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Aslanikashvili A, Rylander C, Manjavidze T, Gamkrelidze A, Baliashvili D, Anda EE. Relationship Between Hepatitis C Infection and Treatment Status and Coronavirus Disease 2019-Related Hospitalizations in Georgia. J Infect Dis 2024; 230:e694-e699. [PMID: 38427715 PMCID: PMC11420765 DOI: 10.1093/infdis/jiae103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/26/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the impact of hepatitis C virus (HCV) infection and treatment status on coronavirus disease 2019 (COVID-19)-related hospitalizations in Georgia. METHODS We analyzed 2020-2021 Georgian health registry data for COVID-19-positive individuals and categorized the data by HCV infection and treatment status. Logistic regression was used to assess the strengths of the associations. RESULTS Treated individuals with HCV had lower odds of COVID-19-related hospitalization compared to anti-HCV-negative individuals, while untreated HCV-viremic and anti-HCV-positive nonviremic individuals had higher odds. CONCLUSIONS HCV treatment prior to COVID-19 infection was associated with lower odds of COVID-19-related hospitalization, highlighting the benefits of HCV management in the context of the pandemic.
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Affiliation(s)
- Ana Aslanikashvili
- Department of Community Medicine, University of Tromsø—The Arctic University of Norway, Tromsø, Norway
| | - Charlotta Rylander
- Department of Community Medicine, University of Tromsø—The Arctic University of Norway, Tromsø, Norway
| | - Tinatin Manjavidze
- Department of Community Medicine, University of Tromsø—The Arctic University of Norway, Tromsø, Norway
- Department of Medical Statistics, National Center for Disease Control and Public Health Georgia, Tbilisi, Georgia
| | | | | | - Erik Eik Anda
- Department of Community Medicine, University of Tromsø—The Arctic University of Norway, Tromsø, Norway
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Tohme RA, Shadaker S, Adamia E, Khonelidze I, Stvilia K, Getia V, Tsereteli M, Alkhazashvili M, Abutidze A, Butsashvili M, Gogia M, Glass N, Surguladze S, Schumacher IT, Gabunia T. Progress Toward the Elimination of Hepatitis B and Hepatitis C in the Country of Georgia, April 2015-April 2024. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:660-666. [PMID: 39088368 PMCID: PMC11305411 DOI: 10.15585/mmwr.mm7330a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
Hepatitis B and hepatitis C are leading causes of cirrhosis and liver cancer and caused 1.3 million deaths worldwide in 2022. Hepatitis B is preventable with vaccination, and hepatitis C is curable with direct-acting antivirals. In 2015, in collaboration with CDC and other partners, Georgia, a country at the intersection of Europe and Asia, launched a hepatitis C elimination program to reduce the prevalence of chronic hepatitis C; at that time, the prevalence was 5.4%, more than five times the global average of 1.0%. In 2016, the World Health Assembly endorsed a goal for the elimination of viral hepatitis as a public health problem by 2030. In 2024, 89% of the Georgian adult population have received screening for hepatitis C, 83% of persons with current chronic HCV infection have received a diagnosis, and 86% of those with diagnosed hepatitis C have started treatment. During 2015-2023, vaccination coverage with the hepatitis B birth dose and with 3 doses of hepatitis B vaccine among infants exceeded 90% for most years. In 2021, the prevalence of hepatitis B surface antigen was 0.03% among children and adolescents aged 5-17 years and 2.7% among adults. Georgia has demonstrated substantial progress toward hepatitis B and hepatitis C elimination. Using lessons from the hepatitis C elimination program, scale-up of screening and treatment for hepatitis B among adults would prevent further viral hepatitis-associated morbidity and mortality in Georgia and would accelerate progress toward hepatitis B and hepatitis C elimination by 2030.
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Gugushvili A. The heterogeneous well-being effects of intergenerational mobility perceptions. J Health Psychol 2024; 29:99-112. [PMID: 37466150 PMCID: PMC11378449 DOI: 10.1177/13591053231187345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Individuals make comparisons with their parents which determine their intergenerational mobility perceptions, yet very little is known about the areas used for intergenerational comparison and whether these matter for individuals' well-being. In 2021 we commissioned a nationally representative survey in Georgia in which we explicitly asked 1159 individuals an open-ended question on the most important areas in their intergenerational comparisons. More than 170 types of answers were provided by respondents and many of these responses went beyond the standard indicators of intergenerational mobility. We show that the areas of intergenerational comparison significantly differ between those who perceive themselves as being downwardly and upwardly mobile or immobile using the measure of mobility previously validated in cross-national research. Using, among other statistical approaches, treatment effects estimators, we demonstrate that some areas of intergenerational comparison, particularly in terms of income attainment, are significantly and consistently associated with internationally validated measures of well-being.
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Ejaz S, Abdullah I, Malik WN, Anjum S, Ashraf M, Akhtar N, Khan A, Hameed Y, Usman M, Cheema U, Sidiq S. Screening of hepatitis B and C viral infection, recognition of risk factors, and immunization of patients against hepatitis B virus: a module developed for effective hepatitis control. Front Public Health 2023; 11:1269209. [PMID: 38106902 PMCID: PMC10721974 DOI: 10.3389/fpubh.2023.1269209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/06/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction The continually increasing incidence of hepatitis, a worldwide health issue, in Pakistan, has highlighted the need to investigate the epidemiology factors and implement preventive measures accordingly. The purpose of this study was to scrutinize the prevalent and significantly associated risk factors of hepatitis in students and employees, screening them for hepatitis B and C virus and vaccinating them against HBV to make IUB hepatitis free. Methodology A total of 12,912 participants including students (n = 10,948) and employees (n = 1964) were screened for HBV and HCV via immunochromatographic test. Hepatitis- positive participants' blood samples were further tested and viral load was estimated by quantitative PCR. All the hepatitis-negative participants were vaccinated against HBV. The demographic and risk factors-related data were collected using the questionnaire. Statistical analysis (Chi-square test and bivariate regression analysis) was performed using SPSS software to explore any association between risk factors and hepatitis. Results Results indicated that 662/12912 participants (students = 478/10,948, employees = 184/1,964) tested positive for hepatitis. Among them, HCV was observed to be more prevalent than HBV among the study participants, employees, and students, and viral count was low in both HBV and HCV-infected participants. However, men were more affected than women. The studied risk factors represented higher frequency among hepatitis-positive participants relative to the hepatitis-negative participants. The Chi-square test revealed that students' gender, history of hepatitis in the family and relatives, dental treatment, sharing cosmetics and shaving blades were significant (p > 0.005) risk factors of hepatitis while in the employees group surgery and age were significant. Moreover, the reused of syringes was found to be associated with hepatitis in both groups. The bivariate analysis helped to identify various new risk factors which were independently, either positively or negatively, associated with hepatitis. Discussion Our study enabled us to recognize different risk factors of hepatitis among the target population. The information thus generated can be usefully applied in planning hepatitis awareness, targeted screening, and effective control programs for other target populations. In general, this module can be further utilized for any other disease.
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Affiliation(s)
- Samina Ejaz
- Department of Biochemistry, Institute of Biochemistry, Biotechnology and Bioinformatics (IBBB), The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iqra Abdullah
- Department of Biochemistry, Institute of Biochemistry, Biotechnology and Bioinformatics (IBBB), The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Waqas Nazir Malik
- Department of Biotechnology, Institute of Biochemistry, Biotechnology and Bioinformatics (IBBB), The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Shazia Anjum
- Institute of Chemistry, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Muhammad Ashraf
- Institute of Chemistry, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Naveed Akhtar
- Department of Pharmaceutics, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | | | - Yasir Hameed
- Department of Biotechnology, Institute of Biochemistry, Biotechnology and Bioinformatics (IBBB), The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Muhammad Usman
- Department of Biochemistry, Institute of Biochemistry, Biotechnology and Bioinformatics (IBBB), The Islamia University of Bahawalpur, Bahawalpur, Pakistan
- Department of Biotechnology, Institute of Biochemistry, Biotechnology and Bioinformatics (IBBB), The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Usman Cheema
- Medical Division, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Safeena Sidiq
- Women Health Care Center and Maternity Home (WHCC&MH), The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Shermadini K, Alkhazashvili M, Vrielink H, Smid WM, Getia V, Gamkrelidze A, Adamia E, Gabunia T. Blood transfusion service in Georgia. Transfus Apher Sci 2023; 62:103807. [PMID: 37673755 DOI: 10.1016/j.transci.2023.103807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Ketevan Shermadini
- National Center for Disease Control and Public Health, Tbilisi, Georgia.
| | | | - Hans Vrielink
- Sanquin Consulting Services, Amsterdam, The Netherlands
| | - W Martin Smid
- Sanquin Consulting Services, Amsterdam, The Netherlands; Academic Institute IDTM, Groningen, The Netherlands
| | - Vladimer Getia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Ekaterine Adamia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Tamar Gabunia
- National Center for Disease Control and Public Health, Tbilisi, Georgia; Ministry for Internally Displaced Persons from the Occupied Territories, Labor, Health and Social Affairs of Georgia, Tbilisi, Georgia
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Gamkrelidze A, Shadaker S, Tsereteli M, Alkhazashvili M, Chitadze N, Tskhomelidze I, Gvinjilia L, Khetsuriani N, Handanagic S, Averhoff F, Cloherty G, Chakhunashvili G, Drobeniuc J, Imnadze P, Zakhashvili K, Armstrong PA. Nationwide Hepatitis C Serosurvey and Progress Towards Hepatitis C Virus Elimination in the Country of Georgia, 2021. J Infect Dis 2023; 228:684-693. [PMID: 36932731 PMCID: PMC10506179 DOI: 10.1093/infdis/jiad064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The country of Georgia initiated its hepatitis C virus (HCV) elimination program in 2015, at which point a serosurvey showed the adult prevalence of HCV antibody (anti-HCV) and HCV RNA to be 7.7% and 5.4%, respectively. This analysis reports hepatitis C results of a follow-up serosurvey conducted in 2021, and progress towards elimination. METHODS The serosurvey used a stratified, multistage cluster design with systematic sampling to include adults and children (aged 5-17 years) providing consent (or assent with parental consent). Blood samples were tested for anti-HCV and if positive, HCV RNA. Weighted proportions and 95% confidence intervals (CI) were compared with 2015 age-adjusted estimates. RESULTS Overall, 7237 adults and 1473 children were surveyed. Among adults, the prevalence of anti-HCV was 6.8% (95% CI, 5.9-7.7). The HCV RNA prevalence was 1.8% (95% CI, 1.3-2.4), representing a 67% reduction since 2015. HCV RNA prevalence decreased among those reporting risk factors of ever injecting drugs (51.1% to 17.8%), and ever receiving a blood transfusion (13.1% to 3.8%; both P < .001). No children tested positive for anti-HCV or HCV RNA. CONCLUSIONS These results demonstrate substantial progress made in Georgia since 2015. These findings can inform strategies to meet HCV elimination targets.
