National Progress Toward Hepatitis C Elimination — Georgia, 2015–2016

Gvinjilia, Lia; Nasrullah, Muazzam; Sergeenko, David; Tsertsvadze, Tengiz; Kamkamidze, George; Butsashvili, Maia; Gamkrelidze, Amiran; Imnadze, Paata; Kvaratskhelia, Valeri; Chkhartishvili, Nikoloz; Sharvadze, Lali; Drobeniuc, Jan; Hagan, Liesl M.; Ward, John W.; Morgan, Juliette; Averhoff, Francisco

doi:10.15585/mmwr.mm6541a2

Cited by 57 publications

(59 citation statements)

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“…A recent study of PWID on OAT, but for whom the majority had urine drug testing that was positive for active drug use throughout treatment, reported high levels (>90%) of SVR (Dore et al, 2016). Although a large HCV elimination project that is receiving massive amounts of external funding is underway in Georgia (Gvinjilia et al, 2016), to our knowledge, this is the largest real-world implementation assessment of HCV treatment of PWID in Eastern Europe and Central Asia. Unlike the HCV elimination project in Georgia where occupationally-exposed persons and those with advanced liver disease were treated first, SVR rates in our sample were 86%, compared to 82% in Georgia.…”

Section: Discussionmentioning

confidence: 99%

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

Mazhnaya

Meteliuk

Barnard

et al. 2017

International Journal of Drug Policy

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Background HCV prevalence estimates among people who inject drugs (PWID) in Ukraine is high (60%-90%), yet barriers to HCV treatment and care remain substantial including limited access to direct acting antiviral (DAA) medications. A feasibility scale-up project implemented HCV treatment in community-based settings to improve access to DAA treatment for key populations in this context. Methods Using program-level data and verified medical records, we describe the development, implementation processes and outcomes for HCV treatment for PWID and other risks groups. Most participants (76%) received a combination of sofosbuvir, pegylated interferon, and ribavirin for 12 weeks. Treatment enrollment started in June 2015; the first two waves are reported. Data on demographics, HIV characteristics, HCV genotype and RNA levels, including sustained virologic response (SVR) were obtained from verified medical records. We used logistic regression to examine the independent correlates of achieving a SVR. Results The project was implemented in 19 healthcare institutions from 16 regions of Ukraine, mainly within AIDS specialty centers. Our analytical sample included 1,126 participants who were mostly men (73%) and the majority were HIV co-infected (79%). Treatment retention was 97.7% and the proportion of participants who achieved SVR for the 1,029 (91%) with complete data was 94.3% (95% CI 92.8%–95.7%). PWID who were currently injecting had comparable SVR rates (89.2%, 95% CI 81.5–94.5%) to PWID not injecting (94.4%, 95% CI 92.4–96.1), PWID on methadone (94.4%, 95%CI 92.4–96.1), and ‘other’ risk group (95.2%, 95% CI 91.3–97.7). Independent factors associated with achieving a SVR were females sex (AOR: 3.44, 95% CI 1.45–8.14), HCV genotype 3 (AOR: 4.57, 95% CI 1.97 - 10.59) compared to genotype 1. SVR rates in PWID actively injecting did not differ significantly from any other group. Conclusion Both patient-level and structural factors influence HCV treatment scale-up in Ukraine, but patient-level outcomes confirm high levels of achieving SVR in PWID, irrespective of injection and treatment status.

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Section: Discussionmentioning

confidence: 99%

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

Mazhnaya

Meteliuk

Barnard

et al. 2017

International Journal of Drug Policy

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“…Another model study in our series shows that managing HCV in prisons can make a substantial contribution to reducing transmission in the community [20]. Several countries, such as Australia, France, Georgia and Portugal, have already announced and started national HCV elimination campaigns, increasing the number of HCV treatments available and removing any restrictions on access [21,22]. There are great opportunities, therefore, to generate robust evidence on how to prevent HCV transmission and HCV-related morbidity in PWID and in the population.…”

