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Screening a nation for hepatitis C virus elimination: a cross-sectional study on prevalence of hepatitis C and associated risk factors in the Rwandan general population
  1. Justine Umutesi1,
  2. Carol Yingkai Liu2,
  3. Michael J Penkunas2,
  4. Jean Damascene Makuza1,
  5. Corneille K Ntihabose1,
  6. Sabine Umuraza2,
  7. Julienne Niyikora2,
  8. Janvier Serumondo3,
  9. Neil Gupta4,5,
  10. Sabin Nsanzimana1,6
  1. 1 Institute of HIV, Diseases Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
  2. 2 Hepatitis Unit, Clinton Health Access Initiative, Boston, Kigali, Rwanda
  3. 3 Rwanda Biomedical Center, Kigali, Rwanda
  4. 4 Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  5. 5 Partners in Health/ Inshuti mu buzima, Kigali, Rwanda
  6. 6 Rwanda Biomedical Center, Institute for HIV, Diseases Prevention and Control, Kigali, Rwanda
  1. Correspondence to Mrs Justine Umutesi; umujustin{at}


Objectives We analysed data collected during programmatic screening activities conducted in 2017 to describe hepatitis C virus (HCV) seroprevalence in the general population and identify associated factors.

Design We analysed data collected between June and September 2017. For both seroprevalence and viraemia, variations across demographic and geographic factors were assessed and multivariate regression models were fit to identify factors independently associated with each marker. Geospatial data were examined for visualisation.

Setting HCV screening was organised within each of the 30 districts in Rwanda. One designated location in each district was selected as the screening site and screening took place for 1 week at each site.

Participants This study included 124 223 male and female volunteers. Anti-HCV-positive individuals were followed up with HCV RNA viral load (VL) testing for infection confirmation.

Main outcome measures Two markers were examined: the presence of HCV antibodies and HCV RNA VL.

Results Among 124 223 individuals screened, 11 003 (8.86%, 95% CIs: 8.70% to 9.02%) were positive for anti-HCV. Anti-HCV prevalence varied by age with the oldest age group (>55 year olds) having a prevalence of 16.46% (95% CIs: 16.14% to 16.80%) and the youngest age group (<25 year olds) having a prevalence of 2.20% (95% CIs: 1.93% to 2.50%) (crude OR=8.78). After adjustment for covariates, an association remained between anti-HCV prevalence and age (p<0.001), province (p<0.001) and socioeconomic status (p<0.001). Of the 3771 anti-HCV-positive individuals who had an available HCV RNA VL result, 2099 (55.66%, 95% CI: 54.06% to 57.25%) had a detectable HCV RNA VL. Age was also associated with HCV viraemia (p<0.001).

Conclusion Results suggest that over 55% of individuals who screened positive for HCV-antibodies were chronically infected. Targeted screening for HCV among older individuals is recommended, given the association between age and infection. Further geographical hotspots of HCV infection can also inform targeted screening as Rwanda moves towards HCV elimination.

  • epidemiology
  • infectious diseases
  • epidemiology
  • internal medicine
  • hepatology

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  • Contributors JU is the principal author and participated in all phases of data collection, analysis and manuscript writing. CYL, MJP, CKN and SN participated in conception, design and implementation of the study. CYL made significant contributions to the analysis of data and drafting of the manuscript. MJP made significant contributions to data interpretation and manuscript writing. JDM, CKN, SU, JN, JS and NG revised the manuscript content critically.

  • Funding These are secondary data collected during routine programmatic activity. For the current study, we did not receive any funding from anyone. MJP was supported through a grant awarded to the Clinton Health Access Initiative by the UK Government’s Department for International Development.

  • Disclaimer The views expressed do not necessarily reflect the UK’s official policies. The funder did not play a role in study design, data collection and analysis, decision to publish or preparation of the current manuscript.

  • Competing interests None declared.

  • Ethics approval Ethical approval was received from National Health Research Committee of Rwanda (NHRC/2017/PROT/037).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets analysed are maintained by Rwanda Biomedical Centre and are available from the corresponding author on reasonable request.

  • Patient consent for publication Not required.

  • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

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