Persistently high hepatitis C rates in haemodialysis patients in Brazil [a systematic review and meta-analysis]

AbstractWe conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil (Prospero CRD #42021275068). We included studies on patients under haemodialysis, comprising both convenience samples and exhaustive information from selected services. Patients underwent HCV serological testing with or without confirmation by HCV RNA PCR. Exclusion criteria were the following: absence of primary empirical information and studies without information on their respective settings, study year, accurate infection rates, or full specification of diagnostic tests. Studies with samples ≤ 30 and serial assessments with repeated information were also excluded. Reference databases included PubMed, LILACS, Scopus, and Web of Science for the period 1989–2019. A systematic review was carried out, followed by two independent meta-analyses: (i) studies with data on HCV prevalence and (ii) studies with a confirmatory PCR (i.e., active infection), respectively. A comprehensive set of different methods and procedures were used: forest plots and respective statistics, polynomial regression, meta-regression, subgroup influence, quality assessment, and trim-and-fill analysis. 29 studies and 11,290 individuals were assessed. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95% CI 26–43%) for studies implemented before 2001. For studies implemented after 2001, the corresponding summary measure was 11% (95% CI 8–15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI 15–25%) in studies carried out before 2001. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI 6–13%). Heterogeneity was pervasive, but different analyses helped to identify its underlying sources. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the studies and publication biases. Our systematic review and meta-analysis documented a substantial decline in HCV prevalence among Brazilian haemodialysis patients from 1992 to 2015. CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil remains elusive, it is necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV in people with CKD, among other high-risk groups. This is of particular concern in the context of a protracted COVID-19 pandemic and a major economic and political crisis.

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Double Jeopardy: Persistently High Hepatitis C Rates in Haemodialysis Patients in Brazil: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-539209/v1 ◽

2021 ◽

Author(s):

Roberta Niquini ◽

Jurema Correa da Mota ◽

Leonardo Soares Bastos ◽

Diego da Costa Moreira Barbosa ◽

Juliane da Silva Falcão ◽

...

Keyword(s):

Systematic Review ◽

Hepatitis C ◽

Polynomial Regression ◽

Meta Analysis ◽

Risk Groups ◽

Hcv Infection ◽

Summary Measure ◽

Targeted Interventions ◽

Hcv Prevalence ◽

Trim And Fill

Abstract Background: We conducted a systematic review and meta-analysis of studies assessing HCV infection rates in haemodialysis patients in Brazil. Methods: A systematic review was carried out, followed by two independent meta-analyses. The 1 st included studies with data on HCV prevalence. The 2 nd included previous studies with a confirmatory PCR (i.e. active infection of hepatitis C). We used both Bayesian and classical statistical concepts and methods. A comprehensive set of different methods and procedures were used, including forest plots and respective statistics, polynomial regression, meta-regression, subgroup, influence, and trim and fill analysis. Results: 11,290 individuals were assessed in the pooled analyses. The average time patients were in haemodialysis varied from 23.5 to 56.3 months. Prevalence of HCV infection was highly heterogeneous, with a pronounced decrease from 1992 to 2001, followed by a plateau and a slight decrease in recent years. The summary measure for HCV prevalence was 34% (95%CI:26%-43%) for studies implemented before 2001. For studies launched after 2001, the corresponding summary measure was 11% (95%CI:8%-15%). Estimates for prevalence of active HCV infection were also highly heterogeneous. There was a marked decline from 1996 to 2001, followed by a plateau and a slight increase after 2010. The summary measure for active HCV infection was 19% (95% CI:15%-25%) in studies launched before 2001, with a high degree of heterogeneity. For studies implemented after 2001, the corresponding summary measure was 9% (95% CI: 6%-13%), again with high heterogeneity. The different analyses helped to identify the underlying sources of heterogeneity. Besides the year each study was conducted, the findings differed markedly between geographic regions and were heavily influenced by the size of the various studies and by publication biases.Conclusions: CKD should be targeted with specific interventions to prevent HCV infection, and if prevention fails, prompt diagnosis and treatment. Although the goal of HCV elimination by 2030 in Brazil appears elusive, it is possible and necessary to adopt measures to achieve micro-elimination and to launch initiatives towards targeted interventions to curb the spread of HCV among people with CKD, among other high-risk groups.

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Performance of HCV Antigen Testing for the Diagnosis and Monitoring of Antiviral Treatment: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2022/7348755 ◽

2022 ◽

Vol 2022 ◽

pp. 1-17

Author(s):

Geane Lopes Flores ◽

Jurema Corrêa Mota ◽

Larissa Tropiano da Silva Andrade ◽

Renata Serrano Lopes ◽

Francisco Inácio Bastos ◽

...

