Background Our study aims to characterise hepatitis C virus (HCV) epidemiology in Afghanistan, as part of the Middle East and North Africa (MENA) HCV Epidemiology Synthesis Project. The MENA HCV Epidemiology Synthesis Project is an ongoing effort to characterise HCV epidemiology and inform research, policy, and programming priorities in MENA countries.

Methods We systematically reviewed and synthesised HCV prevalence and incidence data following PRISMA guidelines. Meta-analyses using DerSimonian-Laird random effects model with inverse weighting were implemented to estimate HCV prevalence among populations at various risk of HCV infection. A risk of bias assessment was incorporated.

Results Our search identified 48 HCV prevalence and one HCV incidence measures. Our meta-analyses estimated HCV prevalence at 0.7% among the general population (range: 0.0–4.0%; 95% CI: 0.3–1.3%), 31.8% among people who inject drugs (PWID; range: 9.5–70.0%; 95% CI: 24.1–40.1%), and 2.5% among populations at intermediate risk (range: 0.0–8.3%; 95% CI: 1.4–3.9%). Among PWID, HCV incidence at 6 months was assessed at 66.7 per 100 person-years in one study. Geographic and temporal variations in HCV prevalence among PWID and prisoners appear to be present. While prevalence among PWID appeared to decline over few years from 36.0% to 27.6% in Kabul, from 12.5% to 9.5% in Jalalabad, and from 24.1% to 18.8% in Mazar-i-Sharif, it increased from 49.1% to 70% in Herat. Among prisoners, HCV prevalence appeared to increase from 1.7% to 4.6% in Kabul and declined from 4.1% to 1.4% in Herat. Risk factors among PWID included a range of injecting behaviours and socio-demographic characteristics.

Conclusions HCV prevalence among the general population in Afghanistan is comparable to developing and developed countries globally. There is an immediate need for increasing access to harm reduction programs among specific populations at risk, specifically PWID and prisoners.

Disclosure of interest statement This publication was made possible by NPRP grant number [NPRP 4–924–3–251] from the Qatar National Research Fund (a member of Qatar Foundation). Additional support was provided by the Biostatistics, Epidemiology, and Biomathematics Research Core at the Weill Cornell Medical College in Qatar. The statements made herein are solely the responsibility of the authors. The funders had no role in the design, conduct, or analysis of the study. The authors have no conflicts of interest to declare.