What is the project about?

This project aims to strengthen Egypt’s national response to HIV and tuberculosis (TB) by expanding prevention, care, and treatment services -- particularly for key and vulnerable populations. It addresses gaps in coverage, improves access to essential health services, strenghthens supply chain systems, and tackles stigma and discrimination within healthcare settings.

Building on previous Global Fund cycles, the project supports a people-centered and sustainable health response through strong partnerships between government institutions and –civil society.

Situational Background

Egypt faces a combination of demographic, socioeconomic, and health system challenges that have intensified the need for a strengthened HIV and TB response:

• Demographic pressures: Egypt’s popultation exceeds 111 million—with nearly 60% under age 30—placing increasing demand on health, education, and employment systems.

• Urbanization strains: Urban crowding, pollution, and inadequate housing -- especially in Cairo and Alexandria -- contribute to health inequities.

• Economic crisis: Currency depreciation and inflation (32.5% in April 2024) have increased healthcare costs and contributed to shortages of essential medicines, including ARVs and TB drugs.

• Stockouts and supply challenges: Hard currency shortages and reliance on imported pharmaceutical ingredients have caused nationwide supply disruptions requiring the use of Global Fund grant savings to prevent ARV interruptions.

• Growing HIV epidemic in key populations: Although national HIV prevalence remains low (<0.1%), Egypt has the fastest-growing HIV epidemic in the MENA region.The recent HIV Integrated Bio Behavorial Survellience (IBBS-2024) findings indicatesignificantly higher prevelance among key populations, mainly men who have sex with men and people who inject drugs.

• TB service gaps: While Egypt has one of Africa’s lowest TB incidence rates (9.8 per 100,000), gaps persist in case detection, Multi-Drugs ResistantTB (MDR-TB) treatment initiation, and TB/HIV integration.

• Health system constraints: Underfunding, health workforce shortages,, unequal access between urban and rural areas, and high outofpocket costs continue to limit service availability.

These combined demographic, economic, epidemiological, and systemic pressures created the need for a targeted, well coordinated approach to protect vulnerable populations, sustain national progress and ensure equitable access to HIV and TB services.

How are we doing this?

The project applies a multilayered approach to expand equitable access to HIV and TB services while strengthening health system resilience:

a) Expanding HIV Prevention and treatment

• Targeting key populations – men who have sex with men, people who inject drugs, and female sex workers -- in the highburden governorates: Cairo, Giza, Alexandria, Minya, and Gharbia.

• Scaling up PrEP and harmreduction services.

• Expanding communitybased and selftesting approaches.

• Strengthening patient literacy on ART adherence and viral load monitoring.

• Procuring PCR and CD4 cartridges to improve treatment monitoring.

b) Strengthening TB diagnosis and care

• Improving detection and treatment of drugsensitive and drugresistant TB.

• Expanding services for vulnerable groups, including migrants, refugees, children, and prisoners.

• Strengthening laboratory systems and improving enrolment in secondline TB treatment.

c) Improving supply chain and drug security

• Upgrading inventory management and procurement systems.

• Implementing contingency planningto prevent stockouts of ARVs, TB medicines, and diagnostics.

• Supporting treatment continuity despite economic and import pressures.

d) Innovation and differentiated service delivery

• Expanding communitybased ART delivery and multimonth dispensing.

• Integrating TB screening with routine HIV services.

• Using virtual platforms and communityled models to reach highrisk groups.

e) Reducing stigma and human rights barriers

• Conducting stigmareduction campaigns and training healthcare workers onnondiscriminatory practices.

• Supporting community empowerment and safer access to services for key populations.

 How will Egypt benefit?:

The project aims to achieve the following key outputs:

1. Strengthened HIV and TB service coverage and access for key and vulnerable populations

• Increased HIV testing, PrEP use, harmreduction access, and ART uptake among key populations.

• Improved TB diagnosis, treatment coverage, and successful treatment outcomes—especially for MDRTB and vulnerable groups such as migrants.

2. Improved health system capacity and continuity of essential medicines and diagnostics

• Strenghthened supply chain systems management to prevent treatment interruptions stockouts.

• Upgraded laboratory capacity through procurement of PCR, CD4, and GeneXpert cartridges and improved monitoring systems.

• Expanded differentiated and communitybased service delivery models.

3. Reduced stigma, discrimination, and structural barriers to accessing care

• Healthcare workers trained in rights-based and nondiscriminatory service delivery.

• Stronger community-led interventions and improved engagement of key populations.

• Increased trust and utilization of HIV and TB services among groups most affected by stigma.

IMPACT: