{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:00:15Z","timestamp":1784203215073,"version":"3.55.0"},"reference-count":106,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hepatitis C virus (HCV) remains a major public health challenge in the Eastern Mediterranean Region (EMR), with prevalence varying across population groups. This umbrella review summarizes the distribution of HCV infection across diverse populations in the region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an umbrella review of systematic reviews with meta-analyses reporting HCV prevalence in the EMR. PubMed, Web of Science, Scopus, Iranian databases, including Magiran and the Scientific Information Database (SID), were searched. Google Scholar was additionally screened to ensure comprehensive coverage. Pooled estimates were extracted across four population groups: apparently healthy individuals; those with clinical or healthcare-associated exposure risk; patients co-infected with hepatitis viruses or other liver-related diseases; and key populations at increased risk (groups disproportionately affected due to their behaviors and higher vulnerability). For time-period analyses, meta-analyses were grouped into two intervals (before 2015 vs. 2015 and after) based on the median year of data collection of primary studies. Pooled prevalence was calculated using a random-effects model in STATA version 17.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 55 meta-analyses were included. The pooled HCV prevalence was 31.0% (95% CI: 27.0\u201338.0) among key populations, and also 31.0% (95% CI: 12.0\u201349.0) among patients co-infected with other hepatitis viruses or liver-related diseases. Those with clinical or healthcare-associated exposure risk showed a prevalence of 28.0% (95% CI: 23.0\u201332.0), whereas the apparently healthy population had the lowest prevalence at 2.0% (95% CI: 1.0\u20132.0). Subgroup analysis indicated a decline in prevalence among clinically exposed populations after 2015, from 29% to 10%, coinciding with the direct-acting antivirals (DAAs) and strengthened infection-control practices. The highest prevalence was observed among key populations in Libya, healthcare-exposed populations in Morocco, and apparently healthy individuals in Egypt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Variation in HCV prevalence across populations in the EMR highlights the need for population-specific strategies to support progress toward World Health Organization elimination targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0346782","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:44:06Z","timestamp":1776793446000},"page":"e0346782","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hepatitis C distribution across diverse population groups in the Eastern Mediterranean Region: An umbrella review"],"prefix":"10.1371","volume":"21","author":[{"given":"Zahra","family":"Abdolahinia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Eybpoosh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parya","family":"Jangipour Afshar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Karamoozian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayhan","family":"Azadmanesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9008-7618","authenticated-orcid":true,"given":"Hamid","family":"Sharifi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"issue":"2","key":"pone.0346782.ref001","doi-asserted-by":"crossref","first-page":"172","DOI":"10.3390\/livers4020013","article-title":"The epidemiology of chronic hepatitis C: Where we are now","volume":"4","author":"C Stasi","year":"2024","journal-title":"Livers"},{"key":"pone.0346782.ref002","unstructured":"Hepatitis C\u2014Key Facts [Internet]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-c"},{"issue":"1","key":"pone.0346782.ref003","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/hep.27259","article-title":"Global distribution and prevalence of hepatitis C virus genotypes","volume":"61","author":"JP Messina","year":"2015","journal-title":"Hepatology"},{"issue":"3","key":"pone.0346782.ref004","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S2468-1253(16)30181-9","article-title":"Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study","volume":"2","author":"Polaris Observatory HCV Collaborators","year":"2017","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"1","key":"pone.0346782.ref005","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1002\/jmv.24921","article-title":"Hepatitis C virus genotypes in the Middle East and North Africa: