Progress and challenges of a pioneering hepatitis C elimination program in the country of Georgia

Averhoff, Francisco; Shadaker, Shaun; Gamkrelidze, Amiran; Kuchuloria, Tinatin; Gvinjilia, Lia; Getia, Vladimer; Sergeenko, David; Butsashvili, Maia; Tsertsvadze, Tengiz; Sharvadze, Lali; Zarkua, Jaba; Skaggs, Beth; Nasrullah, Muazzam

doi:10.1016/j.jhep.2019.11.019

Cited by 42 publications

(49 citation statements)

References 16 publications

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“…Indeed, their respone demonstrated the strength of their public health system in terms of diagnostic capability and supportive care for COVID-19 cases. This was likely helped by recent investments related to the national initiative to eliminate Hepatitis C virus, including improvements in diagnostic facilities and training pathways for primary care doctors 32 . Unfortunately, though, from September 2020 case numbers have increased drastically in Georgia, with only 1,510 cumulative cases reported up to 1 September but nearly 228,000 cases by end of the year 33 .…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and transmission of COVID-19 in cases and close contacts in Georgia in the first four months of the epidemic

Walker

Tskhomelidze

Trickey

et al. 2021

Preprint

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Background Between February and June 2020, 917 COVID-19 cases and 14 COVID-19-related deaths were reported in Georgia. Early on, Georgia implemented non-pharmaceutical interventions (NPI) including extensive contact tracing and restrictions on movement. Aim To characterize the demographics of those tested and infected with COVID-19 in Georgia; to evaluate factors associated with transmission between cases and their contacts; and to determine how transmission varied due to NPI up to 24 June 2020. Methods We use data gathered by the Georgian National Center for Disease Control on all polymerase chain reaction tests conducted (among symptomatic patients, through routine testing and contact tracing); hospitalization data for confirmed cases, and contact tracing data. We calculated the number of contacts per index case, the secondary attack rate (% contacts infected), and effective R number (new cases per index case), and used logistic regression to estimate how age, gender, and contact type affected transmission. Results Most contacts and transmission events were between family members. Contacts <40 years were less likely to be infected, while infected individuals >50 were more likely to die than younger patients. Contact tracing identified 917 index cases with mean 3.1 contacts tested per case, primarily family members. The overall secondary attack rate was 28% (95% confidence interval [CI]: 26-29%) and effective R number was 0.87 (95%CI 0.81-0.93), peaking at 1.1 (95%CI 0.98-1.2) during the period with strongest restrictions. Conclusion Georgia effectively controlled the COVID-19 epidemic in its early stages, although evidence does not suggest transmission was reduced during the strict lockdown period.

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Section: Discussionmentioning

confidence: 99%

Epidemiology and transmission of COVID-19 in cases and close contacts in Georgia in the first four months of the epidemic

Walker

Tskhomelidze

Trickey

et al. 2021

Preprint

Self Cite

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“…Regarding HCV infection, some locations such as Egypt 39 and Georgia 40 are on track to control hepatitis C. Both governments have deployed massive efforts in the fight against hepatitis C over the past years. These programmes have been successful because they have engaged civil society, political actors, industry and funders, as well as used existing platforms of care (for example, for tuberculosis or HIV) involving health-care workers in decentralized areas.…”

