Shiha Gamal, Soliman Reham, Mikhail Nabiel N H, Easterbrook Philippa
Internal Medicine Department, Faculty of Medicine, Mansoura University, Egypt; Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt.
Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt; Tropical Medicine Department, Faculty of Medicine, Port Said University, Egypt.
J Hepatol. 2020 Apr;72(4):658-669. doi: 10.1016/j.jhep.2019.11.004. Epub 2019 Nov 14.
BACKGROUND & AIMS: Egypt has one of the highest burdens of HCV infection worldwide. It has a large treatment programme, but reaching rural communities represents a major challenge. We report on the feasibility and effectiveness of a comprehensive community-based HCV prevention, testing and treatment model whose goal was to eliminate infection from all adult villagers.
An HCV "educate, test and treat" programme was implemented in 73 villages across 7 governorates in Egypt between 06/2015 and 06/2018. The programme model comprised community mobilisation facilitated by a network of village promoters to support the education, testing and treatment of patients, as well as fundraising in the local community. Comprehensive testing, linkage to care and treatment were provided for all eligible villagers aged 12 to 80 years.
Of 221,855 eligible villagers, 204,749 (92.3%, 95% CI 91.6-93.5) were screened for HCV antibody and HBsAg, of whom 33,839 (16.5%, 95% CI 12.2-16.1) and 763 (0.4%, 95% CI 0.3-0.5) were positive, respectively. Nearly all 33,839 HCV antibody positive individuals had a sample immediately collected for HCV RNA testing, and 15,892 were HCV RNA positive. The overall prevalence of HCV viraemia was 7.8%. A total of 14,495 (91.2%, 95% CI 89.9-96.4) patients received treatment within a median of 2.1 weeks from serological diagnosis (IQR 0.6-3.3 weeks) and a sustained virological response was achieved among 14,238 of the treated cases (98.3%, 95% CI 96.7-98.6). Cirrhosis was present in 3,192 patients (20.1%), of whom 166 (5.2%) were diagnosed with hepatocellular carcinoma. There was treatment coverage and cure of 84.6% of the estimated 17,137 infected persons aged 12-80 years across the 73 villages.
In this study of more than 200,000 villagers, we demonstrated the feasibility and effectiveness of a community-based "educate, test and treat" programme as a model for the elimination of HCV infection in rural communities.
A large community-based educate, test and treat hepatitis C programme was conducted in more than 200,000 villagers across 73 villages in Egypt. This study demonstrates that a simplified care model can achieve high uptake of testing, linkage to care and treatment, with high cure rates. We consider this a model for the elimination of hepatitis C virus infection in rural communities, which can be applied to other countries highly affected by hepatitis C.
埃及是全球丙型肝炎病毒（HCV）感染负担最重的国家之一。该国拥有庞大的治疗项目，但覆盖农村社区却是一项重大挑战。我们报告了一种基于社区的综合性HCV预防、检测及治疗模式的可行性与有效性，该模式旨在消除所有成年村民的感染。
2015年6月至2018年6月期间，在埃及7个省的73个村庄实施了一项HCV“教育、检测与治疗”项目。该项目模式包括由村庄推广者网络推动的社区动员，以支持患者的教育、检测和治疗，以及在当地社区筹集资金。为所有年龄在12至80岁的符合条件的村民提供全面检测、护理及治疗衔接服务。
在221,855名符合条件的村民中，204,749人（92.3%，95%置信区间91.6 - 93.5）接受了HCV抗体和乙肝表面抗原（HBsAg）筛查，其中分别有33,839人（16.5%，95%置信区间12.2 - 16.1）和763人（0.4%，95%置信区间0.3 - 0.5）呈阳性。几乎所有33,839名HCV抗体阳性个体均立即采集样本进行HCV RNA检测，其中15,892人HCV RNA呈阳性。HCV病毒血症的总体患病率为7.8%。共有14,495名患者（91.2%，95%置信区间89.9 - 96.4）在血清学诊断后的中位2.1周内（四分位间距0.6 - 3.3周）接受了治疗，14,238例接受治疗的病例中实现了持续病毒学应答（98.3%，95%置信区间96.7 - 98.6）。3192名患者（20.1%）存在肝硬化，其中166人（5.2%）被诊断为肝细胞癌。在这73个村庄中，估计17,137名12 - 80岁感染者的治疗覆盖率和治愈率为84.6%。
在这项针对20多万村民的研究中，我们证明了基于社区的“教育、检测与治疗”项目作为农村社区消除HCV感染模式的可行性和有效性。
在埃及73个村庄的20多万村民中开展了一项大型基于社区的丙型肝炎教育、检测与治疗项目。本研究表明，一种简化的护理模式可以实现高检测率、护理及治疗衔接率以及高治愈率。我们认为这是农村社区消除丙型肝炎病毒感染的一种模式，可应用于其他受丙型肝炎严重影响的国家。