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Affiliation(s)
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maia Tsereteli
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | | | - Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | - Nino Khetsuriani
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Senad Handanagic
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francisco Averhoff
- Abbott Diagnostics, Abbott Park, IL, USA
- Abbott Pandemic Defense Coalition, Abbott Park, IL, USA
| | - Gavin Cloherty
- Abbott Diagnostics, Abbott Park, IL, USA
- Abbott Pandemic Defense Coalition, Abbott Park, IL, USA
| | | | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paata Imnadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Paige A. Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Gvinjilia L, Baliashvili D, Shadaker S, Averhoff F, Kandelaki L, Kereselidze M, Tsertsvadze T, Chkhartishvili N, Butsashvili M, Metreveli D, Gamkrelidze A, Armstrong PA. Impact of Hepatitis C Virus Infection and Treatment on Mortality in the Country of Georgia, 2015-2020. Clin Infect Dis 2023; 77:405-413. [PMID: 37099136 PMCID: PMC10527899 DOI: 10.1093/cid/ciad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Mortality related to hepatitis C virus (HCV) infection is a key indicator for elimination. We assessed the impact of HCV infection and treatment on mortality in the country of Georgia during 2015-2020. METHODS We conducted a population-based cohort study using data from Georgia's national HCV Elimination Program and death registry. We calculated all-cause mortality rates in 6 cohorts: (1) Negative for anti-HCV; (2) anti-HCV positive, unknown viremia status; (3) current HCV infection and untreated; (4) discontinued treatment; (5) completed treatment, no sustained virologic response (SVR) assessment; (6) completed treatment and achieved SVR. Cox proportional hazards models were used to calculate adjusted hazards ratios and confidence intervals. We calculated the cause-specific mortality rates attributable to liver-related causes. RESULTS After a median follow-up of 743 days, 100 371 (5.7%) of 1 764 324 study participants died. The highest mortality rate was observed among HCV infected patients who discontinued treatment (10.62 deaths per 100 PY, 95% confidence interval [CI]: 9.65, 11.68), and untreated group (10.33 deaths per 100 PY, 95% CI: 9.96, 10.71). In adjusted Cox proportional hazards model, the untreated group had almost 6-times higher hazard of death compared to treated groups with or without documented SVR (adjusted hazard ratio [aHR] = 5.56, 95% CI: 4.89, 6.31). Those who achieved SVR had consistently lower liver-related mortality compared to cohorts with current or past exposure to HCV. CONCLUSIONS This large population-based cohort study demonstrated the marked beneficial association between hepatitis C treatment and mortality. The high mortality rates observed among HCV infected and untreated persons highlights the need to prioritize linkage to care and treatment to achieve elimination goals.
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Affiliation(s)
- Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | | | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Francisco Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Levan Kandelaki
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Maia Kereselidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Clinic "Hepa," Tbilisi, Georgia
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | | | | | - Amiran Gamkrelidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Paige A Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Alkhazashvili M, Bloch EM, Shadaker S, Kuchuloria T, Getia V, Turdziladze A, Armstrong PA, Gamkrelidze A. Advancing blood transfusion safety using molecular detection in the country of Georgia. Transfus Clin Biol 2023; 30:307-313. [PMID: 36907246 PMCID: PMC10958484 DOI: 10.1016/j.tracli.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND In 2015, the country of Georgia initiated its hepatitis C virus (HCV) elimination program. Given a high background incidence of HCV infection, centralized nucleic acid testing (NAT) of blood donations was prioritized for implementation. STUDY DESIGN AND METHODS Multiplex NAT screening for HIV, HCV and hepatitis B virus (HBV) was launched in January 2020. An analysis was conducted of serological and NAT donor/donation data for the first year of screening (through December 2020). RESULTS A total of 54,116 donations representing 39,164 unique donors were evaluated. Overall, 671 donors (1.7%) tested positive for at least one infectious marker by serology or NAT, with the highest prevalence among donors aged 40-49 years (2.5%; n = 200), male (1.9%; n = 524), replacement (2.8%; n = 153) and first time (2.1%; n = 642) donors. Sixty donations were seronegative but NAT positive, and therefore would not have been found by traditional serology testing alone. These were more likely among female vs. male (adjusted odds ratio [aOR] 2.06; 95% confidence interval [95%CI]: 1.05-4.05), paid (aOR 10.15; 95%CI: 2.80-36.86) or voluntary (aOR 4.30; 95%CI: 1.27-14.56) vs replacement, and repeat vs. first time (aOR 13.98; 95%CI: 4.06-48.12) donors. On repeat serological testing (including HBV core antibody [HBcAb] testing), 6 HBV + donations, 5 HCV + donations and 1 HIV + donations were deemed NAT yield (detected through the implementation of NAT, and would have otherwise been missed by serology screening alone). CONCLUSION This analysis offers a regional model for NAT implementation, demonstrating the feasibility and clinical utility in a nationwide blood program.
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Affiliation(s)
- Maia Alkhazashvili
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia; The University of Georgia, School of Health Sciences, Tbilisi, Georgia.
| | - Evan M Bloch
- Johns Hopkins University School of Medicine, Baltimore, United States
| | - Shaun Shadaker
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, United States
| | | | - Vladimer Getia
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | | | - Paige A Armstrong
- Johns Hopkins University School of Medicine, Baltimore, United States
| | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia; The University of Georgia, School of Health Sciences, Tbilisi, Georgia
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Khetsuriani N, Gamkrelidze A, Shadaker S, Tsereteli M, Alkhazashvili M, Chitadze N, Tskhomelidze I, Gvinjilia L, Averhoff F, Cloherty G, An Q, Chakhunashvili G, Drobeniuc J, Imnadze P, Zakhashvili K, Armstrong PA. Toward reaching hepatitis B goals: hepatitis B epidemiology and the impact of two decades of vaccination, Georgia, 2021. Euro Surveill 2023; 28:2200837. [PMID: 37498531 PMCID: PMC10375835 DOI: 10.2807/1560-7917.es.2023.28.30.2200837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/10/2023] [Indexed: 07/28/2023] Open
Abstract
BackgroundGeorgia 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.AimWe aimed to assess HBV infection prevalence among children and update estimates for adults in Georgia.MethodsThis 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.ResultsAmong 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.ConclusionsHepatitis 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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Affiliation(s)
- Nino Khetsuriani
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, United States
| | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health of Georgia (NCDC), Tbilisi, Georgia
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, United States
| | - Maia Tsereteli
- National Center for Disease Control and Public Health of Georgia (NCDC), Tbilisi, Georgia
| | - Maia Alkhazashvili
- National Center for Disease Control and Public Health of Georgia (NCDC), Tbilisi, Georgia
| | - Nazibrola Chitadze
- National Center for Disease Control and Public Health of Georgia (NCDC), Tbilisi, Georgia
| | | | - Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention (CDC), Tbilisi, Georgia
| | | | - Gavin Cloherty
- Abbott Pandemic Defense Coalition, Abbott Park, IL, United States
| | - Qian An
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, United States
| | - Giorgi Chakhunashvili
- National Center for Disease Control and Public Health of Georgia (NCDC), Tbilisi, Georgia
| | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, United States
| | - Paata Imnadze
- National Center for Disease Control and Public Health of Georgia (NCDC), Tbilisi, Georgia
| | - Khatuna Zakhashvili
- National Center for Disease Control and Public Health of Georgia (NCDC), Tbilisi, Georgia
| | - Paige A Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, United States
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Walker JG, Tskhomelidze I, Shadaker S, Tsereteli M, Handanagic S, Armstrong PA, Gamkrelidze A, Vickerman P. Insights from a national survey in 2021 and from modelling on progress towards hepatitis C virus elimination in the country of Georgia since 2015. Euro Surveill 2023; 28:2200952. [PMID: 37498534 PMCID: PMC10375834 DOI: 10.2807/1560-7917.es.2023.28.30.2200952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/29/2023] [Indexed: 07/28/2023] Open
Abstract
BackgroundBetween 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.AimAccounting for follow-up surveys in 2021, we validate and update projections of HCV infection prevalence and incidence.MethodWe 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.ResultsThe 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.ConclusionResults 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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Affiliation(s)
- Josephine G Walker
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, United States
| | - Maia Tsereteli
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Senad Handanagic
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, United States
| | - Paige A Armstrong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, United States
| | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
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11
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Baliashvili D, Blumberg HM, Gandhi NR, Averhoff F, Benkeser D, Shadaker S, Gvinjilia L, Turdziladze A, Tukvadze N, Chincharauli M, Butsashvili M, Sharvadze L, Tsertsvadze T, Zarkua J, Kempker RR. Hepatitis C care cascade among patients with and without tuberculosis: Nationwide observational cohort study in the country of Georgia, 2015-2020. PLoS Med 2023; 20:e1004121. [PMID: 37141386 PMCID: PMC10194957 DOI: 10.1371/journal.pmed.1004121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 05/18/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The Eastern European country of Georgia initiated a nationwide hepatitis C virus (HCV) elimination program in 2015 to address a high burden of infection. Screening for HCV infection through antibody testing was integrated into multiple existing programs, including the National Tuberculosis Program (NTP). We sought to compare the hepatitis C care cascade among patients with and without tuberculosis (TB) diagnosis in Georgia between 2015 and 2019 and to identify factors associated with loss to follow-up (LTFU) in hepatitis C care among patients with TB. METHODS AND FINDINGS Using national ID numbers, we merged databases of the HCV elimination program, NTP, and national death registry from January 1, 2015 to September 30, 2020. The study population included 11,985 adults (aged ≥18 years) diagnosed with active TB from January 1, 2015 through December 31, 2019, and 1,849,820 adults tested for HCV antibodies between January 1, 2015 and September 30, 2020, who were not diagnosed with TB during that time. We estimated the proportion of patients with and without TB who were LTFU at each step of the HCV care cascade and explored temporal changes. Among 11,985 patients with active TB, 9,065 (76%) patients without prior hepatitis C treatment were tested for HCV antibodies, of which 1,665 (18%) had a positive result; LTFU from hepatitis C care was common, with 316 of 1,557 (20%) patients with a positive antibody test not undergoing viremia testing and 443 of 1,025 (43%) patients with viremia not starting treatment for hepatitis C. Overall, among persons with confirmed viremic HCV infection, due to LTFU at various stages of the care cascade only 28% of patients with TB had a documented cure from HCV infection, compared to 55% among patients without TB. LTFU after positive antibody testing substantially decreased in the last 3 years, from 32% among patients diagnosed with TB in 2017 to 12% among those diagnosed in 2019. After a positive HCV antibody test, patients without TB had viremia testing sooner than patients with TB (hazards ratio [HR] = 1.46, 95% confidence intervals [CI] [1.39, 1.54], p < 0.001). After a positive viremia test, patients without TB started hepatitis C treatment sooner than patients with TB (HR = 2.05, 95% CI [1.87, 2.25], p < 0.001). In the risk factor analysis adjusted for age, sex, and case definition (new versus previously treated), multidrug-resistant (MDR) TB was associated with an increased risk of LTFU after a positive HCV antibody test (adjusted risk ratio [aRR] = 1.41, 95% CI [1.12, 1.76], p = 0.003). The main limitation of this study was that due to the reliance on existing electronic databases, we were unable to account for the impact of all confounding factors in some of the analyses. CONCLUSIONS LTFU from hepatitis C care after a positive antibody or viremia test was high and more common among patients with TB than in those without TB. Better integration of TB and hepatitis C care systems can potentially reduce LTFU and improve patient outcomes both in Georgia and other countries that are initiating or scaling up their nationwide hepatitis C control efforts and striving to provide personalized TB treatment.
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Affiliation(s)
- Davit Baliashvili
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Henry M. Blumberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Neel R. Gandhi
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Francisco Averhoff
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | | | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | | | | | - Lali Sharvadze
- Clinic “Hepa”, Tbilisi, Georgia
- The University of Georgia, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
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Walker JG, Ivanova E, Jamil MS, Ong JJ, Easterbrook P, Fajardo E, Johnson CC, Luhmann N, Terris-Prestholt F, Vickerman P, Shilton S. Cost-effectiveness of Hepatitis C virus self-testing in four settings. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001667. [PMID: 37018166 PMCID: PMC10075433 DOI: 10.1371/journal.pgph.0001667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/20/2023] [Indexed: 04/06/2023]
Abstract
Globally, there are approximately 58 million people with chronic hepatitis C virus infection (HCV) but only 20% have been diagnosed. HCV self-testing (HCVST) could reach those who have never been tested and increase uptake of HCV testing services. We compared cost per HCV viraemic diagnosis or cure for HCVST versus facility-based HCV testing services. We used a decision analysis model with a one-year time horizon to examine the key drivers of economic cost per diagnosis or cure following the introduction of HCVST in China (men who have sex with men), Georgia (men 40-49 years), Viet Nam (people who inject drugs, PWID), and Kenya (PWID). HCV antibody (HCVAb) prevalence ranged from 1%-60% across settings. Model parameters in each setting were informed by HCV testing and treatment programmes, HIV self-testing programmes, and expert opinion. In the base case, we assume a reactive HCVST is followed by a facility-based rapid diagnostic test (RDT) and then nucleic acid testing (NAT). We assumed oral-fluid HCVST costs of $5.63/unit ($0.87-$21.43 for facility-based RDT), 62% increase in testing following HCVST introduction, 65% linkage following HCVST, and 10% replacement of facility-based testing with HCVST based on HIV studies. Parameters were varied in sensitivity analysis. Cost per HCV viraemic diagnosis without HCVST ranged from $35 2019 US dollars (Viet Nam) to $361 (Kenya). With HCVST, diagnosis increased resulting in incremental cost per diagnosis of $104 in Viet Nam, $163 in Georgia, $587 in Kenya, and $2,647 in China. Differences were driven by HCVAb prevalence. Switching to blood-based HCVST ($2.25/test), increasing uptake of HCVST and linkage to facility-based care and NAT testing, or proceeding directly to NAT testing following HCVST, reduced the cost per diagnosis. The baseline incremental cost per cure was lowest in Georgia ($1,418), similar in Viet Nam ($2,033), and Kenya ($2,566), and highest in China ($4,956). HCVST increased the number of people tested, diagnosed, and cured, but at higher cost. Introducing HCVST is more cost-effective in populations with high prevalence.
