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

Abstract

Background and Aims: Georgia has one of the highest hepatitis C virus (HCV) prevalence rates in the world, with >5% of the adult population (~150,000 people) chronically infected. In April 2015, the Georgian government, in collaboration with CDC and other partners, launched a national program to eliminate HCV through scaling up HCV treatment and prevention interventions, with the aim of achieving a 90% reduction in prevalence by 2020. We evaluate the interim impact of the HCV treatment program as of 31 October 2017, and assess the feasibility of achieving the elimination goal by 2020.Method: We developed a dynamic HCV transmission model to capture the current and historical epidemic dynamics of HCV in Georgia, including the main drivers of transmission. Using the 2015 national sero-survey and prior surveys conducted among people who inject drugs (PWID) from 1997-2015, the model was calibrated to data on HCV prevalence by age, gender and PWID status, and the age distribution of PWID. We use the model to project the interim impact of treatment strategies currently being undertaken as part of the ongoing Georgia HCV elimination program, while accounting for treatment failure/loss to follow up, in order to determine whether they are on track to achieving their HCV elimination target by 2020, or whether strategies need to be modified to ensure success.

Hepatitis C core antigen test as an alternative for diagnosing HCV infection: mathematical model and cost-effectiveness analysis

“…Strategies using antibody tests may lead to under-diagnosis in populations with ongoing transmission. In the Georgian HCV epidemic, where most infections were acquired during the first years after the collapse of the Soviet Union ( Walker et al, 2018 ), this may be of limited relevance except for special groups such as IDU. Also, the antibody test may remain negative in immunosuppressed patients ( Medici et al, 2011 ).…”

Hepatitis C Core Antigen test as an alternative for diagnosing HCV infection: mathematical model and cost-effectiveness analysis

“…However, the Georgian HCV epidemic can be characterized as an “old epidemic”: most HCV infections were acquired during the first years after the collapse of the Soviet Union. 26 Also, in immunosuppressed patients, the antibody test may always be negative. 27 The antigen test in turn misses around two thirds of individuals with VLVL.…”