Prevalence of HIV among injection drug users in Georgia

Piloting a simplified bio-behavioural survey methodology, the BBS-Lite, among people who inject drugs in Georgia

BACKGROUND

During 2021 and 2023 two simplified Biological and Behavioural Study (BBS-Lite) surveys, and in 2022 one Standard Integrated Biological and Behavioural Study (IBBS), were conducted among people who inject drugs in seven cities in Georgia. From these, an opportunity to compare the implementation of these survey methods and results was able to be gained.

METHODS

The two survey types were compared to find points of similarity and difference in their methodologies. The methodologies of the IBBS and BBS-Lite studies shared many characteristics, including the cities where they were implemented, recruitment criteria, sample sizes, and common questionnaire items. All studies were multi-centre cross-sectional involving administration of a face-to-face behavioural questionnaire and collection of biological specimens for testing of HIV, syphilis, hepatitis B virus (HBV), and hepatitis C virus (HCV). The main differences were in the sampling methods. The IBBS utilised respondent-driven sampling (RDS) while participants of the BBS-Lite studies were enrolled through consecutive recruitment at the harm reduction (HR) programme sites and on outreach and through snowball sampling. We compared the results from each study as well as the implementation modalities such as time taken and budgetary requirements, and the complexity of implementation.

RESULTS

Considerably less time was required for recruitment, as well as for interviewing, data entry (4 times less) and the analysis for the BSS-Lite studies compared to the IBBS. The BSS-Lite study budgets were at least 2.5 times less than of the IBBS study. The recruited samples were comparable for age distribution, median age at first injection, the last drug injected, sharing of drug injecting equipment or receiving opioid agonist maintenance treatment (OAMT) during the last 12 months. HIV and HCV prevalence were similar including for stratifications by age, client status and city of recruitment.

CONCLUSION

Our findings have demonstrated that if implemented on a regular basis, the BBS-Lite can be a complementary solution for systematic data collection, filling surveillance gaps and addressing the challenges that persist in obtaining important data on people who inject drugs (PWID) between IBBS rounds in the country. The methodology is recommended for testing in other settings and in other key populations. In addition, the data collected on a routine base can help the harm reduction (HR) program to better understand the changes in the drug scene and observe new trends in HIV risks and drug injecting behaviours, possible barriers for access to harm reduction, drug treatment, and HIV and/or viral hepatitis testing and treatment services.

Prevalence of HIV, HCV and HBV in Central Asia and the Caucasus: A systematic review

BACKGROUND

Human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) are substantial public health threats in the region of Central Asia and the Caucasus, where the prevalence of these infections is currently rising.

METHODS

A systematic review of MEDLINE, Embase and PsycINFO was conducted with no publication date or language restrictions through October 2019. Additional data were also harvested from national surveillance reports, references found in discovered sources, and other "grey" literature. It included studies conducted on high-risk populations (people who inject drugs (PWID), female sex workers (FSW), men who have sex with men (MSM), prisoners, and migrants) in Central Asia: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan; and the Caucasus: Armenia, Azerbaijan, Georgia, and Northern Caucasus region of the Russian Federation.

RESULTS

Wide ranges were noted for HIV prevalence: PWID 0-30.1%, MSM 0-25.1%, prisoners 0-22.8%, FSW 0-10.0%, and migrants 0.06-1.5%, with the highest prevalence of these high-risk groups reported in Kazakhstan (for PWID), Georgia (for MSM and prisoners) and Uzbekistan (for migrants). HCV prevalence also had a wide range: PWID 0.3-92.1%, MSM 0-18.9%, prisoners 23.8-49.7%, FSW 3.3-17.8%, and migrants 0.5-26.5%, with the highest prevalence reported in Georgia (92.1%), Kyrgyzstan (49.7%), and migrants from Tajikistan and Uzbekistan (26.5%). Similarly, HBV prevalence had a wide range: PWID 2.8-79.7%, MSM 0-22.2%, prisoners 2.7-6.2%, FSW 18.4% (one study), and migrants 0.3-15.7%.

CONCLUSION

In Central Asia and the Caucasus, prevalence of HIV, HCV and HBV remains exceedingly high among selected populations, notably PWID and MSM.