Section: MLmentioning

confidence: 99%

Progress towards elimination goals for viral hepatitis

Cox

El-Sayed

Kao

et al. 2020

Nat Rev Gastroenterol Hepatol

143

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Is elimination of viral hepatitis by 2030 feasible? Andrea L. Cox. Hepatitis B virus (HBV) and hepatitis C virus (HCV) combined are among the top four global infectious disease killers alongside tuberculosis, malaria and HIV 1. Although the number of people in the world dying from HIV, tuberculosis and malaria have all declined since 2008, global deaths from chronic HBV and HCV infection continue to rise, with more than 1.4 million deaths each year 1. Globally, HBV-related liver disease represents the seventh highest cause of mortality worldwide 2. Given this burden, viral hepatitis elimination should be a priority. However, available evidence demonstrates that global viral hepatitis elimination by 2030 is highly unlikely. Rates of hepatitis B and C diagnosis are very low, averaging 8% and 18%, respectively, globally 1. Although some regions are approaching prophylaxis and prevalence targets for HBV infection, studies suggest that all regions must substantially scale up rates of diagnosis and access to treatment to meet the global targets 3-5. For HCV infection, 80% of high-income countries are not on track to meet HCV elimination targets by 2030, and 67% will

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“…Having a high prevalence rate of HCV infection at that time, a key strategy with strong commitment, solid cooperation of HCPs/workers, and pragmatic approaches of virus identification, linkage to treatment, and cure for an estimated 150,000 HCV-infected individuals was designed and initiated. Afterward, at the end of 2018, more than one million adult individuals (i.e., 40% of the adult population of the country) have been screened for anti-HCV Abs, and of whom 8.9% participants were found HCV seropositive [ 118 ]. Eighty percent were tested for HCV RNA confirmation, of whom 85.3% tested positive for active HCV infection with detectable HCV RNA.…”

Section: The Real-world Clinical Performance Of Current Hcv Diagnostic Algorithmsmentioning

confidence: 99%

“…The virological surveillance data predicts that from 2015 to 2018, over one-third HCV infected individuals in Georgia were diagnosed with HCV, linked to care, and treatment. However, despite adopting this concrete HCV macro-elimination strategy at the national level, Georgia is still facing the challenge to bring the remaining individuals presumably living with HCV to linkage to care and treatment [ 117 , 118 ].…”

Section: The Real-world Clinical Performance Of Current Hcv Diagnostic Algorithmsmentioning

confidence: 99%

Hepatitis C Diagnosis: Simplified Solutions, Predictive Barriers, and Future Promises

et al. 2021

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The simplification of current hepatitis C diagnostic algorithms and the emergence of digital diagnostic devices will be very crucial to achieving the WHO’s set goals of hepatitis C diagnosis (i.e., 90%) by 2030. From the last decade, hepatitis C diagnosis has been revolutionized by the advent and approval of state-of-the-art HCV diagnostic platforms which have been efficiently implemented in high-risk HCV populations in developed nations as well as in some low-to-middle income countries (LMICs) to identify millions of undiagnosed hepatitis C-infected individuals. Point-of-care (POC) rapid diagnostic tests (RDTs; POC-RDTs), RNA reflex testing, hepatitis C self-test assays, and dried blood spot (DBS) sample analysis have been proven their diagnostic worth in real-world clinical experiences both at centralized and decentralized diagnostic settings, in mass hepatitis C screening campaigns, and hard-to-reach aboriginal hepatitis C populations in remote areas. The present review article overviews the significance of current and emerging hepatitis C diagnostic packages to subvert the public health care burden of this ‘silent epidemic’ worldwide. We also highlight the challenges that remain to be met about the affordability, accessibility, and health system-related barriers to overcome while modulating the hepatitis C care cascade to adopt a ‘test and treat’ strategy for every hepatitis C-affected individual. We also elaborate some key measures and strategies in terms of policy and progress to be part of hepatitis C care plans to effectively link diagnosis to care cascade for rapid treatment uptake and, consequently, hepatitis C cure.

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Progress and challenges of a pioneering hepatitis C elimination program in the country of Georgia

Cited by 42 publications

References 16 publications

Epidemiology and transmission of COVID-19 in cases and close contacts in Georgia in the first four months of the epidemic

Epidemiology and transmission of COVID-19 in cases and close contacts in Georgia in the first four months of the epidemic

Progress towards elimination goals for viral hepatitis

Hepatitis C Diagnosis: Simplified Solutions, Predictive Barriers, and Future Promises

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