Integration of hepatitis C treatment at harm reduction centers in Georgia—Findings from a patient satisfaction survey

Butsashvili, Maia; Kamkamidze, George; Kajaia, Maia; Gvinjilia, Lia; Kuchuloria, Tinatin; Khonelidze, Irma; Gogia, Maka; Dolmazashvili, E; Kerashvili, Vakhtang; Zakalashvili, Mamuka; Shadaker, Shaun; Nasrullah, Muazzam; Shilton, Sonjelle; Japaridze, Maia; Averhoff, Francisco

doi:10.1016/j.drugpo.2020.102893

Cited by 9 publications

(7 citation statements)

References 11 publications

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“…Georgia could leverage the existing surveillance and clinical infrastructure of the hepatitis C elimination programme to establish a national HBV screening programme [18]. Further, expansion of proven approaches to integrated care (HIV, tuberculosis and harm reduction services) could help engage hard-to-reach population groups at high risk of hepatitis B [42][43][44].…”

Section: Discussionmentioning

confidence: 99%

Toward reaching hepatitis B goals: hepatitis B epidemiology and the impact of two decades of vaccination, Georgia, 2021

et al. 2023

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Background Georgia has adopted the World Health Organization European Region’s and global goals to eliminate viral hepatitis. A nationwide serosurvey among adults in 2015 showed 2.9% prevalence for hepatitis B virus (HBV) surface antigen (HBsAg) and 25.9% for antibodies against HBV core antigen (anti-HBc). HBV infection prevalence among children had previously not been assessed. Aim We aimed to assess HBV infection prevalence among children and update estimates for adults in Georgia. Methods This nationwide cross-sectional serosurvey conducted in 2021 among persons aged ≥ 5 years used multi-stage stratified cluster design. Participants aged 5–20 years were eligible for hepatitis B vaccination as infants. Blood samples were tested for anti-HBc and, if positive, for HBsAg. Weighted proportions and 95% confidence intervals (CI) were calculated for both markers. Results Among 5–17 year-olds (n = 1,473), 0.03% (95% CI: 0–0.19) were HBsAg-positive and 0.7% (95% CI: 0.3–1.6) were anti-HBc-positive. Among adults (n = 7,237), 2.7% (95% CI: 2.3–3.4) were HBsAg-positive and 21.7% (95% CI: 20.4–23.2) anti-HBc-positive; HBsAg prevalence was lowest (0.2%; 95% CI: 0.0–1.5) among 18–23-year-olds and highest (8.6%; 95% CI: 6.1–12.1) among 35–39-year-olds. Conclusions Hepatitis B vaccination in Georgia had remarkable impact. In 2021, HBsAg prevalence among children was well below the 0.5% hepatitis B control target of the European Region and met the ≤ 0.1% HBsAg seroprevalence target for elimination of mother-to-child transmission of HBV. Chronic HBV infection remains a problem among adults born before vaccine introduction. Screening, treatment and preventive interventions among adults, and sustained high immunisation coverage among children, can help eliminate hepatitis B in Georgia by 2030.

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Section: Discussionmentioning

confidence: 99%

Toward reaching hepatitis B goals: hepatitis B epidemiology and the impact of two decades of vaccination, Georgia, 2021

et al. 2023

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“…For example, scaling up harm reduction services, hepatitis C testing and treatment for people who inject drugs will be essential. Georgia made substantial progress in this direction and initiated integration of hepatitis C treatment at harm reduction centers and among people receiving methadone substitution therapy [37,38].…”

