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Reduced incidence of hepatitis C in 9 villages in rural Egypt: Progress towards national elimination goals

  • Gamal Shiha
    Correspondence
    Corresponding author. Address: Internal medicine department, Faculty of medicine, Mansoura University, Egypt, CEO, Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt; Tel.: +2 0122328050.
    Affiliations
    Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura, Egypt

    Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Egypt
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  • Reham Soliman
    Affiliations
    Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura, Egypt

    Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt
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  • Nabiel N.H. Mikhail
    Affiliations
    Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura, Egypt

    Biostatistics and Cancer Epidemiology Department, South Egypt Cancer Institute, Assiut University, Egypt
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  • Philippa Easterbrook
    Affiliations
    Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
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Published:September 12, 2020DOI:https://doi.org/10.1016/j.jhep.2020.09.008

      Highlights

      • A comprehensive HCV prevention, test and treat programme project was implemented in 73 villages in Egypt between 06/2015 and 06/2018.
      • In 2018, in 9 of the villages we re-tested 19816 persons who originally tested HCV antibody negative.
      • There were 19 new HCV infections corresponding to an incidence rate of 0.37/1000 person years - an overall 84.6% reduction in incidence compared to a previous baseline estimate of 2.4/1000 person years from 2006.
      • Exposure through surgery and dental procedures were significant independent predictors of incident infections.

      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.

      Graphical abstract

      Keywords

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