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. 2021 Mar 31;9(1):187-200.
doi: 10.9745/GHSP-D-20-00234. Print 2021 Mar 31.

Egypt's Ambitious Strategy to Eliminate Hepatitis C Virus: A Case Study

Ahmed Hassanin  1 , Serageldin Kamel  2 , Iman Waked  3 , Meredith Fort  4
Affiliations

Egypt's Ambitious Strategy to Eliminate Hepatitis C Virus: A Case Study

Ahmed Hassanin et al. Glob Health Sci Pract. .

Abstract

Introduction: Chronic hepatitis C virus (HCV) infection is a major public health problem in many low- and middle-income countries. In 2015, Egypt's HCV infection prevalence of 7% among adults was among the highest in the world and accounted for 7.6% of the country's mortality. In 2014, Egypt embarked on an aggressive screening and treatment program that evolved into a national strategy to eliminate HCV as a public health threat by 2021.

Methods: In this qualitative case study, we analyzed Egypt's HCV control strategy using the Kingdon framework to understand how the problem, policy, and political streams merged to create an opportunity to achieve an ambitious elimination goal. We describe key aspects of the implementation, identify lessons learned, and provide recommendations for other low- and middle-income countries aiming to eliminate HCV.

Results: Between 2014 and 2020, Egypt screened more than 50 million and treated more than 4 million residents for HCV. Five key elements contributed to Egypt's successful HCV elimination program: (1) sufficient and reliable epidemiologic data to quantify and monitor public health threats; (2) a robust public health care infrastructure; (3) inclusive care that reached all sectors of society; (4) increased health care spending; and (5) innovative scientific research and use of information technology.

Conclusion: Egypt conducted a successful HCV screening program that covered more than 50 million residents and treated more than 4 million. It is poised to be the first country in the world to eliminate HCV within its borders. The lessons learned from this experience can inform the elimination plans of other low- and middle-income countries with high HCV burden.

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Figures

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A community health worker educates a group of women about hepatitis C virus in a village in Assiut. © 2018 Tahsin Bakr
FIGURE 1
FIGURE 1
Timeline of the 3 Streams of the Kingdon Framework That Led to Defining Elimination of Hepatitis C Virus Goal Abbreviations: FDA, U.S. Food and Drug Administration; HCV, hepatitis C virus; NCCVH, National Committee for Control of Viral Hepatitis.
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Advertisements in Arabic used in communication strategy for hepatitis C virus that conveyed 5 messages. “It is either us, or hepatitis virus C: (1) Don't use personal items that are not yours; (2) It is ok to have contact with HCV patients; (3) Pills are safer than injections; (4) Consult with a physicians and test for HCV; and (5) HCV treatment is available and effective.” © World Health Organization Regional Office for the Eastern Mediterranean
FIGURE 2
FIGURE 2
Flow of Individuals Screened for Hepatitis C Virus Through by the 100 Million Health Lives Campaign in Egypt Abbreviations: AB, antibody; HCV, hepatitis C virus; PCR, polymerase chain reaction; VPN, Virtual Private Network.
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A medically equipped vehicle used for screening individuals for hepatitis C virus near a construction site in South Sinai, Egypt. © 2018 Tahsin Bakr
FIGURE 3
FIGURE 3
Hepatitis C Virus Screening and Case Cascade Used by Egypt's 100 Million Health Lives Campaign Abbreviation: HCV, hepatitis C virus.
See this image and copyright information in PMC

References

    1. World Health Organization (WHO). Global Hepatitis Report 2017. Accessed March 1, 2021. https://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/
    1. Blach S, Zeuzem S, Manns M, et al. . Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161–176. 10.1016/S2468-1253(16)30181-9. - DOI - PubMed
    1. El-Zanaty F, Way A. Egypt Demographic and Health Survey 2008 Egypt Ministry of Health, El-Zanaty and Associates, Macro International; 2009. Accessed March 1, 2021. https://dhsprogram.com/pubs/pdf/FR220/FR220.pdf
    1. World Health Organization (WHO). Global Health Sector Strategy on Viral Hepatitis, 2016–2021. Accessed March 1, 2021. https://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en
    1. Kingdon J. Agendas, Alternatives, and Public Policies. Little Brown; 1984.