Hepatitis C Virus Infection in Mongolia: Updated Provincial Data on Prevalence, Genotype Distribution, and Age-Specific Risk Factors.

(1) Background: Mongolia has historically reported one of the highest hepatitis C virus (HCV) prevalence rates globally, with past national estimates exceeding 15%, making HCV infection a major public health priority. This study aimed to assess the prevalence, genotype distribution, and risk factors of HCV infection among residents of Arkhangai Province. (2) Methods: This population-based cross-sectional study was conducted in 2022 including 2304 individuals aged 0-80 years. Serum samples were tested for anti-HCV antibodies using ELISA and for HCV RNA using PCR. Positive samples were genotyped, and demographic and exposure data were analyzed using logistic regression to identify independent risk factors. (3) Results: The prevalence of anti-HCV antibodies was 12.0%, and HCV RNA positivity was 7.16%. Infection increased significantly with age (p < 0.001) and was higher among females (14.6%) than males (8.4%). Genotype 1b predominated (98.2%), followed by 1a (1.2%) and 2 (0.6%). Several exposures showed strong associations with HCV infection in univariate analysis, including cupping therapy (OR 2.37, 95% CI 1.71-3.28), shared razor use (OR 2.39, 95% CI 1.59-3.60), cosmetic procedures (OR 1.70, 95% CI 1.11-2.45), and unsafe injections (OR 2.06, 95% CI 1.40-3.02). In multivariable analysis, four exposures remained independently associated with HCV infection: cupping therapy (adjusted OR 1.89, 95% CI 1.32-2.70), shared razor use (adjusted OR 1.98, 95% CI 1.24-2.89), cosmetic procedures (adjusted OR 1.62, 95% CI 1.39-2.24), and unsafe injections (adjusted OR 1.84, 95% CI 1.19-2.83). (4) Conclusions: HCV infection remains prevalent, particularly among older adults and women. Genotype 1b continues to predominate, indicating that the viral genetic distribution has remained largely unchanged over the past decade. Continued education, safe injection practices, and regulation of traditional and cosmetic procedures are essential to reduce HCV transmission and support Mongolia's elimination goals. These findings highlight the need for comprehensive prevention strategies addressing both unsafe traditional/medical practices and the rapidly expanding cosmetic and aesthetic service sector.