How Egypt defied the odds to eliminate hepatitis C

A screening programme began too, integrated within the National Demographic Health survey, which helped to better identify where the problem was most acute.

The tide further turned after the US Food and Drug Administration approved sofosbuvir, a direct-acting antiviral drug with a 90 per cent cure rate, in late 2013. Egypt’s own regulator followed suit the next year and, crucially, manufacturer Gilead Sciences agreed to sell the drug to the government at one per cent of its sale price.

“Such supportive initiatives from manufacturers can significantly facilitate the efforts in resource-constrained countries and further motivate them in implementing their national programmes effectively,” says Ghaffar.

El-Sayed adds that Egypt was an attractive prospect to Gilead, too. The specialised treatment centres and screening programme that had been set in motion five years prior meant “we had the infrastructure, we had the database, we [knew] the number of patients that needed to be treated. And we had a very nice registration system in place, so everything was ready.”

By this stage, the country also had thousands of doctors and nurses trained in HCV treatment.

A joint strategy with the World Health Organisation (WHO) and the Centers for Disease Control and Prevention in the US, published in 2014, was launched alongside the antiviral treatment programme; one million people signed up in the space of a week.

“The numbers were staggering,” remembers El-Sayed, confirming that Egypt had quickly become “the blueprint for all other countries to develop their strategies”.

‘Mobilised’ for nationwide screening

While the government’s fully subsidised plan retained momentum for a period, by 2017, registrations had begun to slow.

Further research showed that an estimated two to three million people in Egypt had HCV without realising they were infected, El-Sayed says. It was clear there was still plenty of work to be done.

So when the WHO pre-approved a rapid diagnostic test in 2018, “we decided to go for a national screening programme, with a presidential initiative and a political will to do this in the shortest time possible,” adds El-Sayed.

There were mobile units set up in youth clubs, mosques and churches – “the whole country was mobilised, starting from the media to all stakeholders, to all the ministries, to everybody: scientists, scientific associations, nongovernmental organisations, civil society, community, and even the people themselves,” El-Sayed says.

The rollout was “very efficient, very fast and very cost effective.”

Over 60 million people, more than half the population, were checked in seven months – “the largest screening programme in the whole world” – with citizens incentivised by the fact screening was also being done for non-communicable diseases at the same time.

“That encouraged a lot of people, and removed the stigma and discrimination about going to get tested for hepatitis C only.”

Egypt has now diagnosed 87 per cent of those infected with HCV, of whom 93 per cent have been given curative treatment – surpassing the WHO gold-tier rates of 80 and 70 per cent, respectively.

A programme has also been set up for the management and follow-up of patients with advanced liver disease to boost early detection of liver cancer, “because that’s going to be a problem for a few years before it starts to go down with the decreasing prevalence of hepatitis C,” says El-Sayed.

The question, now, is how to encourage other nations to follow this same trajectory. “Egypt is collaborating with various countries and organisations to aid in the elimination programmes of multiple African and Asian nations,” explains Ghaffar.

“This support includes capacity-building programmes as well as the provision of HCV and HBV [hepatitis B] diagnostics and medications through direct donations.”

This, as well as the success of their own efforts, remain a huge source of pride for all involved.

“As an Egyptian, I have witnessed for a long time how HCV seriously affected Egyptian families. Bad memories and suffering were synonyms to the word HCV,” Ghaffar says. “This historical achievement brings a brighter future to Egypt, and confirms that nothing is impossible.”

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