Hepatitis C prevalence and risk factors in Georgia, 2015: setting a baseline for elimination

Abstract

Background The country of Georgia launched the world’s first Hepatitis C Virus (HCV) Elimination Program in 2015 and set a 90% prevalence reduction goal for 2020. We conducted a nationally representative HCV seroprevalence survey to establish baseline prevalence to measure progress toward elimination over time. Methods A cross-sectional seroprevalence survey was conducted in 2015 among adults aged ≥18 years using a stratified, multi-stage cluster design ( n = 7000). Questionnaire variables included demographic, medical, and behavioral risk characteristics and HCV-related knowledge. Blood specimens were tested for antibodies to HCV (anti-HCV) and HCV RNA. Frequencies were computed for HCV prevalence, risk factors, and HCV-related knowledge. Associations between anti-HCV status and potential risk factors were calculated using logistic regression. Results National anti-HCV seroprevalence in Georgia was 7.7% (95% confidence interval (CI) = 6.7, 8.9); HCV RNA prevalence was 5.4% (95% CI = 4.6, 6.4). Testing anti-HCV+ was significantly associated with male sex, unemployment, urban residence, history of injection drug use (IDU), incarceration, blood transfusion, tattoos, frequent dental cleanings, medical injections, dialysis, and multiple lifetime sexual partners. History of IDU (adjusted odds ratio (AOR) = 21.4, 95% CI = 12.3, 37.4) and blood transfusion (AOR = 4.5, 95% CI = 2.8, 7.2) were independently, significantly associated with testing anti-HCV+ after controlling for sex, age, urban vs. rural residence, and history of incarceration. Among anti-HCV+ participants, 64.0% were unaware of their HCV status, and 46.7% did not report IDU or blood transfusion as a risk factor. Conclusions Georgia has a high HCV burden, and a majority of infected persons are unaware of their status. Ensuring a safe blood supply, implementing innovative screening strategies beyond a risk-based approach, and intensifying prevention efforts among persons who inject drugs are necessary steps to reach Georgia’s HCV elimination goal.

Assessing the Risk of HIV and Hepatitis C among Internally Displaced Persons in Georgia

“…In 2015, HCV prevalence was significantly higher in the general population (5.4%) compared to HIV, although similar epidemic levels were also present in high risk groups: anti-HCV prevalence rates were 66.5% in IDUs, 42.0% in those previously incarcerated, and 11.9% in those with more than two lifetime sexual partners. Other significant risk factors included urban living, unemployment, having tattoos, receiving more than one medical injection in the past 6 months, and having received blood transfusions [89]. Geographically, the highest rates of HCV were reported in Samegrelo-Zemo Svaneti (10.9%), with elevated rates also recorded in Shida Kartli (7.3%), Tbilisi (9.4%), and Imereti (7.5%), all regions that also host the greatest number and concentration of CCs [89].…”

“…Other significant risk factors included urban living, unemployment, having tattoos, receiving more than one medical injection in the past 6 months, and having received blood transfusions [89]. Geographically, the highest rates of HCV were reported in Samegrelo-Zemo Svaneti (10.9%), with elevated rates also recorded in Shida Kartli (7.3%), Tbilisi (9.4%), and Imereti (7.5%), all regions that also host the greatest number and concentration of CCs [89]. These figures have significantly declined since the start of the HCV elimination program.…”

Interim impact evaluation of the hepatitis C virus elimination program in Georgia

“…Recent advances in treatment for HCV, along with the country's small population, and political and public support led to the development of a HCV elimination programme for Georgia, supported by Gilead 6 . To help guide the elimination programme, a national serosurvey was conducted in 2015 7 . The serosurvey found heterogeneous levels of HCV infection by gender and age.…”

Excellence in viral hepatitis elimination – Lessons from Georgia

“…1 Georgia, a small country in the South Caucasus, has a high prevalence of HCV infection with an estimated 150,000 adults living with hepatitis C, representing 5.4% of the adult population. 2 Georgia was the first country in the world to undertake the challenge of hepatitis C elimination. A serosurvey in 2015 laid the foundation for the elimination program; the survey not only defined the burden of hepatitis C in the country, but also identified the major risk factors for transmission (injection drug use and receipt of blood products) and the demographic profile of those infected, thus allowing for clear characterization of the epidemic including identifying the most at-risk populations.…”

“…A serosurvey in 2015 laid the foundation for the elimination program; the survey not only defined the burden of hepatitis C in the country, but also identified the major risk factors for transmission (injection drug use and receipt of blood products) and the demographic profile of those infected, thus allowing for clear characterization of the epidemic including identifying the most at-risk populations. 2 The cost of treatment in 2015 was prohibitive, so a key partnership was established with Gilead Sciences, who agreed to support the elimination program by providing free-of-charge treatment directly to the country because of the government's commitment to hepatitis C elimination nationwide.…”