Introduction Hepatitis B virus (HBV) infection, although not as prevalent among people who inject drugs (PWID) as hepatitis C, remains a significant public health concern. We present the first detailed global review of HBV prevalence among PWID.
Methods As part of the WHO-funded Global Burden of Disease study, we undertook a systematic review of electronic databases (Medline, Embase, PsycINFO) and relevant conference abstracts to identify studies reporting HBV prevalence among PWID. Experts in the field were invited through a “viral email” to submit unpublished reports, to ensure inclusion of as many studies as possible. Studies were graded according to methodological characteristics and data quality, before national, regional and global prevalence estimates of specific HBV markers were calculated.
Results Two hundred and eighty-nine studies reporting HBV prevalence estimates from more than 50 countries were identified. Most studies were conducted between 1990 and 2010, predominantly in middle- and high-income countries, although there has been an increase in the number of studies from low-income countries recently. HBV markers measured and definitions of HBV infection varied between studies; 146 studies reported specifically on prevalence of antibodies to HBV core antigen, and 90 reported prevalence of HBV surface antigen. Few papers reported age- or gender-specific prevalence estimates.
Conclusions This is the first comprehensive review of the global prevalence of HBV in this high-risk population. Data quality and research methods, particularly HBV markers assessed, varied markedly. Better quality and more complete data are required to accurately assess the scale and significance of this public health problem.
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