The cascade of care in the Eastern European country of Georgia

OBJECTIVES

Individual and public health benefits of antiretroviral therapy (ART) rely on successful engagement of HIV-infected patients in care. We aimed to evaluate the HIV care continuum in the Eastern European country of Georgia.

METHODS

The analysis included all adult (age ≥ 18 years) HIV-infected patients diagnosed in Georgia from January 1989 until June 2012. Data were extracted from the national HIV/AIDS database as of 1 October 2012. The following stages of the HIV care continuum were quantified: HIV infected, HIV diagnosed, linked to care, retained in care, eligible for ART and virologically suppressed.

RESULTS

Of 3295 cumulative cases of adult HIV infection reported in Georgia, 2545 HIV-infected patients were known to be alive as of 1 October 2012, which is 52% of the estimated 4900 persons living with HIV in the country. Of the 2545 persons diagnosed with HIV infection, 2135 (84%) were linked to care and 1847 (73%) were retained in care. Of 1446 patients eligible for ART, 1273 (88%) were on treatment and 985 (77%) of them had a viral load <400 HIV-1 RNA copies/mL. Overall, 39% of those diagnosed and 20% of those infected had a suppressed viral load.

CONCLUSIONS

The findings of our analysis demonstrate that the majority of patients diagnosed with HIV infection are retained in care. Loss of patients occurs at each step of the HIV care continuum, but the major gap is at the stage of HIV diagnosis. Reducing the number of persons living with undiagnosed HIV infection and simultaneously enhancing engagement in continuous care will be critical to achieve maximum individual and public health benefits of ART.

Mortality and causes of death among HIV-infected individuals in the country of Georgia: 1989-2012

Since 2004, the country of Georgia has provided antiretroviral therapy (ART) to all patients in need. A nationwide retrospective cohort study was conducted to assess the effect of universal access to ART on patterns of mortality and causes of death among HIV-infected individuals in Georgia. All known HIV-infected adult individuals (age ≥18 years) diagnosed from 1989 through 2012 were included. Rates and causes of death were determined using routinely collected data from the national HIV/AIDS database. Causes of death were classified according to the Coding of Death in HIV (CoDe) protocol. Between 1989 and 2012, 3,554 HIV-infected adults were registered in Georgia contributing to 13,572 person-years (PY) of follow-up. A total of 779 deaths were registered during follow-up. The mortality rate peaked in 2004 with 10.74 deaths per 100 PY (95% CI: 7.92-14.24) and significantly decreased after the universal availability of ART to 4.02 per 100 PY (95% CI: 3.28-4.87) in 2012. In multivariate analysis the strongest predictor of mortality was having AIDS at the time of HIV diagnosis (hazard ratio: 5.69, 95% CI: 4.72-6.85). AIDS-related diseases accounted for the majority of deaths (n=426, 54.7%). Tuberculosis (TB) was the leading cause of death accounting for 21% of the total deaths reported. Universal access to ART significantly reduced mortality among HIV-infected patients in Georgia. However, overall mortality rates remain high primarily due to late diagnosis, and TB remains a significant cause of death. Improving rates of early HIV diagnosis and ART initiation may further decrease mortality as well as prevent new HIV and TB infections.

Estimating HIV incidence in eastern European country of Georgia: 2010-2012

The knowledge of HIV incidence is essential to better understand patterns of HIV transmission. We estimated HIV incidence over 2010-2012 in the eastern European country of Georgia. Mathematical modeling using Spectrum software and assay-based recent infection testing algorithm were applied. The study included 1155 HIV patients newly diagnosed in 2010-2012 (84% of total diagnoses). Of them, 231 were determined to be recently infected on the recent infection testing algorithm. The proportion of recent cases did not differ between 2010, 2011 and 2012 (20.4% vs. 19.4% vs. 20.2%, p = 0.94). Both study methods derived comparable estimates ranging from 0.2 to 0.3%, which is up to twice as high as rates of new diagnosis reported in the same period. Despite the relatively stable HIV incidence over 2010-2012, the epidemic continues to grow because of the increasing gap between HIV-infected and diagnosed persons. Increased efforts are needed to reduce the number of people with undiagnosed HIV.