Spatial epidemiology of hepatitis C in Khenchela Province, Algeria: identifying HCV incidence hotspots and implications for regional public health

Hepatitis C virus (HCV) infection has a moderate prevalence in Algeria, but Khenchela Province consistently records elevated rates requiring detailed epidemiological investigation. This study aimed to assess the spatial distribution of HCV and identify HCV incidence hotspots to inform targeted public health interventions. A retrospective observational, cross-sectional study was conducted using routinely collected surveillance data from Khenchela Provincial Hospital. A total of 652 laboratory-confirmed HCV cases recorded between January 2018 and December 2022 were included. Demographic, clinical, and geographical data were extracted from medical records. Spatial clustering was assessed using Global Moran's I as a preliminary test, followed by the Getis-Ord Gi* statistic (Fixed Distance Band, 999 permutations) to detect statistically significant hotspots. The study population was predominantly females (60.6%, n = 395) compared to males (39.4%, n = 257). The most affected age group was 46–60 years (37.7%), followed by 30–45 years (29.9%). Spatial analysis identified four significant HCV incidence hotspots: Ouled Rechache (Gi_Bin = + 3, 99% confidence; 43.7/100000), Ain Touila (Gi_Bin = + 2, 95% confidence; 32.7/100000), El Mahmel (Gi_Bin = + 1, 90% confidence; 74.7/100000), and Ensigha (Gi_Bin = + 1, 90% confidence; 3.5/100000), the latter reflecting statistical significance rather than a high absolute case burden. Two cold spots were also identified: Remila (Gi_Bin = -1, 90% confidence) and Kais (Gi_Bin = -1, 90% confidence). Comorbidities were frequent, with end-stage renal disease (24.5%) and diabetes mellitus (20.9%) being the most commonly reported. Regarding reported potential exposures, dental procedures (59.8%) and traditional practices (15.8%) were the most frequently reported among cases. HCV incidence in Khenchela Province exhibits significant geographical clustering, concentrated in four primary municipalities. The predominance of female and middle-aged patients, alongside frequent comorbidities, highlights key at-risk groups. These findings support the need for targeted screening campaigns in identified hotspots and enhanced infection control measures, particularly in dental and dialysis settings.