# Epidemiology and control of hepatitis C virus infection in Brunei Darussalam: a retrospective cohort study

## TL;DR

Hepatitis C virus (HCV) prevalence is rising in Brunei, likely due to lower treatment rates and more severe cases, highlighting the need for better prevention and care.

## Contribution

This study provides the first detailed epidemiological analysis of HCV in Brunei and identifies factors affecting treatment outcomes.

## Key findings

- HCV prevalence increased from 10.1 to 48.7 per 100,000 population between 2013 and 2022.
- Only 52.3% of HCV RNA-positive individuals initiated treatment, with locals and middle-aged groups more likely to start it.
- 44.7% of HCV-related deaths had baseline complications, especially among those aged 50 and older.

## Abstract

•We report an increasing prevalence of hepatitis C virus (HCV) cases in Brunei.•This is possibly due to declining treatment initiation and completion rates.•Almost half of all HCV deaths had baseline HCV-related complications.•Suggests need to improve primary and secondary prevention activities for HCV.

We report an increasing prevalence of hepatitis C virus (HCV) cases in Brunei.

This is possibly due to declining treatment initiation and completion rates.

Almost half of all HCV deaths had baseline HCV-related complications.

Suggests need to improve primary and secondary prevention activities for HCV.

We describe the epidemiology of hepatitis C virus (HCV) cases in Brunei Darussalam and evaluate factors associated with its treatment outcomes.

A retrospective cohort study was conducted using data from two national databases between January 2013 and December 2022.

We identified 801 anti-HCV-positive cases. Although incidence remained relatively stable, prevalence rates increased from 10.1 to 48.7 per 100,00 population. Among those with detectable HCV RNA, treatment was initiated in 52.3% (n = 239). Locals (adjusted odds ratio [aOR] = 2.42, 95% confidence interval [CI] 1.16, 5.36) and age (30-39 years [aOR = 2.41, 95% CI 1.17, 5.07], 40-44 years [aOR = 2.55, 95% CI 1.19, 5.58], and 50-54 years [aOR = 2.76, 95% CI 1.25, 6.24) were associated with treatment initiation. Among those who completed treatment (69.5%, n = 166), 64.5% (n = 107) achieved sustained virologic response. HCV-related complications at baseline were recorded in 7.4% (n = 59) of all cases, particularly among those aged ≥50 years (aOR = 3.32, 95% CI 1.93, 5.79). HCV-related deaths occurred in 36.4% (n = 47), among which 44.7% (n = 21) had HCV-related complications at baseline.

An increasing HCV prevalence (likely due to case management processes and patient-related factors) and the high proportion of deaths with baseline HCV-related complications suggest the need to strengthen HCV screening and management in Brunei.