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Affiliation(s)
- Josephine G. Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Elena Ivanova
- FIND, The Global Alliance for Diagnostics, Geneva, Switzerland
| | - Muhammad S. Jamil
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Jason J. Ong
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Australia
| | - Philippa Easterbrook
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Emmanuel Fajardo
- FIND, The Global Alliance for Diagnostics, Geneva, Switzerland
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl Case Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Niklas Luhmann
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | | | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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13
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Baliashvili D, Blumberg HM, Benkeser D, Kempker RR, Shadaker S, Averhoff F, Gvinjilia L, Adamashvili N, Magee M, Kamkamidze G, Zakalashvili M, Tsertsvadze T, Sharvadze L, Chincharauli M, Tukvadze N, Gandhi NR. Association of Treated and Untreated Chronic Hepatitis C With the Incidence of Active Tuberculosis Disease: A Population-Based Cohort Study. Clin Infect Dis 2023; 76:245-251. [PMID: 36134743 PMCID: PMC10194043 DOI: 10.1093/cid/ciac786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection causes dysregulation and suppression of immune pathways involved in the control of tuberculosis (TB) infection. However, data on the role of chronic hepatitis C as a risk factor for active TB are lacking. We sought to evaluate the association between HCV infection and the development of active TB. METHODS We conducted a cohort study in Georgia among adults tested for HCV antibodies (January 2015-September 2020) and followed longitudinally for the development of newly diagnosed active TB. Data were obtained from the Georgian national programs of hepatitis C and TB. The exposures of interest were untreated and treated HCV infection. A Cox proportional hazards model was used to calculate adjusted hazard ratios (aHRs). RESULTS A total of 1 828 808 adults were included (median follow-up time: 26 months; IQR: 13-39 months). Active TB was diagnosed in 3163 (0.17%) individuals after a median of 6 months follow-up (IQR: 1-18 months). The incidence rate per 100 000 person-years was 296 among persons with untreated HCV infection, 109 among those with treated HCV infection, and 65 among HCV-negative persons. In multivariable analysis, both untreated (aHR = 2.9; 95% CI: 2.4-3.4) and treated (aHR = 1.6; 95% CI: 1.4-2.0) HCV infections were associated with a higher hazard of active TB, compared with HCV-negative persons. CONCLUSIONS Adults with HCV infection, particularly untreated individuals, were at higher risk of developing active TB disease. Screening for latent TB infection and active TB disease should be part of clinical evaluation of people with HCV infection, especially in high-TB-burden areas.
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Affiliation(s)
- Davit Baliashvili
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Henry M Blumberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David Benkeser
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Russell R Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shaun Shadaker
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Francisco Averhoff
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lia Gvinjilia
- Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | | | - Matthew Magee
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | | | | | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Lali Sharvadze
- Clinic “Hepa”, Tbilisi, Georgia
- The University of Georgia, Tbilisi, Georgia
| | | | - Nestan Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Neel R Gandhi
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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14
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Butsashvili M, Abzianidze T, Kamkamidze G, Gulbiani L, Gvinjilia L, Kuchuloria T, Tskhomelidze I, Gogia M, Tsereteli M, Miollany V, Kikvidze T, Shadaker S, Nasrullah M, Averhoff F. Barriers of linkage to HCV viremia testing among people who inject drugs in Georgia. Subst Abuse Treat Prev Policy 2022; 17:23. [PMID: 35346265 PMCID: PMC8962019 DOI: 10.1186/s13011-022-00438-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background People who inject drugs (PWID) in Georgia have a high prevalence of hepatitis C virus antibody (anti-HCV). Access to care among PWID could be prioritized to meet the country’s hepatitis C elimination goals. This study assesses barriers of linkage to HCV viremia testing among PWID in Georgia. Methods Study participants were enrolled from 13 harm reduction (HR) centers throughout Georgia. Anti-HCV positive PWID who were tested for viremia (complete diagnosis [CD]), were compared to those not tested for viremia within 90 days of screening anti-HCV positive (not complete diagnosis [NCD]). Convenience samples of CD and NCD individuals recorded at HR centers using beneficiaries’ national ID were drawn from the National HCV Elimination Program database. Participants were interviewed about potential barriers to seeking care. Results A total of 500 PWID were enrolled, 245 CD and 255 NCD. CD and NCD were similar with respect to gender, age, employment status, education, knowledge of anti-HCV status, and confidence/trust in the elimination program (p > 0.05). More NCD (13.0%) than CD (7.4%) stated they were not sufficiently informed what to do after screening anti-HCV positive (p < 0.05). In multivariate analysis, HCV viremia testing was associated with perceived affordability of the elimination program (adjusted prevalence ratio = 8.53; 95% confidence interval: 4.14–17.62). Conclusions Post testing counselling and making hepatitis C services affordable could help increase HCV viremia testing among PWID in Georgia.
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15
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Dolmazashvili E, Sharvadze L, Abutidze A, Chkhartishvili N, Todua M, Adamia E, Gabunia T, Shadaker S, Gvinjilia L, Arora S, Thornton K, Armstrong PA, Tsertsvadze T. Treatment of hepatitis C in primary health care in the country of Georgia. Clin Liver Dis (Hoboken) 2022; 20:175-178. [PMID: 36447909 PMCID: PMC9700050 DOI: 10.1002/cld.1260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 11/27/2022] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
- Ekaterine Dolmazashvili
- Hepatology DepartmentHepatology Clinic “HEPA”TbilisiGeorgia
- European UniversityTbilisiGeorgia
| | - Lali Sharvadze
- Hepatology DepartmentHepatology Clinic “HEPA”TbilisiGeorgia
- Ivane Javakhishvili Tbilisi State UniversityTbilisiGeorgia
| | - Akaki Abutidze
- Ivane Javakhishvili Tbilisi State UniversityTbilisiGeorgia
- AIDS Outpatient DepartmentInfectious Diseases, AIDS & Clinical Immunology Research CenterTbilisiGeorgia
| | - Nikoloz Chkhartishvili
- AIDS Outpatient DepartmentInfectious Diseases, AIDS & Clinical Immunology Research CenterTbilisiGeorgia
| | - Manana Todua
- Ivane Javakhishvili Tbilisi State UniversityTbilisiGeorgia
| | - Ekaterine Adamia
- Health Policy DepartmentMinistry of Labour, Health and Social Affairs of GeorgiaTbilisiGeorgia
| | - Tamar Gabunia
- Health Policy DepartmentMinistry of Labour, Health and Social Affairs of GeorgiaTbilisiGeorgia
| | - Shaun Shadaker
- Division of Viral HepatitisNational Center for HIV, Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | | | - Paige A. Armstrong
- Division of Viral HepatitisNational Center for HIV, Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Tengiz Tsertsvadze
- Hepatology DepartmentHepatology Clinic “HEPA”TbilisiGeorgia
- Ivane Javakhishvili Tbilisi State UniversityTbilisiGeorgia
- AIDS Outpatient DepartmentInfectious Diseases, AIDS & Clinical Immunology Research CenterTbilisiGeorgia
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16
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Fajardo E, Watson V, Kumwenda M, Usharidze D, Gogochashvili S, Kakhaberi D, Giguashvili A, Johnson CC, Jamil MS, Dacombe R, Stvilia K, Easterbrook P, Ivanova Reipold E. Usability and acceptability of oral-based HCV self-testing among key populations: a mixed-methods evaluation in Tbilisi, Georgia. BMC Infect Dis 2022; 22:510. [PMID: 35641908 PMCID: PMC9154030 DOI: 10.1186/s12879-022-07484-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 05/18/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Hepatitis C virus self-testing (HCVST) is an additional approach that may expand access to HCV testing. We conducted a mixed-methods cross-sectional observational study to assess the usability and acceptability of HCVST among people who inject drugs (PWID), men who have sex with men (MSM) and transgender (TG) people in Tbilisi, Georgia. METHODS The study was conducted from December 2019 to June 2020 among PWID at one harm reduction site and among MSM/TG at one community-based organization. We used a convergent parallel mixed-methods design. Usability was assessed by observing errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. A subset of participants participated in cognitive and in-depth interviews. RESULTS A total of 90 PWID, 84 MSM and 6 TG were observed performing HCVST. PWID were older (median age 35 vs 24) and had a lower level of education compared to MSM/TG (27% vs 59%). The proportion of participants who completed all steps successfully without assistance was 60% among PWID and 80% among MSM/TG. The most common error was in sample collection and this was observed more often among PWID than MSM/TG (21% vs 6%; p = 0.002). More PWID requested assistance during HCVST compared to MSM/TG (22% vs 8%; p = 0.011). Acceptability was high in both groups (98% vs 96%; p = 0.407). Inter-reader agreement was 97% among PWID and 99% among MSM/TG. Qualitative data from cognitive (n = 20) and in-depth interviews (n = 20) was consistent with the quantitative data confirming a high usability and acceptability. CONCLUSIONS HCVST was highly acceptable among key populations in Georgia of relatively high educational level, and most participants performed HCVST correctly. A significant difference in usability was observed among PWID compared to MSM/TG, indicating that PWID may benefit from improved messaging and education as well as options to receive direct assistance when self-testing for HCV.
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Affiliation(s)
- Emmanuel Fajardo
- grid.452485.a0000 0001 1507 3147The Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
| | - Victoria Watson
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Moses Kumwenda
- grid.419393.50000 0004 8340 2442Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), Blantyre, Malawi ,grid.10595.380000 0001 2113 2211College of Medicine, University of Malawi (CoM), Blantyre, Malawi
| | | | | | - David Kakhaberi
- Community-Based Organization Equality Movement, Tbilisi, Georgia
| | - Ana Giguashvili
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Cheryl C. Johnson
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S. Jamil
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Russell Dacombe
- grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Ketevan Stvilia
- National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Philippa Easterbrook
- grid.3575.40000000121633745Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Elena Ivanova Reipold
- grid.452485.a0000 0001 1507 3147The Foundation for Innovative New Diagnostics (FIND), Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland
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17
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Mane A, Kasibhatla SM, Vidhate P, Saxena V, Patil S, Rao A, Nirmalkar A, Kulkarni-Kale U, Panda S. Phylogenetic Analysis of Spread of Hepatitis C Virus Identified during HIV Outbreak Investigation, Unnao, India. Emerg Infect Dis 2022; 28:725-733. [PMID: 35318918 PMCID: PMC8962895 DOI: 10.3201/eid2804.211845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
An HIV outbreak investigation during 2017–2018 in Unnao District, Uttar Pradesh, India, unearthed high prevalence of hepatitis C virus (HCV) antibodies among the study participants. We investigated these HCV infections by analyzing NS5B and core regions. We observed no correlation between HIV–HCV viral loads and clustering of HCV sequences, regardless of HIV serostatus. All HCV isolates belonged to genotype 3a. Monophyletic clustering of isolates in NS5B phylogeny indicates emergence of the outbreak from a single isolate or its closely related descendants. The nucleotide substitution rate for NS5B was 6 × 10−3 and for core was 2 × 10−3 substitutions/site/year. Estimated time to most recent common ancestor of these isolates was 2012, aligning with the timeline of this outbreak, which might be attributable to unsafe injection practices while seeking healthcare. HIV–HCV co-infection underlines the need for integrated testing, surveillance, strengthening of healthcare systems, community empowerment, and molecular analyses as pragmatic public health tools.