Section: Discussionmentioning

confidence: 99%

Risk factors and genotype distribution of hepatitis C virus in Georgia: A nationwide population-based survey

et al. 2022

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In preparation for the National Hepatitis C Elimination Program in the country of Georgia, a nationwide household-based hepatitis C virus (HCV) seroprevalence survey was conducted in 2015. Data were used to estimate HCV genotype distribution and better understand potential sex-specific risk factors that contribute to HCV transmission. HCV genotype distribution by sex and reported risk factors were calculated. We used explanatory logistic regression models stratified by sex to identify behavioral and healthcare-related risk factors for HCV seropositivity, and predictive logistic regression models to identify additional variables that could help predict the presence of infection. Factors associated with HCV seropositivity in explanatory models included, among males, history of injection drug use (IDU) (aOR = 22.4, 95% CI = 12.7, 39.8) and receiving a blood transfusion (aOR = 3.6, 95% CI = 1.4, 8.8), and among females, history of receiving a blood transfusion (aOR = 4.0, 95% CI 2.1, 7.7), kidney dialysis (aOR = 7.3 95% CI 1.5, 35.3) and surgery (aOR = 1.9, 95% CI 1.1, 3.2). The male-specific predictive model additionally identified age, urban residence, and history of incarceration as factors predictive of seropositivity and were used to create a male-specific exposure index (Area under the curve [AUC] = 0.84). The female-specific predictive model had insufficient discriminatory performance to support creating an exposure index (AUC = 0.61). The most prevalent HCV genotype (GT) nationally was GT1b (40.5%), followed by GT3 (34.7%) and GT2 (23.6%). Risk factors for HCV seropositivity and distribution of HCV genotypes in Georgia vary substantially by sex. The HCV exposure index developed for males could be used to inform targeted testing programs.

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“…Observed treatment numbers from the HCV elimination programme database were included through 28 February 2022 (a total of 77,168 treatments initiated since 1 May 2015, averaging 941 per month). Under the programme, treatment is provided through specialised infectious disease clinics, primary healthcare clinics, and harm reduction sites to encourage treatment uptake [15,16]; as in the previous analysis [8], we assume treatments are given at the same rate to PWID and the general population.…”

Section: Key Public Health Messagementioning

confidence: 99%

Insights from a national survey in 2021 and from modelling on progress towards hepatitis C virus elimination in the country of Georgia since 2015

et al. 2023

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Background Between May 2015 and February 2022, 77,168 hepatitis C virus (HCV)-infected people in Georgia have been treated through an HCV elimination programme. To project the programme’s long-term impacts, an HCV infection model was initially developed, based on data from surveys among people who inject drugs and a national serosurvey in 2015. Aim Accounting for follow-up surveys in 2021, we validate and update projections of HCV infection prevalence and incidence. Method We assessed the initial model projections’ accuracy for overall prevalence, by age, sex, and among people who ever injected drugs, compared with 2021 serosurvey data. We used 2021 results to weight model fits and to recalculate the national programme’s impact leading up to March 2022 on HCV infection incidence rates. Cases and deaths averted were estimated. The impact of reduced treatment rates during the COVID-19 pandemic was assessed. Results The original model overpredicted adult (≥ 18 years old) chronic HCV infection prevalence for 2021 (2.7%; 95% credible interval (CrI): 1.9–3.5%) compared with a 2021 serosurvey (1.8%; 95% confidence interval (CI): 1.3–2.4%). Weighted model projections estimated a 60% decrease in HCV infection incidence by March 2022, with an absolute incidence of 66 (95% CrI: 34–131) per 100,000 person-years (overall population). Between May 2015 and March 2022, 9,186 (95% CrI: 5,396–16,720) infections and 842 (95% CrI: 489–1,324) deaths were averted. The COVID-19 pandemic resulted in 13,344 (95% CrI: 13,236–13,437) fewer treatments and 438 (95% CrI: 223-744) fewer averted infections by March 2022. Conclusion Results support the programme’s high effectiveness. At current treatment rate (406/month), 90% reductions in prevalence and incidence in Georgia are achievable by 2030.

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Integration of hepatitis C treatment at harm reduction centers in Georgia—Findings from a patient satisfaction survey

Cited by 9 publications

References 11 publications

Toward reaching hepatitis B goals: hepatitis B epidemiology and the impact of two decades of vaccination, Georgia, 2021

Toward reaching hepatitis B goals: hepatitis B epidemiology and the impact of two decades of vaccination, Georgia, 2021

Risk factors and genotype distribution of hepatitis C virus in Georgia: A nationwide population-based survey

Insights from a national survey in 2021 and from modelling on progress towards hepatitis C virus elimination in the country of Georgia since 2015

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