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Shilton S, Markby J, Japaridze M, Chihota V, Shadaker S, Gvinjilia L, Tsereteli M, Alkhazashvili M, Butsashvili M, Stvilia K, Ruiz RJ, Asatiani A, Adamia E, Easterbrook P, Khonelidze I, Gamkrelidze A. Feasibility and effectiveness of HCV viraemia testing at harm reduction sites in Georgia: A prospective three-arm study. Liver Int 2022; 42:775-786. [PMID: 35129278 PMCID: PMC9306782 DOI: 10.1111/liv.15191] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/03/2021] [Accepted: 01/25/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS In 2015, Georgia began a hepatitis C virus (HCV) elimination programme. Although screening programmes have been decentralized for high-risk groups, viraemic testing remains a bottleneck for people who inject drugs. Here, we describe two models of viraemic testing that aimed to address this gap. METHODS We assigned eight harm reduction sites (HRS) to one of three arms (2,1:1): Xpert HCV viral load testing on-site, blood draw on-site with centralized HCV core antigen testing (HCVcAg), or standard-of-care (SOC) referral with viremia testing performed at treatment centres. RESULTS 1671 HCV-seropositive participants were enrolled (Xpert, 37.1%; HCVcAg, 29.1%; referral, 33.8%). Participants were predominantly male (95.4%), mean age (IQR) 43 (37, 50) years and 1290 (77.2%) were currently injecting drugs. Significantly higher proportions of participants in the Xpert (100%) and HCVcAg (99.8%) arms received viraemia testing compared with the referral arm (91.3%) (Xpert vs referral, p < 0.0001; HCVcAg vs referral, p < 0.0001). Among viraemic participants, treatment uptake was similar (Xpert, 84.0%; HCVcAg, 79.5%; referral, 88.4%). The time between screening and sample collection for viraemia testing was significantly longer in the referral arm compared with both Xpert and HCVcAg arms (median 1 day compared with 0 days respectively), and the overall time between screening to treatment initiation was longer for the referral arm (median 67 days) compared with both Xpert and HCVcAg arms (median 57 and 50 days respectively). CONCLUSIONS Point-of-care viraemia testing and blood drawn on-site for HCVcAg testing yielded more HCV-seropositive patients receiving viraemic testing within a shorter timeframe compared with referrals.
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Affiliation(s)
| | - Jessica Markby
- Foundation for Innovative New DiagnosticsGenevaSwitzerland
| | - Maia Japaridze
- Foundation for Innovative New DiagnosticsGenevaSwitzerland
| | - Violet Chihota
- Foundation for Innovative New DiagnosticsGenevaSwitzerland,Present address:
Aurum InstituteParktownSouth Africa,Present address:
School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa
| | - Shaun Shadaker
- US Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Lia Gvinjilia
- Training Programs in Epidemiology and Public Health Interventions NetworkDecaturGeorgiaUSA
| | - Maia Tsereteli
- National Center for Disease Control and Public HealthTbilisiGeorgia
| | | | | | - Ketevan Stvilia
- National Center for Disease Control and Public HealthTbilisiGeorgia
| | - Ryan Jose Ruiz
- Foundation for Innovative New DiagnosticsGenevaSwitzerland
| | | | - Ekaterine Adamia
- Ministry of Health, Labour and Social Affairs of GeorgiaTbilisiGeorgia
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Irma Khonelidze
- National Center for Disease Control and Public HealthTbilisiGeorgia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Verulava T, Asatiani A, Tirkia J, Ambroliani G, Jorbenadze R. STUDENTS POPULATION'S ATTITUDE CONCERNING ENVIRONMENTAL ISSUES IN GEORGIA. Georgian Med News 2019:150-155. [PMID: 31687969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The aim of this study were to investigate the attitude of university students on the environmental issues, analyze the information received and develop measures for the participation of students in environmental health-improving and preventive activities.. The qualitative study was conducted by using face to face interviewing method with university students. Environmental pollution is one of the most important threats in Georgia and arount the world. The immediate objects of pollution are land, water, soil, air, which directly affects human health and worsens it. The participants have favorable attitudes toward the environment, but they are less involved in environmental activities. Basically these measures are limited to the so-called one-time campaigns. Based on the results, it is recommended the development of integrated measures and schemes to stimulate student participation in the implementation of socially active algorithms to improve the environment.
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Affiliation(s)
- T Verulava
- 1I. Javakhishvili Tbilisi State University, Faculty of Social and Political Science; 3G. Chapidze Emergency Cardiology Center, Tbilisi, Georgia
| | - A Asatiani
- 1I. Javakhishvili Tbilisi State University, Faculty of Social and Political Science
| | - J Tirkia
- 1I. Javakhishvili Tbilisi State University, Faculty of Social and Political Science
| | | | - R Jorbenadze
- 3G. Chapidze Emergency Cardiology Center, Tbilisi, Georgia
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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 Morb Mortal Wkly Rep 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] [What about the content of this article? (0)] [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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