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18
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Butsashvili M, Zurashvili T, Kamkamidze G, Kajaia M, Gulbiani L, Gamezardashvili A, Gvinjilia L, Kuchuloria T, Gamkrelidze A, Shadaker S, Nasrullah M, Averhoff F, Armstrong PA. Door-to-door hepatitis C screening in Georgia: An innovative model to increase testing and linkage to care. J Med Screen 2022; 29:134-136. [PMID: 35293802 PMCID: PMC10068592 DOI: 10.1177/09691413221086497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Georgia has a high prevalence of hepatitis C virus (HCV) infection. In 2015 a national HCV elimination program was launched providing free access to screening and treatment. To achieve elimination, innovative approaches to increase screening coverage and linkage to care are needed. This study estimates feasibility, acceptability, and outcomes of the door-to-door pilot HCV testing program in three cities. METHODS Households were approached by system random sampling and all members were invited for study participation. Researchers used a detailed guide for conducting door-to-door testing and served as case navigators to link anti-HCV-positive individuals to care. RESULTS Testing acceptance rate was high. In total 4804 individuals were tested and 48 (1.0%) were HCV positive. Among the entire sample of newly and previously tested individuals, overall HCV antibody prevalence was 3.6%. Through case navigation, of 48 newly identified and 26 previously identified anti-HCV-positive individuals, 42 (87.5%) and 17 (65.4%), respectively, were successfully linked to care. CONCLUSIONS Door-to-door HCV testing has potential to increase testing uptake. Such community-based approaches not only improve testing, but can also serve to increase linkage to care, which is important in achieving the goal of HCV elimination. The study provides a model for high prevalence countries aiming to eliminate hepatitis C.
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Affiliation(s)
| | | | | | - Maia Kajaia
- Health Research Union/Clinic NEOLAB, Tbilisi, Georgia
| | | | | | | | | | - Amiran Gamkrelidze
- 443716National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Shaun Shadaker
- Division of Viral Hepatitis, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Muazzam Nasrullah
- Division of Viral Hepatitis, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francisco Averhoff
- Division of Viral Hepatitis, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paige A Armstrong
- Division of Viral Hepatitis, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
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19
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Di Marco L, La Mantia C, Di Marco V. Hepatitis C: Standard of Treatment and What to Do for Global Elimination. Viruses 2022; 14:505. [PMID: 35336911 PMCID: PMC8954407 DOI: 10.3390/v14030505] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 12/04/2022] Open
Abstract
Hepatitis C virus infection has a substantial effect on morbidity and mortality worldwide because it is a cause of cirrhosis, hepatocellular carcinoma, liver transplantation, and liver-related death. Direct acting antiviral drugs available today have high efficacy and excellent safety and can be used in all patients with clinically evident chronic liver disease and in groups that demonstrate risk behaviors to reduce the spread of infection. The Global Health Strategy of WHO to eliminate hepatitis infection by 2030 assumes "a 90% reduction in new cases of chronic hepatitis C, a 65% reduction in hepatitis C deaths, and treatment of 80% of eligible people with HCV infections". In this review effective models and strategies for achieving the global elimination of HCV infection are analyzed. The screening strategies must be simple and equally effective in high-risk groups and in the general population; fast and effective models for appropriate diagnosis of liver disease are needed; strategies for direct acting antiviral drug selection must be cost-effective; linkage to care models in populations at risk and in marginalized social classes must be specifically designed and applied; strategies for obtaining an effective vaccine against HCV infection have yet to be developed.
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Affiliation(s)
- Lorenza Di Marco
- Gastroenterology Unit, Department of Medical Specialties, University of Modena & Reggio Emilia, 41100 Modena, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena & Reggio Emilia, 41100 Modena, Italy
| | - Claudia La Mantia
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Vito Di Marco
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
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20
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Milestones to reach Hepatitis C Virus (HCV) elimination in Italy: From free-of-charge screening to regional roadmaps for an HCV-free nation. Dig Liver Dis 2022; 54:237-242. [PMID: 33926816 DOI: 10.1016/j.dld.2021.03.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/11/2022]
Abstract
Although Italy has been on track for Hepatitis C Virus (HCV) elimination since 2019, it fell off track due to the decrease in the number of treated patients. HCV elimination in Italy will be possible if immediate action is taken. A health policy was implemented beginning in 2021, consisting of screening among key populations and birth cohorts (1969-1989), estimated to have a high prevalence of undiagnosed individuals. The active screening requires regional governance that manages the processes' complexity integrating a well-organized network between territory assistance and hospital to achieve an effective HCV care cascade. This document aims to support the regional decision-making process by defining paths for screening and linkage-to-care. Implementing active screening strategies beyond a risk-based approach is required as a General Practitioners' task. Simplified paths must be drawn for the key populations screening. The infrastructure built for COVID-19 vaccination could be used also for HCV screening. According to a multidisciplinary care delivery, screening should be supplemented with rapid linkage-to-care and treatment of newly diagnosed patients. The realization of the proactive screening during the first two years is vital because it will define the tracks for the whole HCV cost-effective screening of 1948-1988 birth cohorts in Italy.
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21
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The impact of COVID-19 pandemic on the 2020 hepatitis C cascade of care in the country of Georgia. Public Health 2022; 205:182-186. [PMID: 35305459 PMCID: PMC9004234 DOI: 10.1016/j.puhe.2022.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In 2015, the Republic of Georgia initiated a National Hepatitis C Elimination Program, with a goal of 90% reduction in prevalence of chronic hepatitis C virus (HCV) infections by 2020. In this article, we explore the impact of the COVID-19 pandemic on the 2020 hepatitis C cascade of care in Georgia. STUDY DESIGN Retrospective analytic study. METHODS We used a national screening registry that includes hospitals, blood banks, antenatal clinics, harm reduction sites, and other programs and services to collect data on hepatitis C screening. A separate national treatment database was used to collect data on viremia and diagnostic testing, treatment initiation, and outcome including testing for and achieving sustained virologic response (SVR). We used these databases to create hepatitis C care cascades for 2020 and 2019. Bivariate associations for demographic characteristics and screening locations per year and care cascade comparisons were assessed using a chi-squared test. RESULTS In 2020 compared to 2019, the total number of persons screened for HCV antibodies decreased by 25% (from 975,416 to 726,735), 59% fewer people with viremic infection were treated for HCV infection (3188 vs. 7868), 46% fewer achieved SVR (1345 vs. 2495), a significantly smaller percentage of persons with viremic infection initiated treatment for HCV (59% vs. 62%), while the percentage of persons who achieved SVR (99.2% vs. 99.3%) remained stable. CONCLUSIONS The COVID-19 pandemic had a negative impact on the hepatitis C elimination program in Georgia. To ensure Georgia reaches its elimination goals, mitigating unintended consequences of delayed diagnosis and treatment of hepatitis C due to the COVID-19 pandemic are paramount.
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22
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Baliashvili D, Averhoff F, Kasradze A, Salyer SJ, Kuchukhidze G, Gamkrelidze A, Imnadze P, Alkhazashvili M, Chanturia G, Chitadze N, Sukhiashvili R, Blanton C, Drobeniuc J, Morgan J, Hagan LM. Risk factors and genotype distribution of hepatitis C virus in Georgia: A nationwide population-based survey. PLoS One 2022; 17:e0262935. [PMID: 35061841 PMCID: PMC8782338 DOI: 10.1371/journal.pone.0262935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/08/2022] [Indexed: 12/02/2022] Open
Abstract
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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Affiliation(s)
- Davit Baliashvili
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
- * E-mail: ,
| | - Francisco Averhoff
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ana Kasradze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Stephanie J. Salyer
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Paata Imnadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Gvantsa Chanturia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | - Curtis Blanton
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Juliette Morgan
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Global Disease Detection – South Caucasus Regional Center, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | - Liesl M. Hagan
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Adee M, Zhuo Y, Zhong H, Zhan T, Aggarwal R, Shilton S, Chhatwal J. Assessing cost-effectiveness of hepatitis C testing pathways in Georgia using the Hep C Testing Calculator. Sci Rep 2021; 11:21382. [PMID: 34725356 PMCID: PMC8560949 DOI: 10.1038/s41598-021-00362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 10/06/2021] [Indexed: 12/03/2022] Open
Abstract
The cost of testing can be a substantial contributor to hepatitis C virus (HCV) elimination program costs in many low- and middle-income countries such as Georgia, resulting in the need for innovative and cost-effective strategies for testing. Our objective was to investigate the most cost-effective testing pathways for scaling-up HCV testing in Georgia. We developed a Markov-based model with a lifetime horizon that simulates the natural history of HCV, and the cost of detection and treatment of HCV. We then created an interactive online tool that uses results from the Markov-based model to evaluate the cost-effectiveness of different HCV testing pathways. We compared the current standard-of-care (SoC) testing pathway and four innovative testing pathways for Georgia. The SoC testing was cost-saving compared to no testing, but all four new HCV testing pathways further increased QALYs and decreased costs. The pathway with the highest patient follow-up, due to on-site testing, resulted in the highest discounted QALYs (124 QALY more than the SoC) and lowest costs ($127,052 less than the SoC) per 10,000 persons screened. The current testing algorithm in Georgia can be replaced with a new pathway that is more effective while being cost-saving.
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Affiliation(s)
| | - Yueran Zhuo
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,College of Business, Mississippi State University, Mississippi State, MS, USA
| | - Huaiyang Zhong
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Jagpreet Chhatwal
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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24
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Kraef C, Bentzon A, Skrahina A, Mocroft A, Peters L, Lundgren JD, Chkhartishvili N, Podlekareva D, Kirk O. Improving healthcare for patients with HIV, tuberculosis and hepatitis C in eastern Europe: a review of current challenges and important next steps. HIV Med 2021; 23:48-59. [PMID: 34468073 DOI: 10.1111/hiv.13163] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In some eastern European countries, serious challenges exist to meet the HIV-, tuberculosis (TB)- and hepatitis-related target of the United Nations Sustainable Development Goals. Some of the highest incidence rates for HIV and the highest proportion of multi-drug-resistant (MDR) tuberculosis worldwide are found in the region. The purpose of this article is to review the challenges and important next steps to improve healthcare for people living with TB, HIV and hepatitis C (HCV) in eastern Europe. METHODS References for this narrative review were identified through systematic searches of PubMed using pre-idientified key word for articles published in English from January 2000 to August 2020. After screening of titles and abstracts 37 articles were identified as relevant for this review. Thirty-eight further articles and sources were identified through searches in the authors' personal files and in Google Scholar. RESULTS Up to 50% of HIV/MDR-TB-coinfected individuals in the region die within 2 years of treatment initiation. Antiretroviral therapy (ART) coverage for people living with HIV (PLHIV) and the proportion virological suppressed are far below the UNAIDS 90% targets. In theory, access to various diagnostic tests and treatment of drug-resistant TB exists, but real-life data point towards inadequate testing and treatment. New treatments could provide elimination of viral HCV in high-risk populations but few countries have national programmes. CONCLUSION Some eastern European countries face serious challenges to achieve the sustainable development goal-related target of 3.3 by 2030, among others, to end the epidemics of AIDS and tuberculosis. Better integration of healthcare systems, standardization of health care, unrestricted substitution therapy for all people who inject drugs, widespread access to drug susceptibility testing, affordable medicines and a sufficiently sized, well-trained health workforce could address some of those challenges.