distribution, diversity, and patterns","volume":"90","author":"S Mahmud","year":"2018","journal-title":"J Med Virol"},{"key":"pone.0346782.ref006","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.ijid.2016.03.012","article-title":"Epidemiology of hepatitis C virus in the Arabian Gulf countries: systematic review and meta-analysis of prevalence","volume":"46","author":"YA Mohamoud","year":"2016","journal-title":"Int J Infect Dis"},{"issue":"9207","key":"pone.0346782.ref007","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/S0140-6736(99)06527-7","article-title":"The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt","volume":"355","author":"C Frank","year":"2000","journal-title":"Lancet"},{"issue":"5","key":"pone.0346782.ref008","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/S2468-1253(21)00472-6","article-title":"Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study","volume":"7","author":"Polaris Observatory HCV Collaborators","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"1","key":"pone.0346782.ref009","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1093\/epirev\/mxy003","article-title":"HIV and viral hepatitis among imprisoned key populations","volume":"40","author":"AL Wirtz","year":"2018","journal-title":"Epidemiol Rev"},{"issue":"4","key":"pone.0346782.ref010","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.kint.2018.11.038","article-title":"Prevalence, incidence, and risk factors for hepatitis C virus infection in hemodialysis patients","volume":"95","author":"M Jadoul","year":"2019","journal-title":"Kidney Int"},{"issue":"12","key":"pone.0346782.ref011","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(17)30375-3","article-title":"Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review","volume":"5","author":"L Degenhardt","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"9","key":"pone.0346782.ref012","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/S2468-1253(22)00082-6","article-title":"Progress towards elimination of viral hepatitis by 2030 in the WHO Eastern Mediterranean Region, 2019","volume":"7","author":"AS Alaama","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"1","key":"pone.0346782.ref013","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1146\/annurev-med-050223-111239","article-title":"Global elimination of hepatitis C virus","volume":"76","author":"RL Fleurence","year":"2025","journal-title":"Annu Rev Med"},{"key":"pone.0346782.ref014","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1186\/1471-2458-10-777","article-title":"HIV and hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis","volume":"10","author":"E Gough","year":"2010","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0346782.ref015","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1186\/s12879-019-4284-9","article-title":"Prevalence of hepatitis C infection among the general population and high-risk groups in the EU\/EEA: a systematic review update","volume":"19","author":"R Han","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"3","key":"pone.0346782.ref016","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/XEB.0000000000000054","article-title":"Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data","volume":"13","author":"Z Munn","year":"2015","journal-title":"Int J Evid Based Healthc"},{"key":"pone.0346782.ref017","unstructured":"UNAIDS terminology guidelines [Internet]. 2024. Available from: https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/2024-terminology-guidelines_en.pdf"},{"issue":"5","key":"pone.0346782.ref018","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1002\/jrsm.1658","article-title":"Estimating pairwise overlap in umbrella reviews: considerations for using the corrected covered area (CCA) index methodology","volume":"14","author":"M Kirvalidze","year":"2023","journal-title":"Res Synth Methods"},{"key":"pone.0346782.ref019","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1471-2288-7-10","article-title":"Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews","volume":"7","author":"BJ Shea","year":"2007","journal-title":"BMC Med Res Methodol"},{"issue":"2","key":"pone.0346782.ref020","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1037\/1082-989X.11.2.193","article-title":"Assessing heterogeneity in meta-analysis: Q statistic or I\u00b2 index?","volume":"11","author":"TB Huedo-Medina","year":"2006","journal-title":"Psychol Methods"},{"issue":"8","key":"pone.0346782.ref021","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.jclinepi.2014.03.003","article-title":"In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias","volume":"67","author":"JP