{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T01:38:59Z","timestamp":1785289139338,"version":"3.55.0"},"reference-count":47,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"unspecified","delay-in-days":36,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008627","name":"Global Affairs Canada","doi-asserted-by":"publisher","award":["CA-3-P011068001"],"award-info":[{"award-number":["CA-3-P011068001"]}],"id":[{"id":"10.13039\/501100008627","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,1,5]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hepatitis C virus (HCV) affects 50\u2009million people globally, with Pakistan contributing 17.8% of the burden. Despite elimination efforts, national estimates overlook high-risk underserved populations, necessitating region-specific data. This study evaluates HCV seroprevalence and viraemic burden in rural and periurban Sindh, Pakistan, highlighting the urgency for targeted interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey (May\u2013July 2023) was conducted in Mirpurkhas, Tando Allahyar, and Sukkur districts using two-stage PPS sampling at public and public-private sector health facilities. Individuals (\u226510 years) were screened for anti-HCV antibodies using rapid diagnostic tests and confirmed for viraemia via PCR. Sociodemographic and risk factor data were collected through structured questionnaires. Survey-adjusted seroprevalence and viraemic prevalence were estimated, with multivariable logistic regression identifying risk factors. Prevalence estimates were extrapolated to the entire Sindh population aged \u226510 years to estimate the absolute number of exposed and infected individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3380 participants, the weighted prevalence of anti-HCV positivity was 17.1% (95% CI 11.9 to 24.1). Of those who screened anti-HCV positive, 44.8% (95% CI 39.4 to 50.3) were viraemic, corresponding to a weighted viraemic prevalence of 7.7% (95% CI 5.5 to 10.6). Extrapolated estimates suggest 4.5\u201310.4\u2009million Sindh residents may have been exposed to HCV. Women aged \u226530 years, individuals with limited education and rural residents were disproportionately affected, with healthcare access disparities posing service barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rural and periurban Sindh faces a significant HCV burden due to healthcare access limitations, low health literacy, stigma and socioeconomic constraints. Targeted, community-based care models are essential. The Prime Minister\u2019s Hepatitis Elimination Program (2024\u20132030) offers an opportunity for expanded screening and treatment, but success requires improving healthcare access, workforce capacity, surveillance and public awareness to prevent infections and promote safer health practices.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003512","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T13:25:16Z","timestamp":1770384316000},"page":"e003512","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Hepatitis C burden in rural and periurban Sindh, Pakistan: insights into prevalence and the urgent need for targeted health services"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5822-8505","authenticated-orcid":false,"given":"Ismat","family":"Lotia-Farrukh","sequence":"first","affiliation":[{"name":"Interactive Research & Development, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabia","family":"Maniar","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zulfiqar Ali","family":"Dharejo","sequence":"additional","affiliation":[{"name":"Communicable Disease Control (CDC) Sindh, Hyderabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Rabb","family":"Khatri","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annum","family":"Aftab","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6535-174X","authenticated-orcid":false,"given":"Ahwaz","family":"Akhtar","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Karachi, Pakistan"},{"name":"The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asadullah","family":"Mir","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pardeep","family":"Kumar","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabeel","family":"Nisar","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minhal","family":"Hyder","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Tariq","family":"Mangrio","sequence":"additional","affiliation":[{"name":"Civil Hospital Mirpurkhas, Mirpurkhas, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samreen","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Communicable Disease Control (CDC) Sindh, Hyderabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6195-1876","authenticated-orcid":false,"given":"Beatrice","family":"Kirubi","sequence":"additional","affiliation":[{"name":"Innovations and Grants, Stop TB Partnership, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Creswell","sequence":"additional","affiliation":[{"name":"Innovations and Grants, Stop TB Partnership, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uzma","family":"Khan","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Singapore"},{"name":"Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"2026020605251106000_4.1.e003512.1","unstructured":"World Health Organization . 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PM\u2019s hepatitis C eradication programme to be launched this month. 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