Egypt has a major treatment programme, with an ambitious goal of HCV elimination by 2021. Our aim was to assess the impact on incidence of new HCV infections in nine villages in rural Egypt following implementation of a comprehensive HCV prevention, test and treat programme.An HCV "educate, test and treat" project was implemented in 73 villages across 7 governorates in Egypt between 06/2015 and 06/2018. In 2018, in 9 of the villages we re-tested persons who originally tested HCV antibody (HCV-Ab) and HBsAg negative using rapid diagnostic tests (RDTs) with HCV RNA confirmation of positive cases. Incidence rate per 1000 person-years (py) was calculated, and risk factors for incident HCV infections assessed through an interviewer administered questionnaire in 1:3 age and gender matched cases and controls.19816 (96.7%) of 20490 individuals who originally tested HCV-Ab negative in the 9 villages during the 2015-2016 implementation of the "educate, test and treat" programme were re-tested in 2018. Over a median of 2.4 years (IQR 2.1-2.7), there were 19 new HCV infections and all were HCV RNA positive (incidence rate 0.37/1000 py) (95%CI 0.24-0.59). Compared to a previous estimate of incidence in Nile Delta region (2.4/1000 py) from 2006, there was a substantial reduction in overall incidence of new HCV infections. Exposures through surgery (OR 51 95%CI 3.5-740.1) and dental procedures (OR 23.8, 95%CI 2.9-194.9) were significant independent predictors of incident infections.This is the first study to show a substantial reduction in incidence of new HCV infections in the general population in Egypt following high coverage of testing and treatment - based on re-testing of those previously tested antibody negative.