. The corresponding author (JGP) had full access to all the data and had final responsibility for the decision to submit for publication.