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Affiliation(s)
- Christian Kraef
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Adrian Bentzon
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alena Skrahina
- Republican Scientific and Practical Center for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Amanda Mocroft
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Lars Peters
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens D Lundgren
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nikoloz Chkhartishvili
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia.,Caucasus International University, Tbilisi, Georgia
| | - Daria Podlekareva
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ole Kirk
- CHIP (Centre of Excellence for Health, Immunity and Infections), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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25
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Stvilia K, Vephkvadze N, Gamkrelidze A, Khonelidze I, Getia V, Tsereteli M, Gvinjilia L, Kuchuloria T. Hepatitis C treatment uptake among patients who have received methadone substitution treatment in the Republic of Georgia. Public Health 2021; 195:42-50. [PMID: 34051674 DOI: 10.1016/j.puhe.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES There is a dearth of research on hepatitis C virus (HCV) treatment uptake among people who inject drugs (PWIDs) and receive methadone substitution treatment (MST) in Eastern Europe and Central Asia countries. This study contributed to addressing that gap. We examined and identified factors that may affect HCV treatment uptake among PWID who received MST in the Republic of Georgia. STUDY DESIGN The design of the study is retrospective cohort study. METHODS We conducted HCV care cascade analysis by matching the data from the web-based national hepatitis C program registry (ELIM C) and the MST treatment database between January 1, 2015, and December 31, 2018. Using the World Health Organization's (WHO) Consensus HCV cascade of care (CoC) global instrument, we assessed the progress made toward the country's 2020 and WHO's 2030 hepatitis C elimination targets for the subpopulation of MST patients. RESULTS Overall, 10,498 individuals have been dispensed methadone during the study period. A total of 6828 MST beneficiaries had HCV screening, of whom 5843 (85.6%) tested positive; 5476 (93.7%) were tested for HCV viremia, and 5275 (96.3%) were confirmed with chronic HCV infection. More than 75% (n = 4000) of HCV-infected MST patients initiated HCV treatment, and 3772 (94.3%) completed the treatment. Of those eligible for sustained virologic response assessment, 71.0% (2641/3715) were evaluated, and the reported cure rate was 96.1% (2537). The study found the odds of patients starting HCV treatment differed by the type of facility they were screened at and whether they were registered as PWID at the screening sites. The patients screened at centers with integrated HCV treatment services had higher treatment uptake rates than those screened at other centers. CONCLUSIONS As the cumulative HCV treatment uptake and cure rates among MST patients with HCV infection are high (75.8% and 96.1%, respectively), the MST patients might become the first microelimination target population in which hepatitis C elimination will be achieved in Georgia. The study found the type of screening facility and whether MST patients registered themselves as PWID or not had significant effects on MST patients starting HCV treatment. At the same time, the study did not find gender and age to be significant predictors of MST patients starting HCV treatment. MST patients used different types of health facilities to get screened for HIV. Many of them did not register themselves as PWID when screened for HIV. The existence of only a few harm reduction sites with integrated HCV treatment services, a high level of stigma, and the criminalization of drug use might have incentivized MST patients to self-navigate across the HCV care continuum with the rest of the population. The implementation of focused, harm reduction, integrated HCV treatment with good peer and professional adherence support at treatment sites could help reach the hepatitis C elimination goals among MST patients.
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Affiliation(s)
- Ketevan Stvilia
- National Center for Disease Control and Public Health, Georgia.
| | | | | | - Irma Khonelidze
- National Center for Disease Control and Public Health, Georgia
| | - Vladimer Getia
- National Center for Disease Control and Public Health, Georgia
| | - Maia Tsereteli
- National Center for Disease Control and Public Health, Georgia
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26
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Tsertsvadze T, Gamkrelidze A, Chkhartishvili N, Abutidze A, Sharvadze L, Kerashvili V, Butsashvili M, Metreveli D, Gvinjilia L, Shadaker S, Nasrullah M, Adamia E, Zeuzem S, Afdhal N, Arora S, Thornton K, Skaggs B, Kuchuloria T, Lagvilava M, Sergeenko D, Averhoff F. Three Years of Progress Toward Achieving Hepatitis C Elimination in the Country of Georgia, April 2015-March 2018. Clin Infect Dis 2021; 71:1263-1268. [PMID: 31563938 DOI: 10.1093/cid/ciz956] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In April 2015, in collaboration with the US Centers for Disease Control and Prevention and Gilead Sciences, the country of Georgia embarked on the world's first hepatitis C elimination program. We aimed to assess progress toward elimination targets 3 years after the start of the elimination program. METHODS We constructed a hepatitis C virus (HCV) care cascade for adults in Georgia, based on the estimated 150 000 persons aged ≥18 years with active HCV infection. All patients who were screened or entered the treatment program during April 2015-March 2018 were included in the analysis. Data on the number of persons screened for HCV were extracted from the national HCV screening database. For the treatment component, we utilized data from the Georgia National HCV treatment program database. Available treatment options included sofosbuvir and ledipasvir/sofosbuvir-based regimens. RESULTS Since April 2015, a cumulative 974 817 adults were screened for HCV antibodies; 86 624 persons tested positive, of whom 61 925 underwent HCV confirmatory testing. Among the estimated 150 000 adults living with chronic hepatitis C in Georgia, 52 856 (35.1%) were diagnosed, 45 334 (30.2%) initiated treatment with direct-acting antivirals, and 29 090 (19.4%) achieved a sustained virologic response (SVR). Overall, 37 256 persons were eligible for SVR assessment; of these, only 29 620 (79.5%) returned for evaluation. The SVR rate was 98.2% (29 090/29 620) in the per-protocol analysis and 78.1% (29 090/37 256) in the intent-to-treat analysis. CONCLUSIONS Georgia has made substantial progress in the path toward eliminating hepatitis C. Scaling up of testing and diagnosis, along with effective linkage to treatment services, is needed to achieve the goal of elimination.
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Affiliation(s)
- Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.,Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | | | | | - Akaki Abutidze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Lali Sharvadze
- Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia.,Hepatology Clinic HEPA, Tbilisi, Georgia
| | - Vakhtang Kerashvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | | | - Lia Gvinjilia
- Centers for Disease Control and Prevention Foundation, Tbilisi, Georgia
| | - Shaun Shadaker
- National Center for HIV, Hepatitis, STD, and TB Prevention, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Muazzam Nasrullah
- National Center for HIV, Hepatitis, STD, and TB Prevention, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ekaterine Adamia
- Ministry of Labour, Health and Social Affairs of Georgia, Tbilisi, Georgia
| | | | - Nezam Afdhal
- Beth Israel Deaconess Medical Center Liver Center, Boston, Massachusetts, USA
| | - Sanjeev Arora
- University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Beth Skaggs
- Centers for Disease Control and Prevention South Caucasus Office, Tbilisi, Georgia
| | - Tinatin Kuchuloria
- Centers for Disease Control and Prevention South Caucasus Office, Tbilisi, Georgia
| | - Maia Lagvilava
- Ministry of Labour, Health and Social Affairs of Georgia, Tbilisi, Georgia
| | - David Sergeenko
- Ministry of Labour, Health and Social Affairs of Georgia, Tbilisi, Georgia
| | - Francisco Averhoff
- National Center for HIV, Hepatitis, STD, and TB Prevention, Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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27
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Accelerating Hepatitis C virus elimination in Egypt by 2030: A national survey of communication for behavioral development as a modelling study. PLoS One 2021; 16:e0242257. [PMID: 33621232 PMCID: PMC7901784 DOI: 10.1371/journal.pone.0242257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/20/2020] [Indexed: 12/24/2022] Open
Abstract
AIM OF THE WORK This study aimed at assessing the dominance of risk practices associated with HCV endemicity in Egypt and detecting the behavioral development level concerning different aspects of HCV risk behaviors with respect to age and gender. The survey highlights the most cost-effective strategies that could accelerate HCV elimination in Egypt. SUBJECTS AND METHODS A national household survey targeted 3780 individuals (age range: 10-85 years). The sample was a systematic probability proportionate to size from 6 governorates representing the six major subdivisions of Egypt. The indicators used for assessing the behavioral development level towards HCV included six domains: awareness (7 indicators), perceived risk (5 indicators), motivation with the intention to change (4 and 5 indicators for males and females respectively), trial, rejection or adoption (6 and 5 indicators for males and females respectively). RESULTS The study revealed that along the continuum of behavior development, the percentage of the participants who acquired half of the scores was as follows: 73.1% aware, 69.8% developed perceived risk, 80.6% motivated with only 28.9% adopting the recommended behaviors, 32% rejected them, 2.3% were in the trial stage versus 35.8% who did not try any. Adolescents had significantly lower levels of development for almost all domains when compared to adults. Statistical higher significance was detected in favor of adults, employees, married, Lower Egypt governorates, and university-educated participants (p<0.001) regarding awareness, perceived risk, and motivation scores. More than half of the participants incorrectly believed that contaminated food, sharing food utilities, contaminated water, mosquitoes, and schistosomiasis would lead to HCV transmission. CONCLUSION Egypt would be closer to HCV elimination when cost-effective strategies are directed not towards creating awareness, perceived risk or motivation to change- (at an acceptable level)- but towards motivating adopting risk-reduction behaviors for HCV, tackling misconceptions and reinforcement of social support.
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28
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Metwally AM, Elmosalami DM, Elhariri H, El Etreby LA, Aboulghate A, El-Sonbaty MM, Mohsen A, Saleh RM, Abdel-Latif GA, Samy S, El Deeb SE, Fathy AM, Salah MM, Abdel Mawla MA, Imam HM, Ibrahim NA, Shaaban FA, Elamir RY, Abdelrahman M, El-Sayed MH. Accelerating Hepatitis C virus elimination in Egypt by 2030: A national survey of communication for behavioral development as a modelling study. PLoS One 2021; 16:e0242257. [DOI: https:/doi.org/10.1371/journal.pone.0242257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Aim of the work
This study aimed at assessing the dominance of risk practices associated with HCV endemicity in Egypt and detecting the behavioral development level concerning different aspects of HCV risk behaviors with respect to age and gender. The survey highlights the most cost-effective strategies that could accelerate HCV elimination in Egypt.
Subjects and methods
A national household survey targeted 3780 individuals (age range: 10–85 years). The sample was a systematic probability proportionate to size from 6 governorates representing the six major subdivisions of Egypt. The indicators used for assessing the behavioral development level towards HCV included six domains: awareness (7 indicators), perceived risk (5 indicators), motivation with the intention to change (4 and 5 indicators for males and females respectively), trial, rejection or adoption (6 and 5 indicators for males and females respectively).
Results
The study revealed that along the continuum of behavior development, the percentage of the participants who acquired half of the scores was as follows: 73.1% aware, 69.8% developed perceived risk, 80.6% motivated with only 28.9% adopting the recommended behaviors, 32% rejected them, 2.3% were in the trial stage versus 35.8% who did not try any. Adolescents had significantly lower levels of development for almost all domains when compared to adults. Statistical higher significance was detected in favor of adults, employees, married, Lower Egypt governorates, and university-educated participants (p<0.001) regarding awareness, perceived risk, and motivation scores. More than half of the participants incorrectly believed that contaminated food, sharing food utilities, contaminated water, mosquitoes, and schistosomiasis would lead to HCV transmission.
Conclusion
Egypt would be closer to HCV elimination when cost-effective strategies are directed not towards creating awareness, perceived risk or motivation to change- (at an acceptable level)- but towards motivating adopting risk-reduction behaviors for HCV, tackling misconceptions and reinforcement of social support.
