The country of Georgia has a very high prevalence of hepatitis C virus (HCV) infection – a 2015 serosurvey estimated it at 7.7%. In April 2015, Georgia launched a program to reduce the prevalence of HCV by 90% by 2020. They increased the number of treatment centers from 4 in Tbilisi to 17 around the country, with 95 staff members in total. Gilead Sciences donated treatment regiments, and patients were charged on a sliding scale.
Hepatitis C virus is a member of the family Flaviviridae, and is an enveloped, helical virus with a (+)ssRNA genome. It is transmitted primarily through blood (needle use, blood products, or maternal-neonatal transmission) and can cause both acute and chronic hepatitis disease, which may eventually lead to cirrhosis of the liver, liver cancer, and/or liver failure.
In its first year, the program registered 27,392 infected individuals, and 5,850 patients completed HCV treatment – a 400% increase compared to the previous 4 years. 2,398 of these were tested for HCV 12 weeks after treatment, and 1,980 of those had no detectable virus and could be considered cured. Cure rates varied between 72% and 92% depending on the patient’s HCV genotype, with genotype 1 having the lowest cure rates and genotype 3 having the highest. People with advanced liver disease were prioritized for treatment.
In addition to providing treatment, the Georgian Ministry of Labor, Health, and Social Affairs (MoLHSA) developed a technical advisory group in collaboration with the CDC and WHO. The advisory group has proposed strategies to address gaps in awareness, surveillance, prevention, and linkage to care.
In order to remain on track toward reaching the 2020 target, the CDC currently recommends that Georgia establish a laboratory quality control system and an infection surveillance system. In addition, a major challenge that remains is bringing patients who are unaware of their HCV infection status into the healthcare system, since this group was not prioritized in the program’s first year but represents a significant portion of HCV infections in Georgia. As more people become aware of their HCV status, the demand for therapy will exceed the system’s current capacity. Overall, a variety of challenges remain for the Georgian HCV reduction program.
- Julia Daniel