Abstract Background and aims People who inject drugs (PWID) are a key population at high risk of hepatitis C virus (HCV) infection. The aim of this study was to delineate the epidemiology of HCV in PWID in the Middle East and North Africa (MENA). Methods Syntheses of data were conducted on the standardized and systematically assembled databases of the MENA HCV Epidemiology Synthesis Project, 1989–2018. Random‐effects meta‐analyses and meta‐regressions were performed. Meta‐regression variables included country, study site, year of data collection and year of publication [to assess trends in HCV antibody prevalence over time], sample size and sampling methodology. Numbers of chronically infected PWID across MENA were estimated. The Shannon Diversity Index was calculated to assess genotype diversity. Results Based on 118 HCV antibody prevalence measures, the pooled mean prevalence in PWID for all MENA was 49.3% [95% confidence interval (CI) = 44.4–54.1%]. The country‐specific pooled mean ranged from 21.7% (95% CI = 4.9–38.6%) in Tunisia to 94.2% (95% CI = 90.8–96.7%) in Libya. An estimated 221 704 PWID were chronically infected, with the largest numbers found in Iran at 68 526 and in Pakistan at 46 554. There was no statistically significant evidence for a decline in HCV antibody prevalence over time. Genotype diversity was moderate (Shannon Diversity Index of 1.01 out of 1.95; 52.1%). The pooled mean percentage for each HCV genotype was highest in genotype 3 (42.7%) and in genotype 1 (35.9%). Conclusion Half of people who inject drugs in the Middle East and North Africa appear to have ever been infected with hepatitis C virus, but there are large variations in antibody prevalence among countries. In addition to > 200 000 chronically infected current people who inject drugs, there is an unknown number of people who no longer inject drugs who may have acquired hepatitis C virus during past injecting drug use. Harm reduction services must be expanded, and innovative strategies need to be employed to ensure accessibility to hepatitis C virus testing and treatment.

中文翻译：

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中东和北非注射吸毒者丙型肝炎病毒感染状况

摘要 背景与目的 注射吸毒者 (PWID) 是丙型肝炎病毒 (HCV) 感染高危人群。本研究的目的是描述中东和北非 (MENA) PWID 中 HCV 的流行病学。方法 在 1989-2018 年 MENA HCV 流行病学综合项目的标准化和系统组装数据库上进行数据综合。进行了随机效应荟萃分析和荟萃回归。元回归变量包括国家、研究地点、数据收集年份和出版年份[以评估 HCV 抗体流行率随时间变化的趋势]、样本量和抽样方法。估计了中东和北非地区慢性感染 PWID 的数量。计算香农多样性指数以评估基因型多样性。结果 基于 118 项 HCV 抗体流行率测量，所有 MENA 的 PWID 合并平均流行率为 49.3% [95% 置信区间 (CI) = 44.4–54.1%]。特定国家的汇总平均值从突尼斯的 21.7% (95% CI = 4.9–38.6%) 到利比亚的 94.2% (95% CI = 90.8–96.7%) 不等。估计有 221 704 名 PWID 被慢性感染，其中伊朗感染人数最多，为 68 526 人，巴基斯坦为 46 554 人。没有统计上显着的证据表明 HCV 抗体流行率随时间推移而下降。基因型多样性适中（香农多样性指数为 1.01，总分 1.95；52.1%）。每种 HCV 基因型的汇总平均百分比在基因型 3 (42.7%) 和基因型 1 (35.9%) 中最高。结论 中东和北非有一半的注射吸毒者似乎曾经感染过丙型肝炎病毒，但各国的抗体流行率存在很大差异。除了超过 200 000 名目前注射吸毒的慢性感染者之外，还有数量不详的不再注射吸毒者可能在过去注射吸毒期间感染了丙型肝炎病毒。必须扩大减少危害服务，并需要采用创新战略来确保丙型肝炎病毒检测和治疗的可及性。