While, sub-Saharan Africa (SSA) has the highest global HCV prevalences, high rates of serologic false positives and low levels of viraemia have made estimating the burden in this area very difficult. The authors prospectively recalled 363 past blood donors (180 who were rapid screen assay (RSA) positive and 183 that were RSA-negative at the time of donation) in order to identify the level of active infection and risk factors for infection. The frequency of active HCV infection ranged from 74.4% to 88% depending upon the criteria used to define activity. Patients with active disease had biochemical evidence of liver inflammation and median viral loads of 5.7 log10 copies/ml. Patients from the northern and upper regions of Ghana appeared to be at greater risk of infection compared to patients from other areas. These risk factors included: traditional circumcision, home birth, tribal scarring and HBV coinfection. Therefore viraemic infections are common among serologically confirmed cases. Several transmission modes are contributing to the current HCV epidemic in Ghana and the distribution of at-risk practices may result in substantial regional variation in prevalence.
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