INTRODUCTION:Injection drug use (IDU) poses significant public health risks, including the transmission of blood-borne infections such as hepatitis B (HBV) and hepatitis C (HCV). This study aims to evaluate the prevalence of risk behaviors associated with IDU and the prevalence of HBV and HCV among people who inject drugs (PWID) in Georgia. METHODS:A cross-sectional study was conducted in seven cities of Georgia in 2022, involving 2005 PWID aged ≥18 years. Participants were recruited using respondent-driven sampling. Data were collected through face-to-face interviews and blood samples were collected for HCV/HBV testing. RESULTS:The majority of study participants (98.6%) were males, 63.2% were older than 40 years, and 51.3% had a history of imprisonment. 24.4% reported using a needle/syringe previously used by someone else. HCV seropositivity was found in 58.1% of respondents, with 32.1% of anti-HCV positive individuals testing positive for HCV RNA. HBV surface antigen was detected in 2.5%. Only 7.5% reported being vaccinated for hepatitis B and 27.8% expressed willingness to be vaccinated. 33.9% had HCV treatment history. HCV prevalence was significantly higher among males, older PWID, those with a history of incarceration and history of sharing needles used by others. CONCLUSION:Our findings highlight the high prevalence of HCV and low HBV vaccination rates among PWID in Georgia, emphasizing the need for strengthened harm reduction strategies. Expanding sterile injection access, integrating HBV vaccination, and removing structural barriers are key to improving prevention and testing efforts and linkage to care.
Dried blood spots (DBS) and plasma separation cards (PSC) have the potential to improve access to hepatitis C virus (HCV) testing. This multicenter study evaluated the performance of two HCV RNA assay platforms using capillary or venous DBS and PSC. Participants were enrolled in Cameroon, Rwanda, Georgia, and Greece. DBS and PSC prepared from capillary and venous blood samples were collected from three target populations; individuals at risk of HCV infection, persons living with HCV, and individuals previously treated for HCV. The diagnostic accuracy of DBS and PSC for detecting HCV RNA was assessed using the cobas HCV nucleic assay on the cobas 4800 and cobas 6800 platforms (Roche), with plasma samples tested using these platforms serving as the reference standard. A total of 936 participants were enrolled. Capillary, venous DBS and venous PSC demonstrated high diagnostic accuracy. Sensitivity and specificity were 97.2% (95% CI: 95.2-98.3) and 88.6% (95%CI: 85.4 -91.2) for capillary DBS, 96.1% (95%CI: 93.9 -97.5) and 87.8% (95%CI: 85.4 -90.4) for venous DBS and 95.2% (95%CI: 92.8 -96.8) and 99.6% (95%CI: 98.5 -99.9) for venous PSC, on the cobas 4800. The cobas 6800 platform had a sensitivity and specificity of 97.3% (95%CI: 95.4 -98.5) and 95.9% (95%CI: 93.7 -97.3) on venous DBS, 96.7% (95%CI: 94.6 -98.0) and 99.8% (95%CI: 98.8 - 100) on venous PSC, and 96.9% (95%CI: 94.8 -98.1) and 99.8% (95%CI: 98.8 - 100) on capillary PSC. The diagnostic accuracy of capillary and venous DBS and PSC for detecting HCV RNA was high on the two platforms evaluated. This study demonstrates that DBS and PSC sample types can be an alternative to plasma to screen for HCV infection, thus facilitating access to testing.ImportanceAlthough the use of point-of-care rapid antibody tests for hepatitis C virus (HCV) is increasing, people who test positive must still undergo a confirmatory test before receiving treatment. Confirmatory testing for HCV RNA can be performed using plasma, serum, or capillary whole blood, depending on the available diagnostic platforms and testing algorithms. Plasma samples are more commonly used; however, their collection, storage, transport, and handling can pose significant challenges in low-resource settings. To improve access to HCV testing, there is a need for alternative sample types. Blood samples dried on filter paper cards (dried blood spots, or DBS) can be collected at the community level, have low biohazard risk, can withstand exposure to ambient temperatures, and are easily stored and shipped. Plasma Separation Cards (PSC), which collect plasma rather than whole blood, have similar properties. This study demonstrated that the diagnostic accuracy of DBS and PSC for detecting HCV RNA using the Roche cobas 4800 and 6800 platforms was high, confirming that they could be viable alternatives to plasma sampling for HCV testing.
