Abstract
Background
The burden of Hepatitis C virus (HCV) is projected to increase substantially over the next 2 decades as a result of complications arising from chronically infected individuals who remain undiagnosed and untreated. Accurate epidemiological data on the prevalence and demographics of Hepatitis C is therefore needed to allow efficient planning of services and resource allocation for prevention and treatment management in the region. In order to minimise transmission and to recognise risk factors and symptoms of HCV infection, population-wide education is also essential.
Aim
This study aimed to identify the prevalence of Hepatitis C among the 40 to 59 year old population living in urban Dunedin. It also set about to identify gaps in knowledge about HCV in the target – assessment of HCV knowledge among this cohort was thought to be important to gaining better understanding any barriers to identification, diagnosis and treatment while concurrently raising awareness of the issue.
Method
A total of 1400 individuals aged between 40 and 59 living in urban Dunedin were randomly identified from the electorate role. A questionnaire was developed and posted to participants that explored risk profile, infection transmission, complications, symptoms and treatment. Participants were also asked to provide a blood sample for anti-HCV and HbsAg testing. Hepatitis B antigen testing (HbsAg) was also tested to allow comparison on prevalence and decrease perceived stigma of testing.
Results
Of the 1400 questionnaires sent, a total of 432 were returned completed and some 306 blood samples were analysed. The prevalence of HCV and Hepatitis B virus (HBV) was estimated to be less than 0.98%, based on a zero numerator.
Significant knowledge gaps were identified. The average correct score from the questionnaire was 59.4%. Both adjusted and unadjusted logistic regression modelling showed that three demographics were statistically significant predictors of an individuals’ score. On average females scored 5.4% higher. Every increase in qualification level showed a 5.0% increase and a 4.8% increase was found between each occupation sector. No statistically significant relationships were found between socioeconomic status (SES) or age.
The population sample recognised all the potential modes of HCV transmission. Only 23% correctly estimating the assumed prevalence of HCV. 93% of the sample population did not recognize that an acute or chronic infection may be asymptomatic and 97% were unaware that there could be no long term sequale to a chronic infection. 23.6% knew that it takes years rather than months weeks or days for symptoms of complications of a chronic infection to become apparent.
Twenty-two per cent were aware that there is no available vaccine, 34.0% do not know that HCV can be treated and of those who do know, only 39.7% are aware that this is funded by the government.
Conclusions
The prevalence rate, although inferred, is lower than expected. Our group has thus committed to undertaken further work in this area to obtain a more representative sample of bloods from which to draw better prevalaence data – though completed, data was not ready for publication in this thesis.
The lack of general knowledge about HCV is of concern as this population is at high risk of transmission and of developing complications related to unassumed chronic infection. It is clear that the majority of this population is unaware of the asymptomatic nature and when the nonspecific symptoms of an HBC or HCV infection are likely to manifest. Further, one-third of the population are unaware that HBV and HCV can be treated and two-thirds are unaware that treatment is fully funded. Well educated women working in the health or white collar sector have the best knowledge about risk of transmission, possible symptoms and treatment. Educational efforts to increase awareness empower people to be aware of symptoms, get diagnosed and undergo treatment needs to target all other population groups.