Keyword(s):

Systematic Review ◽

Diagnostic Accuracy ◽

Meta Analysis ◽

Antiviral Treatment ◽

Hcv Infection ◽

Hcv Rna ◽

Eligibility Criteria ◽

Cross Sectional ◽

High Concordance ◽

Chronic Hcv

Background and Aims. Active hepatitis C virus (HCV) infection is based on the detection of HCV RNA that it is effective but presents high cost and the need to hire trained personnel. This systematic review and meta-analysis is aimed at evaluating the diagnostic accuracy of HCV Ag testing to identify HCV cases and to monitor antiviral treatment including DAA treatment. Methods. The studies were identified through a search in PubMed, Lilacs, and Scopus from 1990 through March 31, 2020. Cohort, cross-sectional, and randomized controlled trials were included. Two independent reviewers extracted data and assessed quality using an adapted Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Our primary outcome was to determine the accuracy of HCV Ag detection for the diagnosis, which we estimated using random-effects meta-analysis. Results. Of 3,062 articles identified, 54 met our eligibility criteria. The studies described cohorts from 20 countries, including 14,286 individuals with chronic HCV individuals. Studies for ECLIA technology demonstrated highest quality compared to studies that used ELISA. The pooled sensitivity and specificity (95% CI) for HCV Ag detection of active HCV infection were 98.82% ( 95 % CI = 98.04 %; 99.30%) and 98.95% ( 95 % CI = 97.84 %; 99.49%), respectively. High concordance was found between HCV Ag testing and HCV RNA detection 89.7% and 95% to evaluate antiviral treatment. Conclusions. According to our findings, HCV Ag testing could be useful to identify HCV active cases in low-resource areas. For antiviral treatment, HCV Ag testing will be useful at the end of treatment.

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Risk of HCV infection associated with hospital-based invasive procedures: a systematic review and meta-analysis

10.1101/2021.11.04.21265936 ◽

2021 ◽

Author(s):

Paul Henriot ◽

Mathieu Castry ◽

Liem Binh Luong Nguyen ◽

Yusuke Shimakawa ◽

Kevin Jean ◽

...

Keyword(s):

Systematic Review ◽

Blood Transfusion ◽

Infection Control ◽

Meta Analysis ◽

Infection Risk ◽

Hcv Infection ◽

Control Measures ◽

Invasive Procedures ◽

Country Level ◽

Hcv Prevalence

Background: Healthcare settings, where invasive procedures are frequently performed, may play an important role in the transmission dynamics of blood-borne pathogens when compliance with infection control precautions remains suboptimal. This study aims at better understanding and quantifying the role of hospital-based invasive procedures on hepatitis C virus (HCV) transmission. Methods: We conducted a systematic review and meta-analysis to identify recent studies reporting association measures of HCV infection risk that are linked to iatrogenic procedures performed in hospital settings. Based on expert opinion, invasive procedures were categorized into 10 groups for which pooled measures were calculated. Finally, the relationship between pooled measures and the country-level HCV prevalence or the Healthcare Access and Quality (HAQ) index was assessed in meta-regressions. Findings: A total of 71 studies were included in the analysis. The most evaluated procedures were blood transfusion and surgery (60 and 37 studies, respectively). The pooled odds ratio (OR) of HCV infection varied widely, ranging from 1.46 (95%CI: 1.14-1.88) for dental procedures to 5.86 (1.26-27.24) for haemodialysis. The OR for blood transfusion was higher for transfusions performed before 1998 (3.77, 2.42-5.88) than for those without a specified date (2.26, 1.81-2.81). Finally, the country-level overall risk for all procedures was significantly associated with HCV prevalence, but not with the HAQ index. In procedure-specific analyses, the HCV infection risk was significantly negatively associated with the HAQ for endoscopy and positively associated with HCV prevalence for endoscopy and surgery. Interpretation: Various invasive procedures were documented to be significantly associated with HCV infection. Our results provide a ranking of procedures in terms of HCV risk that may be used for prioritization of infection control measures, especially in high HCV prevalence settings. Funding: INSERM-ANRS (France Recherche Nord and Sud Sida-HIV Hepatites)

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Seroprevalence of hepatitis C virus infection in Cameroon: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2016-015748 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015748 ◽

Cited By ~ 8

Author(s):

Jean Joel Bigna ◽

Marie A Amougou ◽

Serra Lem Asangbeh ◽

Angeladine Malaha Kenne ◽

Jobert Richie Nansseu

Keyword(s):

