Interim effect evaluation of the hepatitis C elimination programme in Georgia: a modelling study

Walker, Josephine G.; Kuchuloria, Tinatin; Sergeenko, David; Fraser, Hannah; Lim, Aaron G.; Shadaker, Shaun; Hagan, Liesl M.; Gamkrelidze, Amiran; Kvaratskhelia, Valeri; Gvinjilia, Lia; Aladashvili, Malvina; Asatiani, Alexander; Baliashvili, Davit; Butsashvili, Maia; Chikovani, Ivdity; Khonelidze, Irma; Kirtadze, Irma; Kuniholm, Mark H.; Otiashvili, David; Sharvadze, Lali; Stvilia, Ketevan; Tsertsvadze, Tengiz; Zakalashvili, Mamuka; Hickman, Matthew; Martin, Natasha K.; Morgan, Juliette; Nasrullah, Muazzam; Averhoff, Francisco; Vickerman, Peter

doi:10.1016/s2214-109x(19)30483-8

Cited by 19 publications

(28 citation statements)

References 28 publications

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“…We can trace, for example, modelled evidence of treatment-asprevention into global as well as national viral elimination strategies (WHO, 2014(WHO, , 2016bCommonwealth of Australia, 2016;All-Party Parliamentary Group on Liver Health, 2018;Health Protection Scotland, 2019). Moreover, not only do models shape the invention of targets but they are put-to-use and calibrated in relation to these as a means of projecting the interventions and investments required to actualise elimination promise (Razavi et al, 2017(Razavi et al, , 2019Scott et al, 2017Scott et al, , 2018Ward et al, 2018;Gountas et al, 2018;Hefferman et al, 2019;Kwon et al, 2019;Walker et al, 2019). There is then, a recursive relationship between models which evidence-make elimination potential, the invention of viral elimination targets, and models which evidence elimination progress in relation to these.…”

Section: Models and Targets In Viral Eliminationmentioning

confidence: 99%

How to think with models and targets: Hepatitis C elimination as a numbering performance

Rhodes

Lancaster

2021

International Journal of Drug Policy

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The field of public health is replete with mathematical models and numerical targets. In the case of disease eliminations, modelled projections and targets play a key role in evidencing elimination futures and in shaping actions in relation to these. Drawing on ideas within science and technology studies, we take hepatitis C elimination as a case for reflecting on how to think with mathematical models and numerical targets as 'performative actors' in evidence-making. We focus specifically on the emergence of 'treatment-as-prevention' as a means to trace the social and material effects that models and targets make, including beyond science. We also focus on how enumerations are made locally in their methods and events of production. We trace the work that models and targets do in relation to three analytical themes: governing; affecting; and enacting. This allows us to situate models and targets as technologies of governance in the constitution of health, which affect and are affected by their material relations, including in relation to matters-of-concern which extend beyond calculus. By emphasising models and targets as enactments, we draw attention to how these devices give life to new enumerated entities, which detach from their calculative origins and take flight in new ways. We make this analysis for two reasons: first, as a call to bring the social and enumeration sciences closer together to speculate on how we might think with models and targets differently and more carefully; and second, to encourage an approach to science which treats evidencing-making interventions, such as models and targets, as performative and political.

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Section: Models and Targets In Viral Eliminationmentioning

confidence: 99%

How to think with models and targets: Hepatitis C elimination as a numbering performance

Rhodes

Lancaster

2021

International Journal of Drug Policy

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“…Identification of HCV infection among the remaining population appears to be challenging. According to a recent model based on the Georgia data, in 2019, mortality was reduced by 14% and both prevalence and incidence were reduced by 37%[ 16 ].…”

Section: Micro-elimination In Different Geographical Locationsmentioning

confidence: 99%

Hepatitis C virus micro-elimination: Where do we stand?

Mangia¹,

Cotugno²,

Cocomazzi³

et al. 2021

WJG

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Hepatitis C virus (HCV) elimination by 2030, using direct-acting antiviral treatments, has been promoted by the World Health Organization. This achievement is not attainable, however, particularly after the 2020 pandemic of the coronavirus disease 2019. Consequently, the more realistic objective of eliminating HCV from population segments for which targeted strategies of prevention and treatment are easily attained has been promoted in Europe, as a valid alternative. The underlying idea is that micro-elimination will ultimately lead to macro-elimination. The micro-elimination strategy may target different specific populations and at-risk groups. Different settings, including prisons and hospitals, have also been identified as micro-elimination scenarios. In addition, dedicated micro-elimination strategies have been designed that are tailored at the geographical level according to HCV epidemiology and individual country’s income. The main elements of a valid and successful micro-elimination project are reliable epidemiological data and active involvement of all the stakeholders. Community involvement represents another essential component for a successful program.

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“…The goal of the program is 90% reduction in hepatitis C prevalence by 2020 5 . Georgia has achieved substantial treatment scale‐up with the implementation of the hepatitis C elimination program, which has reduced the prevalence of chronic hepatitis C infection among adults by 37%, the incidence by 37%, and mortality by 14% 6 …”

Section: Introductionmentioning

confidence: 99%

Assessment of treatment options for patients with hepatitis C virus recombinant form 2k/1b

Zakalashvili¹,

Zarkua²,

Gish

et al. 2020

Hepatology Research

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Aim Hepatitis C virus (HCV) intergenotype recombinant form (RF) 2k/1b has been actively circulating in HCV‐infected patients, and the prevalence of this RF virus in the Republic of Georgia is one of the highest reported worldwide. The aim of this study was to define the optimal treatment regimen for patients with RF_2k/1b. Methods We analyzed the data of 2735 patients who started treatment at the Medical Center Mrcheveli within Georgia's hepatitis C elimination program from May 2015 through December 2019. The patients were treated with sofosbuvir (SOF)‐based regimens. For identification of RF_2k/1b variants, refinement of standard (INNO‐LiPA) genotyping results for all patient samples assigned the unspecific HCV genotypes (GT) 2a/2c was carried out by sequencing of core and non‐structural protein 5B genes. Results Overall, 444 patients, representing 66% of GT2 and 16% of the total samples, were RF_2k/1b. Treatment of patients with RF_2k/1b with SOF/ledipasvir and SOF/velpatasvir was highly effective and viral cure rates did not differ among genotypes treated with the same regimen: RF_2k/1b, 99% (343/346); GT1, 99% (876/885); GT2, 96% (156/162); and GT3, 99% (545/552). A separate comparison analysis of sustained virologic response rate, treated with SOF plus ribavirin, showed significantly higher sustained virologic response (96%) in patients with confirmed GT2 (by sequencing) compared to unspecified GT2 (by INNO‐LiPA) (79%) (P < 0.05). Conclusion Sofosbuvir‐based regimens are highly effective for treatment of RF 2k/1b patients, and with availability of new pan‐genotypic direct‐acting antivirals, genotyping to identify RF 2k/1b patients might not be necessary.

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Interim effect evaluation of the hepatitis C elimination programme in Georgia: a modelling study

Cited by 19 publications

References 28 publications

How to think with models and targets: Hepatitis C elimination as a numbering performance

How to think with models and targets: Hepatitis C elimination as a numbering performance

Hepatitis C virus micro-elimination: Where do we stand?

Assessment of treatment options for patients with hepatitis C virus recombinant form 2k/1b

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