With affordable drugs secured, the country set out to distribute them at a scale never before attempted. In 2014, they debuted an online portal for those with the disease to register for treatment; within three days, 200,000 people had signed up. Over the next three years, more than 1.6 million Egyptians received hepatitis C treatment, according to data from the World Bank. That is more than all the patients treated during that time in the United States and Europe combined.
But that first flood of Egyptians seeking a cure were largely those already diagnosed with hepatitis C, and over time the challenge has shifted from making the drugs available to identifying additional people who need them. “The people going to those treatment centers tend to dry up,” explains Ward. “Obviously if you’re not testing, you’re not diagnosing, and you don't have anyone to treat.”
So in 2017, the Ministry of Health initiated a nationwide screening program. More than 260 teams of community-health workers are proceeding village by village. By late 2017, they’d screened 1,200 communities. Still, treatment has slowed from a high-point in 2016. According to the CDA Foundation, which compiles epidemiological data on viral hepatitis, the number of Egyptians treated in 2017 fell by roughly 30 percent compared to 2016, despite an estimated 4 million people still infected in the country.
With the promise of free drugs from the government for those diagnosed, civil-society organizations from factories to churches to mosques have gotten involved in screening, too. The prevalence of hepatitis C is around twice as high in the poorest quintile of the population compared to the wealthiest, but J. Stephen Morrison, the senior vice president of the Center for Strategic and International Studies, says the epidemic cuts across society in a way that has benefited the elimination efforts. “[Hepatitis C] may carry a stigma but there are few families in Egypt who haven’t had some loved one who has struggled with this.”
Last year, in the upscale neighborhood of Katameya Heights in New Cairo, a chapter of the Rotary Club arranged a hepatitis C screening for the neighborhood residents and their household staff. One of the organizers was Mohamed Ziwar, who had recently retired from a leadership role at the drug company Bayer. He says the club contracted nurses from a local lab that does genetic analysis to spend three days in the neighborhood, where they screened about 1,000 people, and then arranged treatment for the 30 who tested positive. “After we finished this, we got other requests from relatives of these people, that they would love to go through the investigation,” Ziwar said.
Ziwar estimated that the club ended up spending about $5,000. It could have been much higher but since it was a charitable effort, the lab did the blood analysis nearly at cost. But screening the whole group was significantly more expensive than the price of the drugs needed to treat the 30 infected residents. This is proving to be true at the national level as well. While the diagnostics are inexpensive, as many as 20 people must be screened to identify one new person who is infected, and it adds up. To ensure all the residents of a given community get tested, screening teams must sometimes return multiple times.