Five Axes for Implementing Egypt's Viral Hepatitis Plan of Action, 2014–2018

Axis 1: Strengthening surveillance to detect viral hepatitis transmission and diseaseThe Demographic and Health Survey conducted in 2015 updated the HCV prevalence estimate in adults aged 15–59 years from 10% to 7%, or approximately 4.1 million Egyptians. The survey provided a detailed breakdown of HCV prevalence in rural versus urban areas, between various administrative governorates, and across different socioeconomic strata.
Axis 2: Improving blood products safety to reduce transmission of viral hepatitisTransmission of HCV via blood product transfusion is among the most common modes of HCV infection in Egypt. Policies to prevent such transmission were implemented, and nucleic-acid testing for all blood products in Egypt became mandatory in private and public health care facilities. Screening for HCV for all pregnant women also became mandatory.
Axis 3: Promoting infection control practices to reduce transmission of viral hepatitisMOHP, WHO, CDC, and the biomedical research lab of the U.S. Navy located in Cairo, Egypt, updated national infection control policies and guidelines and launched a national training and auditing campaign with health care workers and facilities to ensure adherence to infection control policies.25 This comprehensive plan launched in 2002 and included policies for prevention of transmission in health care facilities and dialysis centers. It was relaunched in 2014 as part of the Plan of Action for the Prevention, Care & Treatment of Viral Hepatitis. It had a significant impact on hospital-acquired HCV transmission. Among dialysis patients, the annual HCV incidence rate declined from 28% in 2001 to 6% in 201226 and just 1.6% in 2015.27
Axis 4: Educating providers and communities to increase awareness about viral hepatitis and its preventionNongovernmental organizations contributed to community-based education and test-and-treat projects seeking to raise awareness and promote behavioral changes that reduce HCV transmission.28 WHO provided technical support to the MOHP in drafting a 5-year communication strategy and implementation plan to combat HCV.29 The communication strategy focused on 5 main messages, and 5 television outlets, 5 radio outlets, and online social media were used to spread the message. A library of the visual advertisements and messaging is available on the MOHP-sponsored YouTube channel.30
Axis 5: Improving care and treatment to prevent liver disease and cancerIn September 2014, the NCCVH debuted an online portal for people living with HCV to register for treatment. Using this portal, people could register for treatment by inputting basic demographic data, their national identification number, and a call-back number. Within 24 hours, an operator from the call center would call to set up an appointment and give an overview of expectations for the upcoming visit.
In the first month after opening the online portal, over 500,000 people registered to receive HCV treatment. To manage this influx of patients, the number of comprehensive treatment centers across the 27 administrative governorates was increased from 21 centers in 2010 to 54 centers in 2014, with less than 50 km between any two centers. By 2018, the number of centers expanded to 121.31 The treatment centers, which formed the NNTC for HCV, were integrated care units that provide all required services for HCV management. A well-trained, multidisciplinary team of medical doctors, pharmacists, nurses, and administrative staff participated in the assessment and follow-up of each patient. By September 2018, 2.4 million people with HCV had been treated using various sofosbuvir-based direct-acting antiviral drug combinations for 12 or 24 weeks, depending on the presence or absence of cirrhosis (liver failure).22,32 The number of patients treated reflected the number of previously recognized cases awaiting access to treatment and newly diagnosed cases due to expanded screening.
  • Abbreviations: CDC, U.S. Centers for Disease Control and Prevention; HCV, hepatitis C virus, MOHP, Ministry of Health and Population; NCCVH, National Committee for Control of Viral Hepatitis; NNTC, National Network of Treatment Centers; WHO, World Health Organization.