In 2015, Georgia launched a hepatitis C elimination programme with free screening and treatment. However, a large number of persons were lost to follow up after screening for, or diagnosis with, hepatitis C virus (HCV) infection. During February 2023-September 2024, we conducted active outreach to reengage persons who were lost to follow-up in care and assess barriers to hepatitis C care and treatment through questionnaires covering pre- and post-outreach perceptions. Among 18,034 persons who tested HCV antibody (anti-HCV) reactive but were not tested for HCV viremia and had valid contact information, 14,252 (79%) could be reached, among whom 64% were unaware of their test result. After outreach, 4593 (32%) completed HCV viremia testing, among whom 2440 (53%) tested positive and 1577 (65%) initiated treatment. Main reasons for not seeking care after active outreach were having another chronic illness (33%) and being unaware they were screened for anti-HCV (23%). Among 13,151 persons diagnosed with HCV infection who did not initiate treatment and had valid contact information, 6982 (53%) were reached, among whom 2267 (33%) initiated treatment. The main reason for not initiating treatment before outreach was lack of information (62%) and after outreach was distrust in the hepatitis C elimination programme (79%). Treatment initiation was more common among those first tested in recent years. Active outreach successfully identified new infections and nearly 40% of those diagnosed initiated treatment. Educating patients about their test results and promptly linking them to care and treatment is essential to achieve hepatitis C elimination.
We evaluated the cost and cost-effectiveness of alternative screening pathways during 2018–2022 within Georgia’s hepatitis C elimination program, which started in 2015. We calculated patient-level costs (2022 USD$) of hepatitis C treatment with centralized and decentralized diagnostic testing in hospitals, primary healthcare (PHC), harm reduction providers (HRP), or specialized providers (SP) from reimbursement records including the value of donated direct-acting antivirals (DAAs). We model hepatitis C case-finding, transmission, and progression over a 20-year time horizon to project cost-effectiveness of treatment for each screening pathway in terms of cost per quality adjusted life year (QALY), compared to a willingness-to-pay threshold of $1,337. Unit costs of treatment decreased from $3942–$4247 across screening pathways in 2018 to $300–$338 in 2022, primarily due to reductions in DAA costs. The cascade of care varied by screening pathway, with highest hepatitis C virus (HCV) antibody prevalence and percent linked to viremia testing among HRP and SP, while total number of patients screened was highest in hospitals. While DAA costs decreased, the cost of case finding increased during 2018–2022, with the biggest increase in hospital settings mainly due to decreasing yield. The program was not cost-effective with full DAA costs, but excluding DAA costs or using lower 2022 costs make all pathways cost-effective and SP, HRP, and PHC potentially cost-saving. Donated drugs allowed Georgia’s HCV elimination program to be cost-effective, while future programs with generic drug costs are likely to be cost-effective. Reductions in yield from hospital screening suggest that later stages of elimination programs should prioritise targeted pathways.
Low- and middle-income countries with seasonal influenza immunization programs, prior to the COVID-19 pandemic were able to deliver vaccines faster and achieve, higher coverage compared to countries without such capabilities. Middle Income, (lower- and upper-) countries participating in the Partnership for International Vaccine, Initiatives (PIVI) described influenza processes and systems that contributed to more, efficient and effective COVID-19 mass vaccination campaigns because of existing, capacities. Some routine systems were easy to pivot while others required, modifications to address the need for speed and volume when responding to the, COVID-19 pandemic. While annual influenza programs are a natural “warm base” (i.e., keeping operations such as staffing and supply chains operating at a minimum sustainable level during non-crisis periods) for honing emergency response readiness in vaccination, investments in areas more specific to pandemic preparedness remain a need. Regional variations in readiness and opportunities for cooperation should also be explored.