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29
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Alshuwaykh O, Kwo PY. Current and future strategies for the treatment of chronic hepatitis C. Clin Mol Hepatol 2020; 27:246-256. [PMID: 33317245 PMCID: PMC8046635 DOI: 10.3350/cmh.2020.0230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/17/2020] [Indexed: 12/31/2022] Open
Abstract
Chronic hepatitis C infection is a major cause of liver disease and hepatocellular carcinoma worldwide. While hepatitis C has been treated for decades with some success, the introduction of direct acting antiviral agents has revolutionized the treatment of hepatitis C with finite, highly effective, well-tolerated therapy and there are few populations that cannot be successfully treated now or are complicated to manage. The World Health Organization has released elimination targets in an effort to eliminate viral hepatitis and reduce dramatically the morbidity and mortality caused by both viral hepatitis. While hepatitis C is straightforward to treat, it remains problematic to eliminate on a global scale. Diagnosis of hepatitis C remains the major gap in the cascade of care and numerous screening strategies will be required to reduce this gap. While historically, treatment of hepatitis C has been centralized, decentralized approaches will be required to diagnose, evaluate, and link to care the large population of individuals worldwide with hepatitis C across low-, middle-, and high-income countries. With the introduction of multiple pangenotypic treatment options and reduced cost for these therapies, assessment and treatment for those with hepatitis C has been simplified and made more accessible worldwide. There are multiple populations for whom care models are being developed and refined, including those when inject drugs, those who are incarcerated, those who present with sexually transmitted disease including the men who have sex with men population, amongst many others. While a vaccine for hepatitis C remains elusive these efforts continue. Multiple successful elimination efforts have been reported.
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Affiliation(s)
- Omar Alshuwaykh
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul Y Kwo
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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30
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Shadaker S, Nasrullah M, Gamkrelidze A, Ray J, Gvinjilia L, Kuchuloria T, Butsashvili M, Getia V, Metreveli D, Tsereteli M, Tsertsvadze T, Link-Gelles R, Millman AJ, Turdziladze A, Averhoff F. Screening and linkage to care for hepatitis C among inpatients in Georgia's national hospital screening program. Prev Med 2020; 138:106153. [PMID: 32473265 PMCID: PMC7440391 DOI: 10.1016/j.ypmed.2020.106153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/04/2020] [Accepted: 05/22/2020] [Indexed: 02/01/2023]
Abstract
The country of Georgia initiated an ambitious national hepatitis C elimination program. To facilitate elimination, a national hospital hepatitis C screening program was launched in November 2016, offering all inpatients screening for HCV infection. This analysis assesses the effectiveness of the first year of the screening program to identify HCV-infected persons and link them to care. Data from Georgia's electronic Health Management Information System and ELIMINATION-C treatment database were analyzed for patients aged ≥18 years hospitalized from November 1, 2016 to October 31, 2017. We described patient characteristics and screening results and compared linked-to-care patients to those not linked to care, defined as having a test for viremia following an HCV antibody (anti-HCV) positive hospital screening. Of 291,975 adult inpatients, 252,848 (86.6%) were screened. Of them, 4.9% tested positive, with a high of 17.4% among males aged 40-49. Overall, 19.8% of anti-HCV+ patients were linked to care, which differed by sex (20.6% for males vs. 18.4% for females; p = .019), age (23.9% for age 50-59 years vs. 10.7% for age ≥ 70 years; p < .0001), and length of hospitalization (21.8% among patients hospitalized for 1 day vs. 16.1% for those hospitalized 11+ days; p = .023). Redundant screening is a challenge; 15.6% of patients were screened multiple times and 27.6% of anti-HCV+ patients had a prior viremia test. This evaluation demonstrates that hospital-based screening programs can identify large numbers of anti-HCV+ persons, supporting hepatitis C elimination. However, low linkage-to-care rates underscore the need for screening programs to be coupled with effective linkage strategies.
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Affiliation(s)
- Shaun Shadaker
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA.
| | - Muazzam Nasrullah
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | | | - Jessica Ray
- Seattle Children's Hospital, Seattle, Washington, USA
| | | | | | | | - Vladimer Getia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Maia Tsereteli
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Ruth Link-Gelles
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - Alexander J Millman
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | | | - Francisco Averhoff
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
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Butsashvili M, Kamkamidze G, Kajaia M, Gvinjilia L, Kuchuloria T, Khonelidze I, Gogia M, Dolmazashvili E, Kerashvili V, Zakalashvili M, Shadaker S, Nasrullah M, Sonjelle S, Japaridze M, Averhoff F. Integration of hepatitis C treatment at harm reduction centers in Georgia-Findings from a patient satisfaction survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102893. [PMID: 32739613 DOI: 10.1016/j.drugpo.2020.102893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Georgia launched national HCV elimination program in 2015. PWID may experience barriers to accessing HCV care. To improve linkage to care among PWID, pilot program to integrate HCV treatment with HR services at opiate substitution therapy (OST) centers and needle syringe program (NSP) sites was initiated. Our study aimed to assess satisfaction of patients with integrated HCV treatment services at HR centers. METHODS Survey was conducted among convenience sample of patients receiving HCV treatment at 5 integrated care sites and 4 specialized clinics not providing HR services. Simplified pre-treatment diagnostic algorithm and treatment monitoring procedure was introduced for HCV treatment programs at OST/NSP centers which includes fewer pre-treatment and monitoring tests compared to standard algorithm. RESULTS In total, 358 patients participated in the survey - 48.6% receiving HCV treatment at the specialized clinics while 51.4% at HR site with integrated treatment. Similar proportions of surveyed patients at HR sites (88.0%) and clinics (84.5%) stated that they did not face any barriers to enrollment in the elimination program. Most patients from HR pilot sites and specialized clinics stated that they received comprehensive information about the treatment (98.4% vs 94.3%; p<0.010). 95% of respondents at both sites were confident that confidentiality was completely protected during treatment. Higher proportion of patients at pilot sites thought that HCV treatment services provided at facility were good compared to those from the specialized clinics (85.3% vs 81.0%). We found significant difference in the time to treatment, measured as average time from viremia testing to administration of first dose of HCV medication: 42.9% of patients at pilot sites vs 4.6% at specialized clinics received the first dose of medication within two weeks. CONCLUSION Quality of services and perceived satisfaction of patients receiving treatment, suggests that integration of HCV treatment with HR services is feasible.
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Affiliation(s)
- Maia Butsashvili
- Health Research Union/Clinic NEOLAB, 8 Nutsubidze str. Tbilisi 0177, Georgia.
| | - George Kamkamidze
- Health Research Union/Clinic NEOLAB, 8 Nutsubidze str. Tbilisi 0177, Georgia
| | - Maia Kajaia
- Health Research Union/Clinic NEOLAB, 8 Nutsubidze str. Tbilisi 0177, Georgia
| | | | | | - Irma Khonelidze
- National Center for Disease Control and Public Health, 99 Kakheti Highway, Tbilisi 0198, Georgia.
| | - Maka Gogia
- Georgia Harm Reduction Network, 24 Shartava str. 3rd floor, apt 6., Tbilisi, Georgia.
| | - Ekaterine Dolmazashvili
- Clinic HEPA, 18/20 Lubliana str. O. Gudushauri National Medical Center, 3rd floor. Tbilisi, Georgia
| | - Vakhtang Kerashvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, 16 Kazbegi Ave. Tbilisi 0162, Georgia
| | | | - Shaun Shadaker
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Muazzam Nasrullah
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Shilton Sonjelle
- Foundation for Innovative New Diagnostics, Campus Biotech, 9 Chemin des Mines, 1202 Geneva, Switzerland.
| | - Maia Japaridze
- Foundation for Innovative New Diagnostics, Campus Biotech, 9 Chemin des Mines, 1202 Geneva, Switzerland.
| | - Francisco Averhoff
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Kasradze A, Shadaker S, Kuchuloria T, Gamkrelidze A, Nasrullah M, Gvinjilia L, Baliashvili D, Chitadze N, Kodani M, Tejada-Strop A, Drobeniuc J, Hagan L, Morgan J, Imnadze P, Averhoff F. The burden and epidemiology of hepatitis B and hepatitis D in Georgia: findings from the national seroprevalence survey. Public Health 2020; 185:341-347. [PMID: 32738575 DOI: 10.1016/j.puhe.2020.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The burden of hepatitis B virus (HBV) and hepatitis D virus (HDV) infections is unknown in Georgia. This analysis describes the prevalence of hepatitis B and coinfection with HDV and the demographic characteristics and risk factors for persons with HBV infection in Georgia. STUDY DESIGN This is a cross-sectional seroprevalence study. METHODS A cross-sectional, nationwide survey to assess hepatitis B prevalence among the general adult Georgian population (age ≥18 years) was conducted in 2015. Demographic and risk behavior data were collected. Blood specimens were screened for anti-hepatitis B core total antibody (anti-HBc). Anti-HBc-positive specimens were tested for hepatitis B surface antigen (HBsAg). HBsAg-positive specimens were tested for HBV and HDV nucleic acid. Nationally weighted prevalence estimates and adjusted odds ratios (aORs) for potential risk factors were determined for anti-HBc and HBsAg positivity. RESULTS The national prevalence of anti-HBc and HBsAg positivity among adults were 25.9% and 2.9%, respectively. Persons aged ≥70 years had the highest anti-HBc positivity (32.7%), but the lowest HBsAg positivity prevalence (1.3%). Anti-HBc positivity was associated with injection drug use (aOR = 2.34; 95% confidence interval [CI] = 1.46-3.74), receipt of a blood transfusion (aOR = 1.68; 95% CI = 1.32-2.15), and sex with a commercial sex worker (aOR = 1.46; 95% CI = 1.06-2.01). HBsAg positivity was associated with receipt of a blood transfusion (aOR = 2.72; 95% CI = 1.54-4.80) and past incarceration (aOR = 2.72; 95% CI = 1.25-5.93). Among HBsAg-positive persons, 0.9% (95% CI = 0.0-2.0) were HDV coinfected. CONCLUSIONS Georgia has an intermediate to high burden of hepatitis B, and the prevalence of HDV coinfection among HBV-infected persons is low. Existing infrastructure for hepatitis C elimination could be leveraged to promote hepatitis B elimination.
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Affiliation(s)
- A Kasradze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - S Shadaker
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA.
| | | | - A Gamkrelidze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - M Nasrullah
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | | | - D Baliashvili
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - N Chitadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - M Kodani
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - A Tejada-Strop
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - J Drobeniuc
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - L Hagan
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - J Morgan
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - P Imnadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - F Averhoff
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
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Abstract
Background: Georgia is leading one of the world’s first hepatitis C (HCV) elimination programs alongside interventions to combat a HIV epidemic concentrated among high-risk groups. Although progress has been substantial, neither strategy accounts for the nearly 150,000 internally displaced persons residing in collective centers (CC-IDPs) who are susceptible to deeply integrated risk environments that could promote infection. Achieving dedicated goals for HCV elimination and HIV suppression requires a clear understanding of the risks facing CC-IDPs. Objectives: This literature review aims to consolidate what is known about the socio-economic and physical/mental health status of IDPs living in collective centers in Georgia, and to assess their vulnerability to HIV and HCV in light of local and global epidemiological trends. Methods: Sources were compiled from journal publications, reports by government ministries and transnational organizations, and the Integrated Household Survey database (2009–2018; updated annually by the National Statistics Office of Georgia) through manual searches in PUBMED, Google Scholar and Search, ProQuest, and digital repositories of government offices. Findings: Reports indicate that CC-IDPs are more susceptible to poverty, poor living conditions, mental illness, disability, substance use, and in some cases infectious disease; although, the correlation is not always present and subject to variability. These factors were linked to increased transmission and acquisition of HIV/HCV in both displacement and non-displacement contexts abroad. The geographic concentration of HIV/HCV in areas with greater clusters of CC-IDPs, and shared characteristics with local high-risk groups, indicate the possibility of inordinate transmission among CC-IDPs in Georgia. Conclusions: The disproportionate prevalence of psychosocial and clinical harms among CC-IDPs testifies to the serious potential of a greater burden of HIV and hepatitis C. Going forward, targeted research is needed to inform interventions and clarify the health status of CC-IDPs in Georgia.
