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

Hassanin, Ahmed; Kamel, Serageldin; Waked, Imam; Fort, Meredith

doi:10.9745/ghsp-d-20-00234

Cited by 61 publications

(54 citation statements)

References 22 publications

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“…It is interesting to note that despite a high profile national HCV elimination campaign in Egypt where over 50 million have been screened for HCV and 4 million treated since 2015, 24 there remained a proportion of women (13%) who were not aware of HCV and 25% of women had never been tested. Other countries with high HCV burden such as Nigeria also found a high proportion of pregnancy women (52%) with no knowledge of HCV.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, despite a national HCV test and treat campaign in Egypt, with over 50 million screened and 4 million treated since 2015, 17 a small proportion of women (13%) were not aware of HCV, and 25% were never tested. We gave all participants a factsheet to encourage informed responses, however we did not assess whether this information was fully understood or the degree to which it contributed to women’s responses.…”

Section: Discussionmentioning

confidence: 99%

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Acceptability of Hepatitis C screening and treatment during pregnancy in pregnant women in Egypt, Pakistan and Ukraine

Scott

Chappell

Mostafa

et al. 2021

Preprint

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Background: The risk of vertical transmission of hepatitis C virus (HCV) is ≈6%, and evidence suggests HCV negatively affects pregnancy and infant outcomes. Despite this, universal antenatal HCV screening is not available in most settings, and direct acting antivirals (DAA) are yet to be approved for use in pregnancy or breastfeeding period. Larger safety and efficacy trials are needed. At current there is limited understanding of the acceptability of routine HCV screening and use of DAAs in pregnancy but only among women in high HCV burden countries. Methods: We conducted a cross-sectional survey of pregnant or post-partum (<6 months since delivery) women attending antenatal clinics or maternity hospitals in Egypt, Pakistan and Ukraine. In Ukraine, this included one HIV clinic. Acceptability of free universal antenatal HCV screening and potential uptake of DAA treatment in the scenario of DAAs being approved for use in pregnancy was assessed. Results were stratified by HCV status and in Ukraine by HIV status. Descriptive statistics were used to explore differences in acceptability of treatment in pregnancy by country. Findings: Among 630 women (n=210 per country) who participated, the median age was 30 [interquartile range (IQR) 26, 34] years, 73% were pregnant and 27% postpartum, and 27% ever HCV antibody or PCR positive. 40% of women in Ukraine were living with HIV. Overall 93% of women supported free universal HCV screening in pregnancy, with no difference by country. 88% would take DAAs in pregnancy if approved for use: 92%, 98% and 73% among women in Egypt, Pakistan and Ukraine, respectively. Motivation for use of DAAs in pregnancy (to avert vertical transmission or for maternal HCV cure) varied by country, HCV status and HIV status (in Ukraine). No predictors for acceptability of DAAs were identified. Interpretation: Our survey across 3 high burden countries found very high acceptability of free universal HCV screening and DAAs if approved for use in pregnancy. Clinical trials to evaluate the safety and efficacy of DAAs during pregnancy and breastfeeding are urgently required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acceptability of Hepatitis C screening and treatment during pregnancy in pregnant women in Egypt, Pakistan and Ukraine

Scott

Chappell

Mostafa

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Additionally, we observed a high number of infectious diseases as associated causes to schistosomiasis, mainly viral hepatitis, septicemia, and pneumonia. Prior studies have investigated the association between schistosomiasis and hepatitis caused by viruses B and C, especially in Egypt and Brazil [ 12 , 30 - 32 ]. The authors emphasize that the occurrence of both infections can further aggravate the patient's clinical condition, with a greater risk of liver fibrosis, portal hypertension, and the progression of hepatic fibrosis into cirrhosis and hepatocellular carcinoma, which considerably increases the risk of death [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Basic and associated causes of schistosomiasis-related mortality in Brazil: A population-based study and a 20-year time series of a disease still neglected

et al. 2021

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Background Schistosomiasis is a persistent public health problem in Brazil. Regardless advances in diagnosis and mass treatment, schistosomiasis has a severe impact on morbimortality in the country and remains a neglected tropical disease. Herein, we assessed the basic and associated causes of schistosomiasis-related deaths and the temporal and spatial patterns of mortality from the disease in Brazil between 1999 and 2018. Methods We conducted an ecological and time series study. The segmented log-linear regression model was applied to assess time trends, considering all deaths recorded in the category B65/ICD-10. Additionally, we elaborated maps of mortality rates from schistosomiasis in Brazil. Results A total of 4168 schistosomiasis-related deaths were recorded in Brazil in this period, as an associated cause. Time trend analysis revealed an increase in the average age of deaths from schistosomiasis (annual percentage change (APC) = 0.84), and stable trend in Brazil (APC = 0.31). Concerning schistosomiasis-related deaths, we observed disorders related to the digestive system, liver diseases, septicemias, and chronic diseases. Surprisingly, there were deaths caused by non-endemic Schistosoma species in Brazil. Also, municipalities from non-endemic areas in Brazil presented schistosomiasis-related deaths. Conclusion Altogether, our analyses demonstrated that schistosomiasis remains a significant cause of death in Brazil, and it is increasing in some areas, especially in the Northeast region. Additionally, women and the elderly showed a stable time trend of deaths. Thereby, it urgently requires improvements in the control programs strategies, in the sense of an effective reduction in cases and deaths from the disease in Brazil.

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“…With SOF-based therapy, Egypt managed to treat more than 4 million patients with hepatitis C with SVR rates above 95% [22]. We estimate that the current viremic prevalence has decreased from 6% of the population in 2015 (5 million patients) to less than 0.5% of the population in 2021 (less than 500,000 patients).…”

Section: The John Martin and Gilead Impactmentioning

confidence: 99%

Case study of hepatitis C virus control in Egypt: impact of access program

Waked¹

2022

Antiviral Therapy

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Background Although Egypt was the country with the highest prevalence of hepatitis C in the world, the availability of sofosbuvir based therapies enabled Egypt to be the first country to eliminate hepatitis C and cure more than 4 million chronically infected patients. Purpose This is a small tribute to John Martin. Methodology and conclusion Here I present a summary of the HCV problem in Egypt, and how we, through Gilead's Access program under his leadership, were able to eliminate the disease.

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

Abstract: A national hepatitis C virus elimination strategy rooted in mass screening and treatment can be effective in many middle-income countries. A strong public health infrastructure, political commitment, and technological advances are essential to such initiatives.

Cited by 61 publications

References 22 publications

Acceptability of Hepatitis C screening and treatment during pregnancy in pregnant women in Egypt, Pakistan and Ukraine

Acceptability of Hepatitis C screening and treatment during pregnancy in pregnant women in Egypt, Pakistan and Ukraine

Basic and associated causes of schistosomiasis-related mortality in Brazil: A population-based study and a 20-year time series of a disease still neglected

Case study of hepatitis C virus control in Egypt: impact of access program

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