Senior Medical Officer - Alcohol and Other Drugs Service, QLD
HCV elimination program in Georgia - Successes and Challenges - Dr. Maia Butsashvili at AVHEC17
Dr Maia Butsashvili discussed Hepatitis C elimination in Georgia.
Of a total national population of 3.7 million inhabitants, the incidence of chronic Hepatitis C in Georgia is 5.4% (i.e. 150,000 people).
Hepatitis C is found in 3 population subgroups in Georgia - PWID, MSM and healthcare workers; with the peak incidence being men in the 30-49 age group.
Georgia underwent a period of political and economic upheaval in the 1990s with the collapse of the Soviet Union. Injecting drug use was at its peak and healthcare procedures were compromised. Blood transfusions, dental and obstetric procedures (especially terminations of pregnancy as a form of contraception) are thought to be the source of the health care related hepatitis C infections.
With the help of the CDC, Georgia is running a pilot program to eliminate Hepatitis C in its population.The Georgian government has supported this initiative, and the pilot is aiming for 90% diagnosis, 95% treatment and 95% cure of its Hepatitis C population by 2020. Coupled with this aim are the strategies of harm reduction in PWID communities (needle syringe and OST programs) and preventing transmission of Hepatitis C in the healthcare setting.
The pilot was initially established at 4 sites in 2015, and telemedicine support for difficult cases was provided by Boston specialists. All results are reviewed by a committee before treatment was selected and commenced. Treatment was initially with a combination of Sofosbovir, Ribavirin, and Interferon and more recently Harvoni has been added to the treatment regime. There were initial concerns that the treatment provided would be sold as there are no treatment programs in surrounding countries; this has been limited by fortnightly dispensing.
To date, Georgia has treated 30,000 of its target group of 150,000 and has screened half a million people from 2015 to 2017. SVR in 2015 was 85%, and has risen in 2016 to 95%- the difference being the introduction of Harvoni and the treatment of the sickest patients initially. SVR is missing in 25%.
Georgia has extended the pilot to 28 centres, and is now targeting the PWID population to improve detection, prevention and treatment in this community.Georgia has established a treatment centre in a drug treatment clinic (OST) and is using peer workers help PWID clients access and attend healthcare providers.
Other plans to scale up screening include providing incentives to primary care providers and delivering a mass information campaign. It doesn't sound like they are going to stop.