Hunter","year":"2014","journal-title":"J Clin Epidemiol"},{"issue":"5","key":"pone.0346782.ref022","doi-asserted-by":"crossref","first-page":"429","DOI":"10.36233\/0507-4088-234","article-title":"A preregistered meta-meta-analysis on the global distribution of hepatotropic viruses","volume":"69","author":"S Adeiza","year":"2024","journal-title":"Vopr Virusol"},{"issue":"8","key":"pone.0346782.ref023","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(23)00267-X","article-title":"Prevalence of injecting drug use and HIV, hepatitis B, and hepatitis C in people who inject drugs in the Eastern Mediterranean region: a systematic review and meta-analysis","volume":"11","author":"AM Aghaei","year":"2023","journal-title":"The Lancet Global Health"},{"issue":"1","key":"pone.0346782.ref024","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12954-021-00505-4","article-title":"Prevalence of HIV and HCV among injecting drug users in three selected WHO-EMRO countries: a meta-analysis","volume":"18","author":"SJ Shayan","year":"2021","journal-title":"Harm Reduct J"},{"issue":"1","key":"pone.0346782.ref025","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1186\/s12879-019-4403-7","article-title":"Characterization of the hepatitis C virus epidemic in Pakistan","volume":"19","author":"S Mahmud","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"8","key":"pone.0346782.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0135281","article-title":"The Epidemiology of hepatitis C virus in the fertile crescent: systematic review and meta-analysis","volume":"10","author":"H Chemaitelly","year":"2015","journal-title":"PLoS One"},{"issue":"7","key":"pone.0346782.ref027","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1111\/add.14944","article-title":"The status of hepatitis C virus infection among people who inject drugs in the Middle East and North Africa","volume":"115","author":"S Mahmud","year":"2020","journal-title":"Addiction"},{"issue":"1","key":"pone.0346782.ref028","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1038\/s41598-017-17936-4","article-title":"Characterizing hepatitis C virus epidemiology in Egypt: systematic reviews, meta-analyses, and meta-regressions","volume":"8","author":"SP Kouyoumjian","year":"2018","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0346782.ref029","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1186\/s12879-024-09676-4","article-title":"Prevalence of hepatitis B, hepatitis C, and tuberculosis among people living with HIV in Iran: a systematic review and meta-analysis","volume":"24","author":"E Mostafavi","year":"2024","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0346782.ref030","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.vacune.2024.02.014","article-title":"Prevalence of HCV among patients with HIV in Iran: a systematic review and meta-analysis","volume":"25","author":"M Hajizadeh","year":"2024","journal-title":"Vacunas (English Edition)"},{"issue":"11","key":"pone.0346782.ref031","doi-asserted-by":"crossref","DOI":"10.1002\/hsr2.1674","article-title":"Prevalence of HIV, hepatitis B virus, hepatitis C virus, drug use, and sexual behaviors among street children in Iran: a systematic review and meta-analysis","volume":"6","author":"N Nasiri","year":"2023","journal-title":"Health Sci Rep"},{"issue":"1","key":"pone.0346782.ref032","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12954-020-00441-9","article-title":"Harm reduction program and hepatitis C prevalence in people who inject drugs (PWID) in Iran: an updated systematic review and cumulative meta-analysis","volume":"18","author":"A Rajabi","year":"2021","journal-title":"Harm Reduct J"},{"issue":"6","key":"pone.0346782.ref033","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1007\/s10508-019-01574-0","article-title":"HIV and other sexually transmitted infections among female sex workers in Iran: a systematic review and meta-analysis","volume":"49","author":"M Karamouzian","year":"2020","journal-title":"Arch Sex Behav"},{"issue":"5","key":"pone.0346782.ref034","doi-asserted-by":"crossref","DOI":"10.5812\/hepatmon.102004","article-title":"Prevalence of hepatitis C virus in Iranian prisoners: an updated systematic review and multilevel meta-analysis study","volume":"20","author":"A Najimi","year":"2020","journal-title":"Hepat Mon"},{"issue":"1","key":"pone.0346782.ref035","first-page":"72","article-title":"Prevalence and distribution of Hepatitis C virus in Iranian drug user: systematic review and meta-analysis