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confidence: 88%

New developments and opportunities for preventing hepatitis C virus (HCV) among people who use and inject drugs-announcing anAddictionseries

et al. 2017

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We announce a new series for Addiction on HCV (hepatitis C virus). This is prompted by the changing treatment and prevention landscape and syndemic of HCV and drug use, specifically concerning people who inject drugs (PWID). In some developing countries more than 80% of HCV is among people with a history of drug injection; globally, almost 40% of HCV burden is attributable to injecting drug use and in many countries one in two PWID are likely to be living with HCV [1][2][3]. HCV is an important cause of liver disease, along with alcohol, hepatitis B virus (HBV) and metabolic causes, and the only one that can be cured easily [4]. There is no vaccine available for HCV. However, new HCV anti-viral drugs-so-called direct-acting anti-virals (DAAs)-are highly tolerable, of short duration (8-12 weeks) and can cure the disease in the vast majority of cases, with trials involving PWID reporting more than 90% cure rates [5][6][7].These advancements have raised excitement around the possibility of using HCV treatment as Prevention (TasP). Globally, however, very few PWID are treated for their HCV. Although the cost of DAA therapies can be high, health economic models suggest that prioritizing PWID for early HCV treatment because of the prevention benefits is likely to be cost-effective [8]. In addition, there is strengthening empirical evidence that primary prevention interventions such as opioid substitution treatment (OST) and needle and syringe programmes (NSP) can reduce HIV and HCV [9][10][11][12]. However, theoretical model projections suggest that substantial reductions in HCV transmission among PWID will require both traditional harm reduction/primary prevention and HCV treatment scale-up [13,14]. The ease of administration of these new DAA therapies means that they could be delivered by non-specialists in the community and within drug treatment services, leading to the recommendation that HCV treatment, drug treatment and prevention services should be integrated, which may have advantages and disadvantages in the way that drug treatment services are delivered [15].International clinical guidelines recommend that people at risk of transmitting HCV are treated for HCV [16][17][18]. The World Health Organization Global Health Sector Strategy (GHSS) on Viral Hepatitis has set a challenging goal of eliminating viral hepatitis as a major public health threat by 2030, reducing new chronic infections by 90% and mortality by 65%. In most countries these targets can be achieved only through scaling-up both OST, NSP and HCV treatment for PWID, as highlighted in a recent paper (the first in our series) on HCV in Greece [19]. Another model study in our series shows that managing HCV in prisons can make a substantial contribution to reducing transmission in the community [20]. Several countries, such as Australia, France, Georgia and Portugal, have already announced and started national HCV elimination campaigns, increasing the number of HCV treatments available and removing any restrictions on access [21,22]. There are great o...

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“…The World Health Organization (WHO) adopted the first global health sector strategy on viral hepatitis (SVH) in 2016, which recognized viral hepatitis as an international public health priority and proposed eliminating it as a major public health threat by 2030 3 . Prior to this, the republic of Georgia, which has one of the highest prevalences of HCV globally (5.4% chronic infection prevalence among adults in 2015 5 ), launched the first national HCV elimination program 6 , aiming to reduce HCV prevalence by 90% by 2020.…”

Section: Introductionmentioning

confidence: 99%

Interim impact evaluation of the hepatitis C virus elimination program in Georgia

Walker

Lim

Fraser

et al. 2018

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Background and Aims: Georgia has one of the highest hepatitis C virus (HCV) prevalence rates in the world, with >5% of the adult population (~150,000 people) chronically infected. In April 2015, the Georgian government, in collaboration with CDC and other partners, launched a national program to eliminate HCV through scaling up HCV treatment and prevention interventions, with the aim of achieving a 90% reduction in prevalence by 2020. We evaluate the interim impact of the HCV treatment program as of 31 October 2017, and assess the feasibility of achieving the elimination goal by 2020.Method: We developed a dynamic HCV transmission model to capture the current and historical epidemic dynamics of HCV in Georgia, including the main drivers of transmission. Using the 2015 national sero-survey and prior surveys conducted among people who inject drugs (PWID) from 1997-2015, the model was calibrated to data on HCV prevalence by age, gender and PWID status, and the age distribution of PWID. We use the model to project the interim impact of treatment strategies currently being undertaken as part of the ongoing Georgia HCV elimination program, while accounting for treatment failure/loss to follow up, in order to determine whether they are on track to achieving their HCV elimination target by 2020, or whether strategies need to be modified to ensure success.

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National Progress Toward Hepatitis C Elimination — Georgia, 2015–2016

Cited by 57 publications

References 4 publications

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

Implementing and scaling up HCV treatment services for people who inject drugs and other high risk groups in Ukraine: An evaluation of programmatic and treatment outcomes

New developments and opportunities for preventing hepatitis C virus (HCV) among people who use and inject drugs-announcing anAddictionseries

Interim impact evaluation of the hepatitis C virus elimination program in Georgia

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