Systematic Review ◽

Hepatitis C ◽

Methodological Quality ◽

Meta Analysis ◽

Hcv Infection ◽

Representative Study ◽

East Region ◽

Pooled Prevalence ◽

Rural Settings

ObjectiveBetter knowledge of hepatitis C virus (HCV) seroprevalence at the national level can help to implement pertinent strategies to address the HCV-related burden. The aim of this paper was to estimate the seroprevalence of HCV infection in Cameroon.DesignSystematic review and meta-analysis.ParticipantsPeople residing in Cameroon.Data sourcesElectronic databases including PubMed/MEDLINE, AJOL, WHO-Afro Library, Africa Index Medicus, National Institute of Statistics and National AIDS Control Committee, Cameroon from 1 January 2000 to 15 December 2016 were searched. English and French languages papers were considered. Two independent investigators selected studies. The methodological quality of the studies was assessed using the Newcastle–Ottawa scale.Results31 studies including 36 407 individuals were finally considered. There was no national representative study. The overall pooled prevalence was 6.5% (95% CI 4.5% to 8.8%; I²=98.3%). A sensitivity analysis of individuals at low risk of HCV infection showed a pooled prevalence of 3.6% (95% CI 2.3% to 5.2%, I²=97.7%, 18 studies) among 22 860 individuals (general population, blood donors and pregnant women), which was higher than for a high-risk population (healthcare workers and people with other identified comorbidities), 12.2% (95% CI 4.9% to 22.2%; I²=98.3%, 13 studies); p=0.018. The prevalence was higher in the East region, in rural settings, and when using an enzyme immunoassay technique for detecting HCV antibodies. Sex, sites, study period, sample size, timing of data collection and methodological quality of studies were not sources of heterogeneity.LimitationOne-third of studies (29.0%) had a low risk bias in their methodology and most were facility-based (87.1%).ConclusionThe seroprevalence of HCV infection in Cameroon indicates the need for comprehensive and effective strategies to interrupt HCV transmission in the Cameroonian population. Specific attention is needed for the East region of the country, rural settings and high-risk populations. A national representative study is needed to provide better estimates.

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Handwash versus hand-rub practices for preventing nosocomial infection in hospital intensive care units: A systematic review and meta-analysis

Canadian Journal of Infection Control ◽

10.36584/cjic.2020.009 ◽

2020 ◽

pp. 82-90

Author(s):

S Bello ◽

EA Bamgboye ◽

DT Ajayi ◽

EN Ossai ◽

EC Aniwada ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Adverse Events ◽

Nosocomial Infection ◽

Intensive Care Units ◽

Meta Analysis ◽

Healthcare Providers ◽

Length Of Hospital Stay ◽

Clinical Effectiveness ◽

Infection Rates

Background: Compliance with handwashing in busy healthcare facilities, such as intensive care units (ICUs), is suboptimal and alcohol hand-rub preparations have been suggested to improve compliance. There is no evidence on the comparative effectiveness between handwash and hand-rub strategies. This systematic review was to assess the effectiveness of handwash versus hand-rub strategies for preventing nosocomial infection in ICUs. Methods Studies conducted in ICUs and indexed in PubMed comparing the clinical effectiveness and adverse events between handwash and hand-rub groups were included in a systematic review. The primary outcome was nosocomial infection rates. Secondary outcomes included microbial counts on healthcare providers’ hands, mortality rates, patient/hospital cost of treatment of healthcare-associated infections (HCAIs), length of ICU/hospital stays, and adverse events. Studies were independently screened and data extracted by at least two authors. Meta-analyses of risk ratios (RR), incidence rate ratios (IRR), odds ratios (OR) and mean differences (MD), were conducted using the RevMan 5.3 software. Results: Seven studies published between 1992-2009 and involving a total of 11,663 patients were included. Five studies (10,981 patients) contributed data to the ICU acquired nosocomial infection rates. The pooled IRR was 0.71 (95% CI 0.61, 0.82; I2 = 94%). On sensitivity analysis, pooled IRR was 0.39 (95% CI 0.32, 0.48; 4 studies; 8,247 patients; I2 = 0%) in favour of hand rub. The pooled OR for mortality was 0.95 (95% CI 0.78, 1.61; 4 studies; 3,475 patients; I2 = 39%). The pooled MD for length of hospital stay was -0.74 (95% CI -2.83, 1.34; 3 studies; 741 patients; I2 = 0%). The pooled OR for an undesirable skin effect was 0.37 (95% CI 0.23, 0.60; 3 studies;1504 patients; I2 = 0%) in favour of hand rub. Overall quality of evidence was low. Conclusion: Hand rub appeared more effective when compared to handwash in ICUs.

