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.