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Bloch EM, Kipiani E, Shadaker S, Alkhazashvili M, Gvinjilia L, Kuchuloria T, Chitadze N, Keating SM, Gamkrelidze A, Turdziladze A, Getia V, Nasrullah M, Averhoff F, Izoria M, Skaggs B. Blood transfusion safety in the country of Georgia: collateral benefit from a national hepatitis C elimination program. Transfusion 2020; 60:1243-1252. [PMID: 32542715 DOI: 10.1111/trf.15815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/14/2020] [Accepted: 03/23/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND In April 2015, the government of Georgia (country) initiated the world's first national hepatitis C elimination program. An analysis of blood donor infectious screening data was conducted to inform a strategic plan to advance blood transfusion safety in Georgia. STUDY DESIGN AND METHODS Descriptive analysis of blood donation records (2015-2017) was performed to elucidate differences in demographics, donor type, remuneration status, and seroprevalence for infectious markers (hepatitis C virus antibody [anti-HCV], human immunodeficiency virus [HIV], hepatitis B virus surface antigen [HBsAg], and Treponema pallidum). For regression analysis, final models included all variables associated with the outcome in bivariate analysis (chi-square) with a p value of less than 0.05. RESULTS During 2015 to 2017, there were 251,428 donations in Georgia, representing 112,093 unique donors; 68.5% were from male donors, and 51.2% of donors were paid or replacement (friends or family of intended recipient). The overall seroprevalence significantly declined from 2015 to 2017 for anti-HCV (2.3%-1.4%), HBsAg (1.5%-1.1%), and T. pallidum (1.1%-0.7%) [p < 0.0001]; the decline was not significant for HIV (0.2%-0.1%). Only 41.0% of anti-HCV seropositive donors underwent additional testing to confirm viremia. Infectious marker seroprevalence varied by age, sex, and geography. In multivariable analysis, first-time and paid donor status were associated with seropositivity for all four infectious markers. CONCLUSION A decline during the study period in infectious markers suggests improvement in blood safety in Georgia. Areas that need further improvement are donor recruitment, standardization of screening and diagnostic follow-up, quality assurance, and posttransfusion surveillance.
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Affiliation(s)
- Evan M Bloch
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Eteri Kipiani
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Shaun Shadaker
- Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Lia Gvinjilia
- South Caucasus Office of the U.S. Centers for Disease Control (CDC), Tbilisi, Georgia
| | - Tinatin Kuchuloria
- South Caucasus Office of the U.S. Centers for Disease Control (CDC), Tbilisi, Georgia
| | | | - Sheila M Keating
- Vitalant Research Institute (formerly Blood Systems Research Institute), San Francisco, California, USA.,University of California San Francisco, San Francisco, California, USA
| | | | | | - Vladimer Getia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Muazzam Nasrullah
- Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Francisco Averhoff
- Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mariam Izoria
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Beth Skaggs
- South Caucasus Office of the U.S. Centers for Disease Control (CDC), Tbilisi, Georgia
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Averhoff F, Shadaker S, Gamkrelidze A, Kuchuloria T, Gvinjilia L, Sergeenko D, Butsashvili M, Tsertsvadze T, Sharvadze L, Zarkua J, Skaggs B, Nasrullah M, Nasrullah M. Progress and challenges of a pioneering hepatitis C elimination program in the country of Georgia. J Hepatol 2020; 72:680-687. [PMID: 31811882 PMCID: PMC7418146 DOI: 10.1016/j.jhep.2019.11.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Georgia, with a high prevalence of HCV infection, launched the world's first national hepatitis C elimination program in April 2015. A key strategy is the identification, treatment, and cure of the estimated 150,000 HCV-infected people living in the country. We report on progress and key challenges from Georgia's experience. METHODS We constructed a care cascade by analyzing linked data from the national hepatitis C screening registry and treatment databases during 2015-2018. We assessed the impact of reflex hepatitis C core antigen (HCVcAg) testing on rates of viremia testing and treatment initiation (i.e. linkage to care). RESULTS As of December 31, 2018, 1,101,530 adults (39.6% of the adult population) were screened for HCV antibody, of whom 98,430 (8.9%) tested positive. Of the individuals who tested positive, 78,484 (79.7%) received viremia testing, of whom 66,916 (85.3%) tested positive for active HCV infection. A total of 52,576 people with active HCV infection initiated treatment and 48,879 completed their course of treatment. Of the 35,035 who were tested for cure (i.e., sustained virologic response [SVR]), 34,513 (98.5%) achieved SVR. Reflex HCVcAg testing, implemented in March 2018, increased rates of monthly viremia testing by 97.5% among those who screened positive for anti-HCV, however, rates of treatment initiation decreased by 60.7% among diagnosed viremic patients. CONCLUSIONS Over one-third of people living with HCV in Georgia have been detected and linked to care and treatment, however, identification and linkage to care of the remaining individuals with HCV infection is challenging. Novel interventions, such as reflex testing with HCVcAg, can improve rates of viremia testing, but may result in unintended consequences, such as decreased rates of treatment initiation. Linked data systems allow for regular review of the care cascade, allowing for identification of deficiencies and development of corrective actions. LAY SUMMARY This report describes progress in Georgia's hepatitis C elimination program and highlights efforts to promote hepatitis C virus screening and treatment initiation on a national scale. Georgia has made progress towards eliminating hepatitis C, treating over 50,000 people, approximately one-third of the number infected, and achieving cure for 98.5% of those tested. However, identifying infected individuals and linking them to care remains challenging. Novel approaches to increase diagnostic testing can have unintended consequences further down the care cascade.
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Affiliation(s)
- Francisco Averhoff
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, Atlanta, Georgia, USA.
| | - Shaun Shadaker
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, Atlanta, USA
| | | | - Tatia Kuchuloria
- TEPHINET independent contractor for Georgia Hepatitis C Elimination Program
| | - Lia Gvinjilia
- TEPHINET independent contractor for Georgia Hepatitis C Elimination Program
| | - David Sergeenko
- Ministry of IDPs from the Occupied Territories, Labour, Health, and Social Affairs of Georgia, Tbilisi, Georgia
| | | | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Jaba Zarkua
- Hepatology and Gastroenterology Department, Medical Center Mrcheveli, Tbilisi, Georgia
| | - Beth Skaggs
- Division of Global Health Protection, Center for Global Health, South Caucasus Regional Office, Tbilisi, Georgia
| | - Muazzam Nasrullah
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, Atlanta, USA
| | - Muazzam Nasrullah
- Centers for Disease Control and Prevention, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention, Atlanta, Georgia, USA
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Walker JG, Kuchuloria T, Sergeenko D, Fraser H, Lim AG, Shadaker S, Hagan L, Gamkrelidze A, Kvaratskhelia V, Gvinjilia L, Aladashvili M, Asatiani A, Baliashvili D, Butsashvili M, Chikovani I, Khonelidze I, Kirtadze I, Kuniholm MH, Otiashvili D, Sharvadze L, Stvilia K, Tsertsvadze T, Zakalashvili M, Hickman M, Martin NK, Morgan J, Nasrullah M, Averhoff F, Vickerman P. Interim effect evaluation of the hepatitis C elimination programme in Georgia: a modelling study. Lancet Glob Health 2020; 8:e244-e253. [PMID: 31864917 PMCID: PMC7025283 DOI: 10.1016/s2214-109x(19)30483-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Georgia has a high prevalence of hepatitis C, with 5·4% of adults chronically infected. On April 28, 2015, Georgia launched a national programme to eliminate hepatitis C by 2020 (90% reduction in prevalence) through scaled-up treatment and prevention interventions. We evaluated the interim effect of the programme and feasibility of achieving the elimination goal. METHODS We developed a transmission model to capture the hepatitis C epidemic in Georgia, calibrated to data from biobehavioural surveys of people who inject drugs (PWID; 1998-2015) and a national survey (2015). We projected the effect of the administration of direct-acting antiviral treatments until Feb 28, 2019, and the effect of continuing current treatment rates until the end of 2020. Effect was estimated in terms of the relative decrease in hepatitis C incidence, prevalence, and mortality relative to 2015 and of the deaths and infections averted compared with a counterfactual of no treatment over the study period. We also estimated treatment rates needed to reach Georgia's elimination target. FINDINGS From May 1, 2015, to Feb 28, 2019, 54 313 patients were treated, with approximately 1000 patients treated per month since mid 2017. Compared with 2015, our model projects that these treatments have reduced the prevalence of adult chronic hepatitis C by a median 37% (95% credible interval 30-44), the incidence of chronic hepatitis C by 37% (29-44), and chronic hepatitis C mortality by 14% (3-30) and have prevented 3516 (1842-6250) new infections and averted 252 (134-389) deaths related to chronic hepatitis C. Continuing treatment of 1000 patients per month is predicted to reduce prevalence by 51% (42-61) and incidence by 51% (40-62), by the end of 2020. To reach a 90% reduction by 2020, treatment rates must increase to 4144 (2963-5322) patients initiating treatment per month. INTERPRETATION Georgia's hepatitis C elimination programme has achieved substantial treatment scale-up, which has reduced the burden of chronic hepatitis C. However, the country is unlikely to meet its 2020 elimination target unless treatment scales up considerably. FUNDING CDC Foundation, National Institute for Health Research, National Institutes of Health.
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Affiliation(s)
- Josephine G Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Tinatin Kuchuloria
- Centers for Disease Control and Prevention Foundation, Tbilisi, Georgia; TEPHINET, Tbilisi, Georgia
| | - David Sergeenko
- Ministry of Labor Health and Social Affairs of Georgia, Tbilisi, Georgia
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shaun Shadaker
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Liesl Hagan
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | | | - Lia Gvinjilia
- Centers for Disease Control and Prevention Foundation, Tbilisi, Georgia; TEPHINET, Tbilisi, Georgia
| | - Malvina Aladashvili
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Alexander Asatiani
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Davit Baliashvili
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Irma Khonelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Irma Kirtadze
- Addiction Research Center Alternative Georgia, Tbilisi, Georgia; Ilia State University, Faculty of Arts and Sciences, Institute of Addiction Studies, Tbilisi, Georgia
| | - Mark H Kuniholm
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY, USA
| | | | | | - Ketevan Stvilia
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Division of Infectious Diseases and Global Public Health, UC San Diego, California, USA
| | - Juliette Morgan
- Division of Global Health Protection, South Caucasus Centers for Disease Control and Prevention Office, Tbilisi, Georgia
| | - Muazzam Nasrullah
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francisco Averhoff
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Khetsuriani N, Chitadze N, Russell S, Ben Mamou M. Measles and rubella seroprevalence among adults in Georgia in 2015: helping guide the elimination efforts. Epidemiol Infect 2019; 147:e319. [PMID: 31822310 PMCID: PMC7003625 DOI: 10.1017/s0950268819002048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/23/2019] [Accepted: 11/07/2019] [Indexed: 11/16/2022] Open
Abstract
A large-scale measles outbreak (11 495 reported cases, 60% aged ≥15 years) occurred in Georgia during 2013-2015. A nationwide, multistage, stratified cluster serosurvey for hepatitis B and C among persons aged ≥18 years conducted in Georgia in late 2015 provided an opportunity to assess measles and rubella (MR) susceptibility after the outbreak. Residual specimens from 3125 participants aged 18-50 years were tested for Immunoglobulin G antibodies against MR using ELISA. Nationwide, 6.3% (95% CI 4.9%-7.6%) of the surveyed population were seronegative for measles and 8.6% (95% CI 7.1%-10.1%) were seronegative for rubella. Measles susceptibility was highest among 18-24 year-olds (10.1%) and declined with age to 1.2% among 45-50 year-olds (P < 0.01). Susceptibility to rubella was highest among 25-29 year-olds (15.3%), followed by 18-24 year-olds (11.6%) and 30-34 year-olds (10.2%), and declined to <5% among persons aged ≥35 years (P < 0.001). The susceptibility profiles in the present serosurvey were consistent with the epidemiology of recent MR cases and the history of the immunization programme. Measles susceptibility levels >10% among 18-24 year-olds in Georgia revealed continued risk for outbreaks among young adults. High susceptibility to rubella among 18-34 year-olds indicates a continuing risk for congenital rubella cases.