study","volume":"6","author":"A Najimi-Varzaneh","year":"2020","journal-title":"J Biostat Epidemiol"},{"issue":"3","key":"pone.0346782.ref036","doi-asserted-by":"crossref","first-page":"37","DOI":"10.21315\/mjms2019.26.3.3","article-title":"Prevalence of HIV, Hepatitis B and C virus co-infections among Iranian high-risk groups: a systematic review and meta-analysis","volume":"26","author":"AA Hashiani","year":"2019","journal-title":"Malays J Med Sci"},{"issue":"1","key":"pone.0346782.ref037","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1186\/s12879-019-4403-7","article-title":"Characterization of the hepatitis C virus epidemic in Pakistan","volume":"19","author":"S Mahmud","year":"2019","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0346782.ref038","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12954-018-0231-0","article-title":"Prevalence of hepatitis C virus infection among prisoners in Iran: a systematic review and meta-analysis","volume":"15","author":"M Behzadifar","year":"2018","journal-title":"Harm Reduct J"},{"key":"pone.0346782.ref039","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.puhe.2018.04.011","article-title":"Prevalence of hepatitis C virus infection among high-risk groups in Iran: a systematic review and meta-analysis","volume":"161","author":"S Nematollahi","year":"2018","journal-title":"Public Health"},{"issue":"3","key":"pone.0346782.ref040","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0151946","article-title":"HIV, HBV and HCV coinfection prevalence in Iran--a systematic review and meta-analysis","volume":"11","author":"F Bagheri Amiri","year":"2016","journal-title":"PLoS One"},{"key":"pone.0346782.ref041","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.ijid.2015.09.022","article-title":"High hepatitis C virus prevalence among drug users in Iran: systematic review and meta-analysis of epidemiological evidence (2001-2012)","volume":"40","author":"M Malekinejad","year":"2015","journal-title":"Int J Infect Dis"},{"issue":"1","key":"pone.0346782.ref042","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S2468-1253(20)30303-4","article-title":"Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis","volume":"6","author":"F Jin","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"4","key":"pone.0346782.ref043","doi-asserted-by":"crossref","first-page":"180257","DOI":"10.1098\/rsos.180257","article-title":"The epidemiology of hepatitis C virus in Pakistan: systematic review and meta-analyses","volume":"5","author":"Z Al Kanaani","year":"2018","journal-title":"R Soc Open Sci"},{"issue":"2","key":"pone.0346782.ref044","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0149966","article-title":"Hepatitis C virus epidemiology in Djibouti, Somalia, Sudan, and Yemen: systematic review and meta-analysis","volume":"11","author":"K Chaabna","year":"2016","journal-title":"PLoS One"},{"issue":"1","key":"pone.0346782.ref045","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s40249-018-0469-5","article-title":"Prevalence of hepatitis C virus among street children in Iran","volume":"7","author":"M Behzadifar","year":"2018","journal-title":"Infect Dis Poverty"},{"key":"pone.0346782.ref046","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.ijid.2015.09.022","article-title":"High hepatitis C virus prevalence among drug users in Iran: systematic review and meta-analysis of epidemiological evidence (2001-2012)","volume":"40","author":"M Malekinejad","year":"2015","journal-title":"Int J Infect Dis"},{"key":"pone.0346782.ref047","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.puhe.2021.11.020","article-title":"Prevalence of HIV, hepatitis B virus, and hepatitis C virus among incarcerated people in Iran: a systematic review and meta-analysis","volume":"203","author":"S Mehmandoost","year":"2022","journal-title":"Public Health"},{"issue":"1","key":"pone.0346782.ref048","first-page":"1","article-title":"Prevalence of hepatitis C in Iranian prisoners (2001-2016): a systematic review and meta-analysis","volume":"22","author":"M Mohammadi","year":"2018","journal-title":"Zanco J Med Sci"},{"issue":"1","key":"pone.0346782.ref049","doi-asserted-by":"crossref","DOI":"10.1186\/s43162-025-00432-x","article-title":"Prevalence and clinical implications of occult hepatitis C infection: a meta-analysis of studies conducted in Egypt","volume":"37","author":"A Azzam","year":"2025","journal-title":"Egypt J Intern Med"},{"issue":"4","key":"pone.0346782.ref050","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1002\/hep4.1491","article-title":"Hepatitis C virus