Bridging the data gaps in the epidemiology of hepatitis C virus infection in Malaysia using multi-parameter evidence synthesis

Scott A McDonald, Rosmawati Mohamed, Maznah Dahlui, Herlianna Naning, Adeeba Kamarulzaman

BackgroundCollecting adequate information on key epidemiological indicators is a prerequisite to informing a public health response to reduce the impact of hepatitis C virus (HCV) infection in Malaysia. Our goal was to overcome the acute data shortage typical of low/middle income countries using statistical modelling to estimate the national HCV prevalence and the distribution over transmission pathways as of the end of 2009.MethodsMulti-parameter evidence synthesis methods were applied to combine all available relevant data sources - both direct and indirect - that inform the epidemiological parameters of interest.ResultsAn estimated 454,000 (95% credible interval [CrI]: 392,000 to 535,000) HCV antibody-positive individuals were living in Malaysia in 2009; this represents 2.5% (95% CrI: 2.2¿3.0%) of the population aged 15¿64 years. Among males of Malay ethnicity, for 77% (95% CrI: 69¿85%) the route of probable transmission was active or a previous history of injecting drugs. The corresponding proportions were smaller for male Chinese and Indian/other ethnic groups (40% and 71%, respectively). Females of all ethnicities represented 1% (95% CrI: 0.6 to 1.4%) of all HCV infections, 92% (95% CrI: 88 to 95%) of which were attributable to non-drug injecting routes of transmission.ConclusionsThe prevalent number of persons living with HCV infection in Malaysia is estimated to be very high. Low/middle income countries often lack a comprehensive evidence base; however, evidence synthesis methods can assist in filling the data gaps required for the development of effective policy to address the future public health and economic burden due to HCV.