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Affiliation(s)
- N. Khetsuriani
- Global Immunization Division, Center for Global Health (CGH), Centers for Disease Control and Prevention (CDC), Atlanta, USA
- CDC South Caucasus Office, Tbilisi, Georgia
| | - N. Chitadze
- National Center for Disease Control and Public Health, Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia, Tbilisi, Georgia
| | - S. Russell
- Division of Global Health Protection, CGH, CDC, Atlanta, USA
| | - M. Ben Mamou
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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38
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Averhoff F, Lazarus JV, Sergeenko D, Colombo M, Gamkrelidze A, Tsertsvadze T, Butsashvili M, Metreveli D, Sharvadze L, Hellard M, Gnes S, Gabunia T, Nasrullah M. Excellence in viral hepatitis elimination - Lessons from Georgia. J Hepatol 2019; 71:645-647. [PMID: 31356831 DOI: 10.1016/j.jhep.2019.06.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 12/04/2022]
Affiliation(s)
- Francisco Averhoff
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD and TB Prevention, Atlanta, USA
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; European Association for the Study of the Liver (EASL) International Liver Foundation, Geneva, Switzerland
| | - David Sergeenko
- Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health, and Social Affairs of Georgia, Tbilisi, Georgia
| | - Massimo Colombo
- European Association for the Study of the Liver (EASL) International Liver Foundation, Geneva, Switzerland
| | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infection Diseases, AIDS, and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | | | - Lali Sharvadze
- Joint Georgian-French Hepatology Clinic Hepa, Tbilisi, Georgia
| | | | - Stefano Gnes
- European Association for the Study of the Liver (EASL) International Liver Foundation, Geneva, Switzerland
| | - Tamar Gabunia
- Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health, and Social Affairs of Georgia, Tbilisi, Georgia
| | - Muazzam Nasrullah
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD and TB Prevention, Atlanta, USA.
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39
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Chkhartishvili N, Bolokadze N, Rukhadze N, Dvali N, Abutidze A, Sharvadze L, Tsertsvadze T. Impact of hepatitis C virus antibody positivity on mortality and causes of death in people living with HIV in Georgia. Int J STD AIDS 2019; 30:1185-1193. [PMID: 31558133 DOI: 10.1177/0956462419866055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Hepatitis C co-infection in people living with HIV (PLWH) is common in Georgia. Antiretroviral therapy (ART) is widely available in the country since 2004, and from 2011, patients have unlimited access to hepatitis C virus (HCV) treatment. A retrospective nationwide cohort study included adult PLWH diagnosed between 2004–2016, who were followed up until 31 December 2017. Predictors of mortality were assessed in Cox proportional hazards regression model. A total of 4560 persons contributed 22,322 person-years (PY) of follow-up, including 2058 (45.1%, 10,676 PY) anti-HCV+ patients. After the median 4.1 years of follow-up, 954 persons died, including 615 anti-HCV+ patients. Persons with HCV had higher overall mortality compared to HIV monoinfection (5.76/100 PY vs. 2.91/100 PY, p < 0.0001). In multivariable analysis, anti-HCV positivity was significantly associated with mortality (adjusted hazard ratio: 1.42, 95% CI: 1.09–1.85). Among anti-HCV+ persons, liver-related mortality due to viral hepatitis before the availability of HCV therapy (2004–2011) was 2.11 cases per 100 PY and this decreased to 0.79 cases per 100 PY after 2011 (p < 0.0001). AIDS remained the leading cause of death prior to and after 2011. Wide availability of ART and anti-HCV therapy translated into a significant decline in mortality including due to liver-related causes. Improving earlier diagnosis will decrease excess AIDS-related mortality among people living with HIV/HCV co-infection.
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Affiliation(s)
| | - Natalia Bolokadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Nino Rukhadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Natia Dvali
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Akaki Abutidze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Lali Sharvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.,Faculty of medicine, Department of Infectious Diseases, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.,Faculty of medicine, Department of Infectious Diseases, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia
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40
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Stvilia K, Spradling PR, Asatiani A, Gogia M, Kutateladze K, Butsashvili M, Zarkua J, Tsertsvadze T, Sharvadze L, Japaridze M, Kuchuloria T, Gvinjilia L, Tskhomelidze I, Gamkrelidze A, Khonelidze I, Sergeenko D, Shadaker S, Averhoff F, Nasrullah M. Progress in Testing for and Treatment of Hepatitis C Virus Infection Among Persons Who Inject Drugs - Georgia, 2018. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:637-641. [PMID: 31344021 PMCID: PMC6660105 DOI: 10.15585/mmwr.mm6829a2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In April 2015, the country of Georgia, with a high prevalence of hepatitis C virus (HCV) infection (5.4% of the adult population, approximately 150,000 persons), embarked on the world's first national elimination program (1,2). Nearly 40% of these infections are attributed to injection drug use, and an estimated 2% of the adult population currently inject drugs, among the highest prevalence of injection drug use in the world (3,4). Since 2006, needle and syringe programs (NSPs) have been offering HCV antibody testing to persons who inject drugs and, since 2015, referring clients with positive test results to the national treatment program. This report summarizes the results of these efforts. Following implementation of the elimination program, the number of HCV antibody tests conducted at NSPs increased from an average of 3,638 per year during 2006-2014 to an average of 21,551 during 2015-2018. In 2017, to enable tracking of clinical outcomes among persons who inject drugs, NSPs began encouraging clients to voluntarily provide their national identification number (NIN), which all citizens must use to access health care treatment services. During 2017-2018, a total of 2,780 NSP clients with positive test results for HCV antibody were identified in the treatment database by their NIN. Of 494 who completed treatment and were tested for HCV RNA ≥12 weeks after completing treatment, 482 (97.6%) were cured of HCV infection. Following the launch of the elimination program, Georgia has made much progress in hepatitis C screening among persons who inject drugs; recent data demonstrate high cure rates achieved in this population. Testing at NSPs is an effective strategy for identifying persons with HCV infection. Tracking clients referred from NSPs through treatment completion allows for monitoring the effectiveness of linkage to care and treatment outcomes in this population at high risk, a key to achieving hepatitis C elimination in Georgia. The program in Georgia might serve as a model for other countries.
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Russell S, Sturua L, Li C, Morgan J, Topuridze M, Blanton C, Hagan L, Salyer SJ. The burden of non-communicable diseases and their related risk factors in the country of Georgia, 2015. BMC Public Health 2019; 19:479. [PMID: 32326912 PMCID: PMC6696664 DOI: 10.1186/s12889-019-6785-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Non-communicable diseases (NCDs), mainly cardiovascular diseases, are a substantial cause of mortality in the country of Georgia, accounting for approximately 93% of all deaths (standardized mortality rate 630.7 deaths per 100,000 persons per year) and an important threat to health security. We conducted a nationally representative survey examining the prevalence of NCDs and their risk factors as part of a 2015 Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) serosurvey. Methods We conducted a cross-sectional serosurvey among adults aged ≥18 years using a stratified, multi-stage cluster design (n = 7000). We asked participants standardized questions from the Global Adult Tobacco Survey and the WHO STEPwise approach to Surveillance (STEPS) Survey. We also measured blood pressure and Body Mass Index for each participant. Weighted frequencies were computed for NCD and risk factor prevalence and compared to 2010 STEPS results. Results Georgians reported high rates of smoking, alcohol use, elevated blood pressure, obesity, diabetes and cardiovascular disease. An estimated 27.1% (95% confidence interval [CI]: 25.3, 28.8%) of adults (51.5% of men and 6.0% of women) reported daily use of tobacco products and 27.5% (95% CI: 25.7, 29.2%) of adults (52.1% of men and 7.0% of women) reported binge drinking within the last 30 days. Physical measurements revealed that 37.5% (95% CI: 35.8, 39.3%) of adults had elevated blood pressure and 33.4% (95% CI: 31.8, 35.0%) had obesity. 5.4% (95% CI: 4.6, 6.2%) of adults had self-reported diagnosed diabetes and 15.3% (95% CI: 14.1, 16.6%) had self-reported diagnosed cardiovascular disease. From 2010 to 2015, the prevalence of obesity increased by 8.3 percentage points (95% CI: 5.9, 10.7%; p < 0.01) and the prevalence of elevated blood pressure increased by 4.1 percentage points (95% CI: 1.4, 6.8%; p < 0.01). Conclusions Georgia has a high NCD burden, and results from the survey showed an increase in obesity and elevated blood pressure since 2010. The prevalence of other major NCDs have remained near levels reported in the 2010 STEPs survey. Comprehensive public health interventions are needed to control the heath security threats of major NCDs and their risk factors in the future. Electronic supplementary material The online version of this article (10.1186/s12889-019-6785-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven Russell
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
| | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Chaoyang Li
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA
| | - Juliette Morgan
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA.,Global Disease Detection - South Caucasus Regional Center, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | - Marina Topuridze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Curtis Blanton
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 3005 Chamblee Tucker Rd, Atlanta, GA, 30341, USA
| | - Liesl Hagan
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, 3 Corporate Blvd NE, Atlanta, GA, 30329, USA
| | - Stephanie J Salyer
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, USA.
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Harris AM, Chokoshvili O, Biddle J, Turashvili K, Japaridze M, Burjanadze I, Tsertsvadze T, Sharvadze L, Karchava M, Talakvadze A, Chakhnashvili K, Demurishvili T, Sabelashvili P, Foster M, Hagan L, Butsashvili M, Morgan J, Averhoff F. An evaluation of the hepatitis C testing, care and treatment program in the country of Georgia's corrections system, December 2013 - April 2015. BMC Public Health 2019; 19:466. [PMID: 32326938 PMCID: PMC6696696 DOI: 10.1186/s12889-019-6783-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The country of Georgia has a high burden of chronic hepatitis C virus (HCV) infection, and prisoners are disproportionately affected. During 2013, a novel program offering no cost screening and treatment of HCV infection for eligible prisoners was launched. METHODS The HCV treatment program implemented a voluntary opt-in anti-HCV testing policy to all prisoners. Anti-HCV positive persons received HCV RNA and genotype testing. Transient elastography was also performed on prisoners with positive HCV RNA results. Prisoners with chronic HCV infection who had ≥F2 Metavir stage for liver fibrosis and a prison sentence ≥ 6 months were eligible for interferon-based treatment, which was the standard treatment prior to 2015. We conducted an evaluation of the HCV treatment program among prisoners from the program's inception in December 2013 through April 2015 by combining data from personal interviews with corrections staff, prisoner data in the corrections database, and HCV-specific laboratory information. RESULTS Of an estimated 30,000 prisoners who were incarcerated at some time during the evaluation period, an estimated 13,500 (45%) received anti-HCV screening, of whom 5175 (38%) tested positive. Of these, 3840 (74%) received HCV RNA testing, 2730 (71%) tested positive, and 880 (32%) met treatment eligibility. Of these, 585 (66%) enrolled; 405 (69%) completed treatment, and 202 (50%) achieved a sustained virologic response at least 12 weeks after treatment completion. CONCLUSIONS HCV infection prevalence among Georgian prisoners was high. Despite challenges, we determined HCV treatment within Georgian Ministry of Correction facilities was feasible. Efforts to address HCV infection among prison population is one important component of HCV elimination in Georgia.
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Affiliation(s)
- Aaron M. Harris
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS: G37, Atlanta, GA 30329 USA
| | - Otar Chokoshvili
- Infectious diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Joshua Biddle
- Hubert Fellowship, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
| | | | - Maia Japaridze
- Global Disease Detection, Division of Global Health Protection, Centers for Disease Control and Prevention, Tbilisi, Georgia
| | - Irma Burjanadze
- National Center for Disease Control and Public Health of Georgia, Ministry of Labour Health and Social Affairs (MoLHSA) of Georgia, Tbilisi, Georgia
| | - Tengiz Tsertsvadze
- Infectious diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Lali Sharvadze
- Infectious diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | - Marine Karchava
- Infectious diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia
| | | | | | | | | | - Monique Foster
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS: G37, Atlanta, GA 30329 USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Liesl Hagan
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS: G37, Atlanta, GA 30329 USA
| | | | - Juliette Morgan
- Global Disease Detection, Division of Global Health Protection, Centers for Disease Control and Prevention, Tbilisi, Georgia
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Francisco Averhoff
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS: G37, Atlanta, GA 30329 USA
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