infection in populations with liver-related diseases in the Middle East and North Africa","volume":"4","author":"S Mahmud","year":"2020","journal-title":"Hepatol Commun"},{"issue":"1","key":"pone.0346782.ref051","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1038\/s41598-017-17936-4","article-title":"Characterizing hepatitis C virus epidemiology in Egypt: systematic reviews, meta-analyses, and meta-regressions","volume":"8","author":"SP Kouyoumjian","year":"2018","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0346782.ref052","doi-asserted-by":"crossref","first-page":"37","DOI":"10.21315\/mjms2019.26.3.3","article-title":"Prevalence of HIV, Hepatitis B and C virus co-infections among iranian high-risk groups: a systematic review and meta-analysis","volume":"26","author":"AA Hashiani","year":"2019","journal-title":"Malays J Med Sci"},{"issue":"2","key":"pone.0346782.ref053","doi-asserted-by":"crossref","first-page":"242","DOI":"10.4254\/wjh.v13.i2.242","article-title":"Occult hepatitis C virus infection in the Middle East and Eastern Mediterranean countries: a systematic review and meta-analysis","volume":"13","author":"MR Hedayati-Moghaddam","year":"2021","journal-title":"World J Hepatol"},{"issue":"15","key":"pone.0346782.ref054","doi-asserted-by":"crossref","first-page":"3243","DOI":"10.1017\/S0950268817002242","article-title":"Epidemiology of hepatitis C virus among hemodialysis patients in the Middle East and North Africa: systematic syntheses, meta-analyses, and meta-regressions","volume":"145","author":"M Harfouche","year":"2017","journal-title":"Epidemiol Infect"},{"issue":"1","key":"pone.0346782.ref055","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3748\/wjg.v23.i1.151","article-title":"Prevalence of hepatitis C virus infection among hemodialysis patients in the Middle-East: a systematic review and meta-analysis","volume":"23","author":"S Ashkani-Esfahani","year":"2017","journal-title":"World J Gastroenterol"},{"issue":"2","key":"pone.0346782.ref056","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s10389-010-0366-2","article-title":"Epidemiology and risk factors of HCV infection among hemodialysis patients in countries of the Eastern Mediterranean Regional Office of WHO (EMRO): a quantitative review of literature","volume":"19","author":"S-M Alavian","year":"2010","journal-title":"J Public Health"},{"issue":"3","key":"pone.0346782.ref057","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/j.1542-4758.2010.00437.x","article-title":"Hepatitis C infection in hemodialysis patients in Iran: a systematic review","volume":"14","author":"S-M Alavian","year":"2010","journal-title":"Hemodial Int"},{"issue":"1","key":"pone.0346782.ref058","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1186\/s12879-024-10153-1","article-title":"Sexually transmitted infections in the middle east and North Africa: comprehensive systematic review and meta-analysis","volume":"24","author":"D Obeid","year":"2024","journal-title":"BMC Infect Dis"},{"issue":"2","key":"pone.0346782.ref059","doi-asserted-by":"crossref","first-page":"242","DOI":"10.4254\/wjh.v13.i2.242","article-title":"Occult hepatitis C virus infection in the Middle East and Eastern Mediterranean countries: a systematic review and meta-analysis","volume":"13","author":"MR Hedayati-Moghaddam","year":"2021","journal-title":"World J Hepatol"},{"key":"pone.0346782.ref060","article-title":"Epidemiology of Hepatitis C virus in Iranian thalassemic, hemodialysis and hemophiliac patients: a meta-analysis study","author":"A Molaei","year":"2021","journal-title":"J Biostat Epidemiol"},{"issue":"2","key":"pone.0346782.ref061","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1515\/labmed-2018-0150","article-title":"Seroprevalence and geographical distribution of hepatitis C virus in Iranian patients with thalassemia: a systematic review and meta-analysis","volume":"43","author":"A Shamshirian","year":"2019","journal-title":"J Lab Med"},{"issue":"5","key":"pone.0346782.ref062","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s00705-018-3767-0","article-title":"The prevalence of hepatitis C virus infection in thalassemia patients in Iran from 2000 to 2017: a systematic review and meta-analysis","volume":"163","author":"M Behzadifar","year":"2018","journal-title":"Arch Virol"},{"key":"pone.0346782.ref063","doi-asserted-by":"crossref","first-page":"216","DOI":"10.4103\/ijpvm.IJPVM_458_17","article-title":"Oncogenic viral infections among Iranian hemodialysis patients: a systematic review","volume":"10","author":"N Ramezan Ghorbani","year":"2019","journal-title":"Int