The Egyptian hepatitis C programme: A model of HCV treatment intervention?

Lemoine, Maud; Cooke, Graham

doi:10.1016/j.jhep.2018.01.021

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…New pan‐genotypic DAA regimens may remove the need for HCV genotype testing prior to treatment initiation, particularly for people who are DAA treatment naive and do not have cirrhosis, which would further enhance progression through the care cascade and facilitate rapid treatment initiation strategies, especially where Point of Care HCV RNA tests are available. Removal of HCV genotype testing prior to treatment initiation has been suggested to be particularly beneficial for improving treatment initiation in resource‐limited settings where burden of disease is high.…”

Section: Discussionmentioning

confidence: 99%

The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals

Bartlett

Chapinal

et al. 2019

Liver International

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Background: Population-level monitoring of hepatitis C virus (HCV) infected people across cascades of care identifies gaps in access and engagement in care and treatment. We characterized the population-level care cascade for HCV in British Columbia (BC), Canada before and after introduction of Direct Acting Antiviral (DAA) treatment. Methods: BC Hepatitis Testers Cohort (BC-HTC) includes 1.7 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2018 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV care cascade stages: (a) antibody diagnosed; (b) RNA tested; (c) RNA positive; (d) genotyped; (e) initiated treatment; and (f) achieved sustained virologic response (SVR). Results:We estimated 61 127 people were HCV antibody positive in BC in 2018 (undiagnosed: 7686, 13%; diagnosed: 53 441, 87%). Of those diagnosed, 83% (44 507) had HCV RNA testing, and of those RNA positive, 90% (28 716) were genotyped. Of those genotyped, 61% (17 441) received therapy, with 90% (15 672) reaching SVR.Individuals from older birth cohorts had lower progression to HCV RNA testing.While people who currently inject drugs had the highest proportional progression to RNA testing, this group had the lowest proportional treatment uptake. Conclusions: Although gaps in HCV RNA and genotype testing after antibody diagnosis exist, the largest gap in the care cascade is treatment initiation, despite introduction of DAA treatment and removal of treatment eligibility restrictions. Further interventions are required to ensure testing and treatment is equitably accessible in BC.

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Section: Discussionmentioning

confidence: 99%

The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals

Bartlett

Chapinal

et al. 2019

Liver International

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“…This is consistent with the overall prevalence of anti-HCV antibodies in the most recent EHIS 2015 [13] study, which was 9.9%. All screened participants who were positive for anti-HCV were tested for HCV RNA at the Luxor center and if positive received treatment without prioritization [20].…”

Section: Discussionmentioning

confidence: 99%

Mass screening for hepatitis B and C in Southern Upper Egypt

Soliman

Elzalabany

Hassanein³

et al. 2019

BMC Public Health

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BackgroundIt is well documented that Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world. The recent development of highly effective direct acting antiviral drugs (DAAs), has opened the possibility of treating and curing HCV infection in the Egyptian population on a large scale.MethodsA screening demonstration project was implemented in southern Egypt in and around the city of Luxor. Free screening and if indicated, treatment, was offered to those 16 years or older for anti-HCV antibodies (anti-HCV) and hepatitis B surface antigen (HBsAg) using third generation enzyme immunoassays (Enzygnost® Anti-HCV and HbsAg). Statistical methods included estimation of odds ratios (OR) and 95% confidence intervals (95% CI).ResultsThere was a large turnout of 67,042 persons who were screened in a 12-month period starting in June 2016. Thirty-one thousand nine hundred sixty-four males (47.7%) and 35,074 females (52.3%) were screened with a mean age of 43.6 ± 14.3 years. Nine thousand seven hundred one patients (14.5%) were positive for anti-HCV and 2950 (4.4%) for HBsAg. Prevalence of anti-HCV was significantly higher in males than females (19.67% vs.9.73% OR = 2.27; CI 2.2 to 2.4; p < 0.001) and the same for HBsAg (6.2% vs. 2.8% OR = 2.3; CI 2.2 to 2.5; p < 0.001). The prevalence of anti-HCV was significantly associated with age (p < 0.001), ranging from between 1 and 4% in individuals below the age of 40 years, then increased steadily to 42% at age 60 followed by a precipitous decline in age specific prevalence.ConclusionsThe results showed unanticipated patterns in the Luxor area of anti-HCV and HBsAg by age and gender in contrast to previous reports on this unique HCV epidemic in Egypt. Moreover, the level and rate of turnout, cost, and other logistical issues, provided essential information for effective planning, design, and evaluation methods for larger national mass screening and treatment programs.

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“…In 2014, Egypt negotiated with Gilead Sciences a reduced access price for sofosbuvir at $900 for 12 weeks of treatment (Donald, 2015), and this was followed by a reduced price of simeprevir from Janssen and daclatasvir from Bristol Meyers Squibb (BMS) at $750 for 12 weeks of treatment. However, the cost of treatment with SOF plus PEG or simeprevir or DCV was beyond the affordability of the national program that planned to treat more than 350,000 patients a year (Waked et al, 2014;WHO, 2018), and with scale up of the program by the end of 2015, the only option to treat the necessary number of patients to adhere to the disease elimination plan targets was to introduce low-cost generics (Lemoine and Cooke, 2018;Elsharkawy et al, 2018a).…”

Section: Discussionmentioning

confidence: 99%