Three Years of Progress Toward Achieving Hepatitis C Elimination in the Country of Georgia, April 2015–March 2018

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.

French hepatitis C care cascade: substantial impact of direct-acting antivirals, but the road to elimination is still long

“…However, the latter approach is not adapted to the rapidly evolving situation in the era of DAAs. Furthermore, published studies on the HCV CoC in the DAA era are scarce [7,11,12].…”

Current and future strategies for the treatment of chronic hepatitis C

“…However, to reach elimination targets by 2025, existing diagnostic and treatment practices must be increased nearly 4.5-fold and 3-fold, respectively. Finally, Numerous successful reports of elimination projects have been reported in Rwanda , Mongolia, and the Republic of Georgia amongst others [50][51][52] .…”

Hepatitis C Vaccine: 10 Good Reasons for Continuing

“…In Georgia, despite considerable effort to set up an HCV elimination program, 65% of the estimated 150,000 adults living with chronic HCV infection remain to be identified. ( 14 ) In the United States, the Centers for Disease Control and Prevention recommend identifying chronic HCV carriers by performing serological tests on individuals attending the emergency department, targeting “baby boomers” born between 1945 and 1965. This has been effective to identify a significant number of subjects for treatment.…”