J Prev Med"},{"issue":"3","key":"pone.0346782.ref064","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0151946","article-title":"HIV, HBV and HCV coinfection prevalence in Iran--a systematic review and meta-analysis","volume":"11","author":"F Bagheri Amiri","year":"2016","journal-title":"PLoS One"},{"issue":"21","key":"pone.0346782.ref065","first-page":"3174","article-title":"Hepatitis C virus infection among hemodialysis patients in Asia: a meta-analysis","volume":"18","author":"Y-B Liu","year":"2014","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"4","key":"pone.0346782.ref066","doi-asserted-by":"crossref","first-page":"244","DOI":"10.5812\/hepatmon.844","article-title":"Lack of knowledge about Hepatitis C infection rates among patients with inherited coagulation disorders in countries under the Eastern Mediterranean Region Office of WHO (EMRO): a meta-analysis","volume":"12","author":"SM Alavian","year":"2012","journal-title":"Hepat Mon"},{"issue":"3","key":"pone.0346782.ref067","first-page":"270","article-title":"A systematic review and meta-analysis on the epidemiology of hepatitis B and hepatitis C virus among beta-thalassemia major patients in Pakistan","volume":"13","author":"U Waheed","year":"2021","journal-title":"J Lab Phys"},{"issue":"1","key":"pone.0346782.ref068","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1615\/CritRevEukaryotGeneExpr.2017018953","article-title":"Epidemiology of hepatitis C infection in Pakistan: current estimate and major risk factors","volume":"27","author":"A Arshad","year":"2017","journal-title":"Crit Rev Eukaryot Gene Expr"},{"key":"pone.0346782.ref069","unstructured":"Alavian S, Tabatabaei S, Bagheri LK. Epidemiology of HCV infection among thalassemia patients in eastern Mediterranean countries: a quantitative review of literature. 2010;12(4):365\u201376."},{"issue":"3","key":"pone.0346782.ref070","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/j.1542-4758.2010.00437.x","article-title":"Hepatitis C infection in hemodialysis patients in Iran: a systematic review","volume":"14","author":"S-M Alavian","year":"2010","journal-title":"Hemodial Int"},{"issue":"1","key":"pone.0346782.ref071","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3748\/wjg.v23.i1.151","article-title":"Prevalence of hepatitis C virus infection among hemodialysis patients in the Middle-East: a systematic review and meta-analysis","volume":"23","author":"S Ashkani-Esfahani","year":"2017","journal-title":"World J Gastroenterol"},{"issue":"1","key":"pone.0346782.ref072","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1186\/s12889-020-8414-5","article-title":"The prevalence of hepatitis C virus infection in \u03b2-thalassemia patients in Pakistan: a systematic review and meta-analysis","volume":"20","author":"S Akhtar","year":"2020","journal-title":"BMC Public Health"},{"issue":"5","key":"pone.0346782.ref073","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232931","article-title":"The prevalence of hepatitis C virus in hemodialysis patients in Pakistan: a systematic review and meta-analysis","volume":"15","author":"S Akhtar","year":"2020","journal-title":"PLoS One"},{"key":"pone.0346782.ref074","doi-asserted-by":"crossref","first-page":"102327","DOI":"10.1016\/j.eclinm.2023.102327","article-title":"Hepatitis C infection seroprevalence in pregnant women worldwide: a systematic review and meta-analysis","volume":"66","author":"F Abbasi","year":"2023","journal-title":"EClinicalMedicine"},{"key":"pone.0346782.ref075","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.ijid.2016.03.012","article-title":"Epidemiology of hepatitis C virus in the Arabian Gulf countries: systematic review and meta-analysis of prevalence","volume":"46","author":"YA Mohamoud","year":"2016","journal-title":"Int J Infect Dis"},{"issue":"6","key":"pone.0346782.ref076","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1111\/liv.15212","article-title":"Seroprevalence of hepatitis C virus infection in children: a systematic review and meta-analysis","volume":"42","author":"M Abdel-Gawad","year":"2022","journal-title":"Liver Int"},{"issue":"12","key":"pone.0346782.ref077","doi-asserted-by":"crossref","DOI":"10.5812\/ircmj.58045","article-title":"Seroprevalence of Hepatitis C Virus among blood donors in Middle Eastern Countries: a systematic review and meta-analysis","volume":"19","author":"H Ghaderi-Zefrehi","year":"2017","journal-title":"Iran Red Crescent Med J"},{"issue":"1","key":"pone.0346782.ref078","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1186\/s12879-024-10153-1","article-title":"Sexually