Search

Background & Aims Egypt has a major HCV burden and a well established treatment programme, with an ambitious goal of HCV elimination. Our aim was to assess the impact of a comprehensive HCV prevention, test and treat programme on the incidence of new HCV infections in 9 villages in rural Egypt. Methods An HCV “educate, test and treat” project was implemented in 73 villages across 7 governorates in Egypt between 06/2015 and 06/2018. In 2018, in 9 of the villages we re-tested individuals who originally tested HCV antibody (HCV-Ab) and HBsAg negative using rapid diagnostic tests (RDTs); confirmatory HCV RNA testing was performed for positive cases. The incidence rate per 1,000 person-years (py) was calculated, and risk factors for incident HCV infections assessed through an interviewer-administered questionnaire in 1:3 age- and gender-matched cases and controls. Results Out of 20,490 individuals who originally tested HCV-Ab negative in the 9 villages during the 2015–2016 implementation of the “educate, test and treat” programme, 19,816 (96.7%) were re-tested in 2018. Over a median of 2.4 years (IQR 2.1–2.7), there were 19 new HCV infections all of which were HCV RNA positive (incidence rate 0.37/1,000 py) (95% CI 0.24–0.59). Compared to a previous estimate of incidence in the Nile Delta region (2.4/1,000 py) from 2006, there was a substantial reduction in overall incidence of new HCV infections. Exposures through surgery (odds ratio 51; 95% CI 3.5–740.1) and dental procedures (odds ratio 23.8; 95% CI 2.9–194.9) were significant independent predictors of incident infections. Conclusions This is the first study to show a substantial reduction in incidence of new HCV infections in a sample of the general population in Egypt following attainment of high testing and treatment coverage. New infections were significantly associated with healthcare-associated exposures. Lay summary Egypt has a major national HCV testing and treatment programme with the goal of eliminating HCV infection. We assessed the impact of a comprehensive HCV prevention, test and treat programme in 73 villages that achieved high coverage of testing and treatment on the subsequent incidence of new HCV infections in nine of the villages. We re-tested people who were previously HCV antibody negative and found that the rate of new HCV infections was greatly reduced compared to previous estimates. We also found that exposure through surgery and dental procedures were associated with these new infections. This highlights the importance of continued strengthening of infection control and prevention measures, alongside treatment scale-up.

Background Egypt has one of the highest burdens of HCV infection worldwide, and a large treatment programme, but reaching rural communities represents a major challenge. We report the feasibility and effectiveness of a comprehensive community-based HCV prevention, testing and treatment model in 73 villages across Egypt, with the goal to eliminate infection from all adult villagers. Methods An HCV “educate, test and treat” programme was implemented in 73 villages across 7 governorates in Egypt between 06/2015 and 06/2018. The programme model comprised community mobilization facilitated by a network of village promoters to support the education, test and treat campaign as well as fund raising in the local community; a comprehensive testing, linkage to care and treatment of all eligible villagers aged 12 to 80 years using HCV antibody and HBsAg rapid diagnostic tests (RDTs), HCV RNA confirmation of positive cases, staging of liver disease using transient elastography (FibroScan) or FIB4 score, treatment with 12 or 24 weeks of a direct acting antiviral (DAA) regimen, and an assessment of cure at 12 weeks after completion of treatment (SVR12); and an education campaign to raise awareness and disseminate messages about safer practices to reduce transmission through public events, promotional materials and house-to-house visits. Key outcomes assessed in each village were: uptake of serological HCV and HBV testing, HCV viral load confirmation and treatment, and SVR12. Findings 204749 (92.3%, 95% CI 91.6-93.5) of 221855 eligible villagers were screened for HCV antibody and HBsAg, and 33839 (16.5%, 95% CI 12.2-16.1) and 763 (0.4%, 95% CI 0.3-0.5) were positive, respectively. Nearly all 33839 HCV antibody positive individuals had immediate sample collected for HCV RNA and 15892 (47.0%, 95% CI 44.8-53.8) were positive. Overall, prevalence of HCV viremia was 7.8%, 95% CI 6.6-7.9. 14495 (91.2%, 95% CI 89.9-96.4) received treatment within a median of 2.1 weeks from serological diagnosis (IQR: 0.6 to 3.3 weeks). SVR12) was achieved among 14238 of the treated cases (98.3%, 95% CI 96.7-98.6). 3192 (20.1%) had cirrhosis, and of these 166 (5.2%) were diagnosed with HCC. Interpretation This large community-based educate, test and treat programme in more than 200,000 villagers demonstrates the feasibility and effectiveness of this model for elimination of HCV infection in rural communities. We estimate treatment coverage and cure of 84.6% of the estimated 17137 infected persons aged 12-80 years across the 73 villages.

Background/Aims We evaluated whether surrogate serum biomarkers for liver injury are comparable to liver biopsy in Egyptian patients with hepatitis C virus (HCV) infection. Subjects Two hundred and twenty Egyptian patients, 91% infected with genotype-4 HCV, undergoing liver biopsy during evaluation for interferon/ribavirin therapy. Methods Liver biopsy scored by the Ishak method was compared to biochemical tests, platelet count and two fibrosis biomarkers: hyaluronic acid (HA) and YKL-40. Univariate and logistic regression analyses determined independent predictors of fibrotic, inflammatory, and fatty changes. Biomarkers were evaluated for ability to differentiate between severe fibrosis/cirrhosis and no/mild fibrosis. Results Although increasing age, HA, YKL-40, AST, reduced platelet count, and AST and HA/platelet count ratios were associated with fibrosis by univariate analysis, the other variables were not significant after controlling for HA ( p =0.0001) and age ( p =0.004). Although age and some biomarkers were associated with inflammation, none remained significant after controlling for fibrosis. YKL-40 ( p =0.04) and aspartate aminotransferase ( p =0.05) remained associated with steatosis after controlling for fibrosis. Conclusions In Egyptians with chronic HCV, young patients with low levels of HA are at very low risk of fibrosis. This can limit the number of liver biopsies to those whose clinical findings conflict with the biomarker results.