Modeling The Hepatitis C Virus Epidemic In Egypt: A Study Of Epidemic Characteristics And Effective Interventions
Mohlman, Mary Katherine M.
<italic>Introduction</italic>: The hepatitis C virus (HCV) is a public health concern that impacts both developing and developed countries alike. The World Health Organization estimates that currently 130-150 million people worldwide are chronically infected; Egypt has the highest prevalence in the world with an estimated 14.7% of its population exposed to HCV and 9.8% chronically infected. HCV infection leads to chronic liver disease and its long term sequelae including cirrhosis and hepatocellular carcinoma; therefore the need for prevention and control is urgent, both in terms of patient morbidity and mortality and the burden to the healthcare system, especially in a low-income country such as Egypt. Providing a tool that public health officials can use to evaluate the effectiveness of different prevention and control approaches is an important step towards allocating resources to where they will be most beneficial.Method: I approached this challenge by building a dynamic compartmental disease model. I recreated the historical HCV incidence curve in Egypt based on HCV prevalence and incidence and on demographics. I then developed a model with compartments for the susceptible and infectious populations. I used transmission parameters that were based on results from a systematic review of studies on transmission risk factors.Results: The review of transmission risk factors revealed that the most frequently researched risk factors are those associated with the formal healthcare sector, while the roles of the informal sector and community sources such as intrafamilial transmission are not as well understood. The historical incidence curve showed a substantial decline in incidence following the end of the parenteral anti-schistosomiasis therapy campaigns. The model projected the number of infectious individuals with the status quo maintained over the next 85 years would gradually decrease. Implementing infection control and treatment interventions will return HCV prevalence to pre-epidemic levels by 2025.Conclusion: A dynamic model is a valuable tool in assessing the most effective intervention approaches to ending endemic HCV transmission in Egypt. Furthermore, the model indicates that HCV prevalence and incidence are sensitive to the introduction of interventions, a promising finding for those dedicated to tackling HCV in Egypt.
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