transmitted infections in the middle east and North Africa: comprehensive systematic review and meta-analysis","volume":"24","author":"D Obeid","year":"2024","journal-title":"BMC Infect Dis"},{"issue":"3","key":"pone.0346782.ref079","doi-asserted-by":"crossref","first-page":"237","DOI":"10.34172\/mejdd.2021.231","article-title":"Prevalence of HBV and HCV infections in Iranian blood donors; an updated systematic review and meta-analysis","volume":"13","author":"L Kasraian","year":"2021","journal-title":"Middle East J Dig Dis"},{"issue":"2","key":"pone.0346782.ref080","doi-asserted-by":"crossref","DOI":"10.5812\/hepatmon.42291","article-title":"Update on the prevalence of hepatitis C virus infection among Iranian general population: a systematic review and meta-analysis","volume":"17","author":"B Mirminachi","year":"2017","journal-title":"Hepat Mon"},{"issue":"8","key":"pone.0346782.ref081","first-page":"674","article-title":"Prevalence and trend of hepatitis C virus infection among blood donors in Iran: a systematic review and meta-analysis","volume":"18","author":"M Khodabandehloo","year":"2013","journal-title":"J Res Med Sci"},{"issue":"3","key":"pone.0346782.ref082","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1055\/s-0041-1731110","article-title":"A systematic review and meta-analysis on the epidemiology of hepatitis B and hepatitis C virus among beta-thalassemia major patients in Pakistan","volume":"13","author":"U Waheed","year":"2021","journal-title":"J Lab Physicians"},{"issue":"3","key":"pone.0346782.ref083","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0121873","article-title":"The epidemiology of hepatitis C virus in the Maghreb region: systematic review and meta-analyses","volume":"10","author":"FA Fadlalla","year":"2015","journal-title":"PLoS One"},{"issue":"0","key":"pone.0346782.ref084","first-page":"0","article-title":"Prevalence of hepatitis C viral infection in Somalia: a systematic review and meta-analysis.","volume":"0","author":"AS Ali Mude","year":"2024","journal-title":"Microb Infect Dis"},{"issue":"34","key":"pone.0346782.ref085","doi-asserted-by":"crossref","first-page":"3927","DOI":"10.3748\/wjg.v24.i34.3927","article-title":"Epidemiology of viral hepatitis in Somalia: Systematic review and meta-analysis study","volume":"24","author":"MA Hassan-Kadle","year":"2018","journal-title":"World J Gastroenterol"},{"key":"pone.0346782.ref086","unstructured":"Hepatitis C fact sheet, Sep 2025 [Internet]. 2024. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hepatitis-c"},{"issue":"10","key":"pone.0346782.ref087","first-page":"20418","article-title":"ECDC publishes the annual epidemiological report 2012","volume":"18","author":"EE team","year":"2013","journal-title":"Euro Surveill"},{"key":"pone.0346782.ref088","unstructured":"Introduction of Hepatitis C Look Back [Internet]. 1994. Available from: chrome-extension:\/\/efaidnbmnnnibpcajpcglclefindmkaj\/https:\/\/www.infectedbloodinquiry.org.uk\/sites\/default\/files\/2023-08-03%20SI\/2023-08-03%20SI\/DHSC0003533_023%20-%20Introduction%20of%20Hepatitis%20C%20Look%20Back%20-%2001%20Dec%201994.pdf?utm_source=chatgpt.com"},{"key":"pone.0346782.ref089","volume-title":"Badlands: il cinema dell\u2019ultima Roma","author":"F Capoferri","year":"2022"},{"issue":"2","key":"pone.0346782.ref090","doi-asserted-by":"crossref","first-page":"31","DOI":"10.47709\/brilliance.v2i2.1541","article-title":"A Hepatitis B virus, hepatitis C virus and human immunodeficiency virus infection in expatriate workers and Libyan people in Darna","volume":"2","author":"HK Ibrahim","year":"2022","journal-title":"Brilliance: Res Artif Intell"},{"issue":"6","key":"pone.0346782.ref091","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1007\/s10508-019-01574-0","article-title":"HIV and other sexually transmitted infections among female sex workers in Iran: a systematic review and meta-analysis","volume":"49","author":"M Karamouzian","year":"2020","journal-title":"Arch Sex Behav"},{"issue":"5","key":"pone.0346782.ref092","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1097\/COH.0000000000000179","article-title":"The HCV epidemics in key populations (including PWID, prisoners, and MSM): the use of DAAs as treatment for prevention","volume":"10","author":"NK Martin","year":"2015","journal-title":"Curr Opin HIV AIDS"},{"issue":"1","key":"pone.0346782.ref093","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/s12954-025-01286-w","article-title":"How to eliminate hepatitis C between people who inject drugs in community services and prisons