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Do Adhesive Drapes Have an Effect on Infection Rates in Orthopaedic Surgery? A Systematic Review and Meta-Analysis

Clinical Orthopaedics and Related Research ◽

10.1097/corr.0000000000001958 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Raman Mundi ◽

Nicholas Nucci ◽

Seper Ekhtiari ◽

Jesse Wolfstadt ◽

Bheeshma Ravi ◽

...

Keyword(s):

Systematic Review ◽

Orthopaedic Surgery ◽

Meta Analysis ◽

Infection Rates

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From nowhere to nowhere. Homelessness and incarceration: a systematic review and meta-analysis

International Journal of Prisoner Health ◽

10.1108/ijph-01-2021-0010 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Ahmad Y. Bashir ◽

Noreen Moloney ◽

Musaab E. Elzain ◽

Isabelle Delaunois ◽

Ali Sheikhi ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Mental Illnesses ◽

Significant Heterogeneity ◽

Inclusion Criteria ◽

Systematic Review Methodology ◽

Content Type ◽

Targeted Interventions ◽

The Usa

Purpose This study aims to review international literature systematically to estimate the prevalence of homelessness among incarcerated persons at the time of imprisonment and the time of discharge. Design/methodology/approach A systematic review methodology was used to identify quantitative observational studies that looked at the prevalence of homelessness at the time of imprisonment, or up to 30 days prior to that point (initial homelessness), and at the time of discharge from prisons. Studies reported in English from inception to 11 September 2019 were searched for using eight databases (PsycInfo, Medline, Embase, CINAHL, PsycArticles, Scopus, Web of Science and the Campbell Collaboration), in addition to grey literature. Studies were screened independently by three researchers. Results of studies meeting inclusion criteria were meta-analysed using a random effects model to generate pooled prevalence data. Findings A total of 18 out of 2,131 studies met the inclusion criteria. All studies originated from the USA, Canada, UK, Ireland or Australia. The estimated prevalence of initial homelessness was 23.41% and at time of discharge was 29.94%. Substantial heterogeneity was observed among studies. Originality/value People in prisons are over twenty times more likely to be homeless than those in the general population. This is likely attributable to a range of health and social factors. Studies in this analysis suggest higher rates of homelessness in minority populations and among those with mental illnesses and neurodevelopmental disorders. While there was significant heterogeneity among studies, the results highlight the global burden of this issue and a clear necessity for targeted interventions to address homelessness in this population.

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Role of pulsed-xenon ultraviolet light in reducing healthcare-associated infections: a systematic review and meta-analysis

Epidemiology and Infection ◽

10.1017/s095026882000148x ◽

2020 ◽

Vol 148 ◽

Author(s):

Zhenhong Dong ◽

Na Zhou ◽

Guijuan Liu ◽

Li Zhao

Keyword(s):

Systematic Review ◽

Ultraviolet Light ◽

Meta Analysis ◽

Pooled Analysis ◽

Current Evidence ◽

Healthcare Associated Infections ◽

Infection Rates ◽

Healthcare Settings ◽

Meta Regression Analysis ◽

Healthcare Associated

Abstract Pulsed-xenon-ultraviolet light (PX-UVL) is increasingly used as a supplemental disinfection method in healthcare settings. We undertook a systematic search of the literature through several databases and conducted a meta-analysis to evaluate the efficacy of PX-UVL in reducing healthcare-associated infections. Eleven studies were included in the systematic review and nine in the meta-analysis. Pooled analysis of seven studies with before-after data indicated a statistically significant reduction of Clostridium difficile infection (CDI) rates with the use of the PX-UVL (incidence rate ratio (IRR): 0.73, 95% CI 0.57–0.94, I2 = 72%, P = 0.01), and four studies reported a reduction of risk of methicillin-resistant Staphylococcus aureus (MRSA) infections (IRR: 0.79, 95% CI 0.64–0.98, I2 = 35%, P = 0.03). However, a further four trials found no significant reduction in vancomycin-resistant enterococci (VRE) infection rates (IRR: 0.80, 95% CI 0.63–1.01, I2 = 60%, P = 0.06). The results for CDI and MRSA proved unstable on sensitivity analysis. Meta-regression analysis did not demonstrate any influence of study duration or intervention duration on CDI rates. We conclude that the use of PX-UVL, in addition to standard disinfection protocols, may help to reduce the incidence of CDI and MRSA but not VRE infection rates. However, the quality of evidence is not high, with unstable results and wide confidence intervals, and further high-quality studies are required to supplement the current evidence.

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