Egypt has introduced mass treatment of hepatitis C with direct-acting antivirals, with the Egyptian programme now being the largest in the world. The authors were interested in the Egyptian experience in planning and prioritising mass treatment for patients with HCV. They examined the baseline data of 337,042 patients, treated between 2014 and 2016 and grouped them into three equal time intervals of six months each. Patients were treated with different combinations of direct-acting antivirals, with or without ribavirin and pegylated interferon. The outcomes of 94,258 patients treated in the subsequent 2 months were also included in the analysis. For cohort-1, treatment was prioritised for patients with advanced fibrosis (F3-F4 fibrosis, liver stiffness ≥9.5 kPa or Fibrosis-4 ≥3.25). For cohort-2, all stages of fibrosis were included (F0-F4). This prioritisation strategy in cohort-1 caused delays in enrolment and significant backlogs. Cohort-1 patients were significantly older and more had advanced fibrosis compared to subsequent cohorts. The percentage of patients with known sustained virologic response results were low initially and increased with each cohort. Sofosbuvir-ribavirin therapy for 24 weeks had the lowest SVR12 rate (82.7%), while other therapies were associated with SVR12 rates between 94% and 98%. Therefore prioritisation based on fibrosis stage was not effective and enrolment only increased only after including all stages of fibrosis.
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