in Catalonia","volume":"22","author":"E Yela","year":"2025","journal-title":"Harm Reduct J"},{"issue":"46","key":"pone.0346782.ref094","doi-asserted-by":"crossref","first-page":"17265","DOI":"10.3748\/wjg.v20.i46.17265","article-title":"Health care-associated hepatitis C virus infection","volume":"20","author":"B Pozzetto","year":"2014","journal-title":"World J Gastroenterol"},{"key":"pone.0346782.ref095","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1111\/j.1478-3231.2011.02539.x","article-title":"A systematic review of hepatitis C virus epidemiology in Europe, Canada and Israel","volume":"31","author":"M Cornberg","year":"2011","journal-title":"Liver Int"},{"key":"pone.0346782.ref096","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1478-3231.2011.02540.x","article-title":"A systematic review of hepatitis C virus epidemiology in Asia, Australia and Egypt","volume":"31","author":"W Sievert","year":"2011","journal-title":"Liver Int"},{"issue":"12","key":"pone.0346782.ref097","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1056\/NEJMsr1912628","article-title":"Screening and treatment program to eliminate hepatitis C in Egypt","volume":"382","author":"I Waked","year":"2020","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0346782.ref098","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1111\/jvh.12671","article-title":"Impact of treatment on hepatitis C virus transmission and incidence in Egypt: a case for treatment as prevention","volume":"24","author":"HH Ayoub","year":"2017","journal-title":"J Viral Hepat"},{"issue":"1","key":"pone.0346782.ref099","doi-asserted-by":"crossref","first-page":"30","DOI":"10.21106\/ijtmrph.126","article-title":"Epidemiological, clinical and virological characteristics of patients with hepatitis C in Morocco","volume":"4","author":"MR Tagajdid","year":"2020","journal-title":"Int J Transl Med Res Public Health"},{"issue":"2","key":"pone.0346782.ref100","first-page":"253","article-title":"Review Article: Egyptian efforts to control hepatitis C virus in Egypt","volume":"6","author":"M El Behery","year":"2025","journal-title":"Alfarama J Basic Appl Sci"},{"issue":"4","key":"pone.0346782.ref101","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/j.jhep.2019.11.004","article-title":"An educate, test and treat model towards elimination of hepatitis C infection in Egypt: Feasibility and effectiveness in 73 villages","volume":"72","author":"G Shiha","year":"2020","journal-title":"J Hepatol"},{"key":"pone.0346782.ref102","article-title":"Global hepatitis C elimination: Updates, challenges, and opportunities from real-world experiences in Europe and North America","author":"O S\u0103ndulescu","year":"2025","journal-title":"Hepatology"},{"key":"pone.0346782.ref103","doi-asserted-by":"crossref","unstructured":"Health and healing in the Eastern Mediterranean Region: Progress on Vision 2023 and the priority health targets [Internet]. 2023. Available from: https:\/\/www.emro.who.int\/emhj-volume-30-2024\/volume-30-issue-7\/health-and-healing-in-the-eastern-mediterranean-region-progress-on-vision-2023-and-the-priority-health-targets.html?utm_source=chatgpt.com","DOI":"10.26719\/2024.30.7.467"},{"key":"pone.0346782.ref104","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1186\/1471-2334-13-382","article-title":"All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997-2010","volume":"13","author":"V Hernando","year":"2013","journal-title":"BMC Infect Dis"},{"issue":"15","key":"pone.0346782.ref105","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.4254\/wjh.v7.i15.1936","article-title":"Hepatitis C in human immunodeficiency virus co-infected individuals: Is this still a \u201cspecial population\u201d?","volume":"7","author":"DE Karageorgopoulos","year":"2015","journal-title":"World J Hepatol"},{"issue":"03","key":"pone.0346782.ref106","doi-asserted-by":"crossref","first-page":"115","DOI":"10.4236\/ojgas.2017.73013","article-title":"The diagnostic challenges, possible etiologies and lack of researches of hepatocellular carcinoma in Somalia","volume":"07","author":"MA Hassan-Kadle","year":"2017","journal-title":"OJGas"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0346782","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:44:24Z","timestamp":1776793464000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0346782"}},"subtitle":[],"editor":[{"given":"Ashraf","family":"Elbahrawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":106,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0346782","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]}}}