Not All Injection Drug Users Are Created Equal: Heterogeneity of HIV, Hepatitis C Virus, and Hepatitis B Virus Infection in Georgia

Kuniholm, Mark H.; Aladashvili, Malvina; Rı́o, Carlos del; Stvilia, Ketavan; Gabelia, Nino; Chitale, Rohit A.; Tsertsvadze, Tengiz; Nelson, Kenrad E.

doi:10.1080/10826080802108293

Cited by 16 publications

(10 citation statements)

References 26 publications

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“…In Estonia and Lithuania, an estimated 58–70% of PWID had been in prison at least once 74. In Georgia and Russia, this figure was between 6% and 37%,18 52 64 65 79 121 122 In Central Europe, between 18% and 50% of respondents report previously having been in prison 93 107…”

Section: Resultsmentioning

confidence: 99%

“…Estimates of HIV prevalence among PWID vary widely throughout the region. A total of 79 sources reported HIV prevalence estimates (some multiple), of which 67 reported unique HIV prevalence estimates among PWID in the region; 44 from Eastern Europe and Central Asia 6 49–88 and 21 from Central Europe 89–109 and two that contained data from both regions. 40 110 …”

Section: Resultsmentioning

confidence: 99%

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HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

et al. 2012

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Background and objectivesHIV among people who inject drugs (PWID) is a major public health concern in Eastern and Central Europe and Central Asia. HIV transmission in this group is growing and over 27 000 HIV cases were diagnosed among PWID in 2010 alone. The objective of this systematic review was to examine risk factors associated with HIV prevalence among PWID in Central and Eastern Europe and Central Asia and to describe the response to HIV in this population and the policy environments in which they live.DesignA systematic review of peer-reviewed and grey literature addressing HIV prevalence and risk factors for HIV prevalence among PWID and a synthesis of key resources describing the response to HIV in this population. We used a comprehensive search strategy across multiple electronic databases to collect original research papers addressing HIV prevalence and risk factors among PWID since 2005. We summarised the extent of key harm reduction interventions, and using a simple index of ‘enabling’ environment described the policy environments in which they are implemented.Studies reviewedOf the 5644 research papers identified from electronic databases and 40 documents collected from our grey literature search, 70 documents provided unique estimates of HIV and 14 provided multivariate risk factors for HIV among PWID.ResultsHIV prevalence varies widely, with generally low or medium (<5%) prevalence in Central Europe and high (>10%) prevalence in Eastern Europe. We found evidence for a number of structural factors associated with HIV including gender, socio-economic position and contact with law enforcement agencies.ConclusionsThe HIV epidemic among PWID in the region is varied, with the greatest burden generally in Eastern Europe. Data suggest that the current response to HIV among PWID is insufficient, and hindered by multiple environmental barriers including restricted access to services and unsupportive policy or social environments.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

et al. 2012

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“…In particular, men ages 40–49 years had the highest prevalence of both reported IDU (17.4%, data not shown) and anti-HCV (22.7%). (This cohort came of age during a drug trafficking and IDU epidemic in Georgia during the 1990s/early 2000s following the collapse of the former Soviet Union [23]). However, injecting behavior poses an important challenge for HCV elimination regardless of the age of persons injecting, and those actively injecting drugs will be a key target to curb transmission.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…Previous research reported that in some subgroups more than four out of five opioid-injecting drug-using men in Georgia are sharing needles with others [26,27]. Thus, even if the opioid-injecting male partners of illicit-drug-free females are not having sex with other women or men, the male partner remains at high risk of getting infected with HIV and HCV and passing these infections to his female partner through sexual contact.…”

Section: Discussionmentioning

confidence: 99%

Female partners of opioid-injecting men in the Republic of Georgia: an initial characterization

Lund

Kirtadze²,

Otiashvili

et al. 2012

Subst Abuse Treat Prev Policy

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BackgroundHIV and Hepatitis C virus (HCV) infections are strongly related to injection drug use in the Republic of Georgia. Little information is available about HIV and HCV status, sexual risk, support for their partner, and risk for physical violence among the female partners of opioid-injecting men in the Republic of Georgia, many of whom may not be using drugs, yet may be at high risk of being infected with HIV and HCV from their drug-using partners.MethodsIn order to better understand the risks for females whose partners are injecting drugs, the present study conducted an initial investigation of the non-substance-using female partners of 40 opioid-injecting men who were participating in a clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone. The 40 female partners were assessed at their male partners’ study intake.ResultsThe female sample was 32.3 years old (SD=6.7), 37 (93%) were married, with 15.5 years of education. A majority reported at least partial employment the majority of the time during the past 3 years, with only one woman reported being unemployed most of the time during the past 3 years. They self-reported they were 3% HIV-positive and 8% HCV-positive. Their HIV sex risk scores indicated a relatively low risk. However, only 4 (10%) women reported using a condom most of the time while having sex and 15 (38%) report not having had sex during the last 30 days. Experiences of interpersonal violence were common, with 42% reporting physical abuse by their partner during the last year and 48% reporting feeling unsafe in their current relationship.ConclusionsThe alarmingly high rate of failure to use barrier protection methods, together with the high percentage who did not know their HIV and HCV status, suggest that it may be beneficial to include non-substance-using female partners in prevention programs along with their partners to reduce the risk of HIV and HCV spreading from the population of injection-drug–using males into the general population. [This secondary analysis study was funded by an international supplement to the parent randomized clinical trial “Treating the Partners of Drug Using Pregnant Women: Stage II (HOPE)”. ClinicalTrials.gov Identifier: NCT00496990.]

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Not All Injection Drug Users Are Created Equal: Heterogeneity of HIV, Hepatitis C Virus, and Hepatitis B Virus Infection in Georgia

Cited by 16 publications

References 26 publications

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

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

Female partners of opioid-injecting men in the Republic of Georgia: an initial characterization

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