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Background: A national serosurvey in 2015 found the country of Georgia had high hepatitis C virus (HCV) prevalence, with 5.4% of adults (~150,000 people) chronically infected. In April 2015, Georgia launched a national program to eliminate HCV infection (reduce prevalence by 90%). We developed an HCV transmission model to capture current and historical dynamics of HCV infection in Georgia, and project long-term impact of the elimination program. A follow-up serosurvey in 2021 provided data used to validate the model and update impact projections. Method(s): The original model was calibrated to the 2015 serosurvey and surveys among people who inject drugs (PWID), accounting for age, sex, PWID status, and liver disease state. We compare model projected prevalence overall and by age group, sex, and among ever injected drugs to 2021 serosurvey prevalence, and weight the parameter sets to match the serosurvey results. We used logistic regression to assess which input parameters or model characteristics affect fit. We used program data on 77,168 persons treated May 2015-February 2022 to estimate current incidence of HCV infection, cases and deaths averted. We project the impact of reductions in treatment rates during the COVID-19 epidemic. Result(s): The original modelled adult hepatitis C prevalence for 2021 (2.7%, 1.9-3.5%) was higher than the observed serosurvey prevalence (1.8%, 1.3-2.4%);across all groups uncertainty bounds overlap. Parameter sets that fit the 2021 serosurvey data suggest the model overestimated the initial burden of infection. Weighted Hepatitis C incidence in March 2022 is estimated to be 0.05 (95% credible interval (CrI) 0.03-0.11) per 100 person-years in general population, and 1.14 (0.08-6.4) per 100 person-years in PWID, a 60% decrease since 2015. As of March 2022, 9,186 (5,396-16,720) infections and 842 (489-1324) deaths have been averted, with benefit accumulating to 26,154 (15,850-47,627) infections and 3,971 (2,516-5,536) deaths averted if tracked to 2030. Treatment numbers went from 996/ month in 2019 to 406/month March 2020-February 2022 during the COVID-19 pandemic, resulting in 14,127 fewer treatments, 471 (242-817) fewer infections averted by March 2022. At 406 treatments/month, elimination can be reached in 2031. Conclusion(s): HCV prevalence reduction due to treatment and prevention interventions was greater than originally projected, but treatment numbers must still increase in order to reach HCV elimination by 2030.
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Background and aims: The country of Georgia launched its national Hepatitis C Virus (HCV) Elimination Program in 2015, and a serosurvey the same year showed prevalence of HCV antibody (anti-HCV) and HCV RNA among adults aged ≥18 years was 7.7%, and 5.4%, respectively. Since then, over 76, 000 people with chronic HCV have been treated, with a cure rate of 98.9%. To monitor progress, a second serosurvey was conducted in 2021 to estimate the prevalence of hepatitis C, hepatitis B, and anti-SARS-CoV-2. This analysis reports hepatitis C results of the serosurvey and progress towards elimination. Method: The serosurvey used a stratified, multi-stage cluster design with systematic sampling. Adults and children ≥5 years consenting (or assenting with parental consent) to the interviewand blood draw were eligible to participate. All blood samples were tested for anti- HCV and if positive, HCV RNA. Nationally representative weighted proportions and 95% confidence intervals (CI) were calculated and compared with 2015 age-adjusted estimates for adults. Results: A total of 7, 237 adults and 1, 473 children participated in the survey. For adults, the median age was 46 years (interquartile range: 32–60), and 53.3% (95% CI: 51.3–55.2)were female. The prevalence of anti-HCV was 6.8% (95% CI: 5.9–7.7), which was not significantly different from 2015 (7.7% [95% CI: 6.6–8.8];p = 0.20). The HCV RNA prevalencewas 1.8% (95% CI: 1.3–2.4), compared to 5.4% [95% CI: 4.5– 6.3] in 2015 (p < 0.001). This represents a 67% reduction in persons with chronic HCV infection, despite the program having treated 51% of the estimated 150, 000 infected. HCV RNA prevalence decreased among all age groups, most notably among those aged 40–59 years (9.3% in 2015 to 2.2% in 2021;p < 0.001). Substantial decreases were also observed among both males (9.0% to 3.1%;p < 0.001) and females (2.2% to 0.6%;p < 0.001). HCV RNA prevalence also decreased from 51.1% to 17.8% among persons who ever injected drugs, and 13.1% to 3.8% among those who received a blood transfusion (both p < 0.001). No children tested positive for anti-HCV or HCV RNA. Conclusion: These results demonstrate the substantial progress made since Georgia launched its HCV Elimination Program in 2015. The 67% reduction in chronic HCV infections during 2015–2021 also supports treatment as a means for prevention, as the reduction is larger than would be expected based on those treated alone. These findings can inform strategies to meet HCV elimination targets.
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Background and aims: A national serosurvey in 2015 found the country of Georgia had high hepatitis C virus (HCV) prevalence, with 5.4% of adults (∼150, 000 people) chronically infected. In April 2015, Georgia launched a national program to eliminate HCV infection (reduce prevalence by 90%). We developed an HCV transmission model to capture current and historical dynamics of HCV infection in Georgia, and project long-term impact of the elimination program. A follow-up serosurvey in 2021 provided data which was used to validate the model and update impact projections. Method: The original model was calibrated to the 2015 serosurvey and surveys among people who inject drugs (PWID), accounting for age, sex, PWID status, and liver disease state. We compare model projected prevalence overall and by age group, sex, and among ever injected drugs to 2021 serosurvey prevalence, and filter the original 532 parameter sets to match the serosurvey results.We used logistic regression to assess which input parameters or model characteristics affect fit.We used program data on 77,168 persons treated May 2015- February 2022 to estimate current incidence of HCV infection, cases and deaths averted.We project the impact of reductions in treatment rates that occurred in during the COVID-19 epidemic. Results: The original modelled adult hepatitis C prevalence for 2021 (2.7%, 1.9–3.5%) was higher than the observed serosurvey prevalence (1.8%, 1.3–2.4%);across all groups uncertainty bounds overlap. Only 14% of 532 model runs fit within the 95% confidence interval of all hepatitis C prevalence estimates;32% fit overall, 28% fit in females, 43% fit in males, 85% fit in ever-injected drugs. Runs that fit the 2021 serosurvey data tend to have lower total population and lower general population hepatitis C incidence, suggesting the model overestimated the initial burden of infection. After filtering, modelled hepatitis C adult prevalence is slightly higher than the observed prevalence (2.1%, 1.6–2.4%). Hepatitis C incidence in March 2022 is estimated to be 0.05 (95% credible interval (CrI) 0.03–0.11) per 100 person-years in general population, and 1.14 (0.08–6.4) per 100 person-years in PWID, a 60% decrease since 2015. As of March 2022, 9, 186 (5, 396–16, 720) infections and 842 (489–1324) deaths have been averted, with benefit accumulating to 26, 154 (15, 850–47, 627) infections and 3, 971 (2, 516–5, 536) deaths averted if tracked to 2030. Treatment numbers went from 996/month in 2019 to 406/month March 2020-March 2022 during the COVID-19 pandemic, resulting in 14, 127 fewer treatments, 471 (242–817) fewer infections averted by March 2022. At 406 treatments/month, elimination can be reached in 2031.(Figure Presented)Conclusion: HCV prevalence reduction due to treatment and prevention interventions was greater than originally projected, but treatment numbers must still increase in order to reach HCV elimination by 2030
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Background and aims: Georgia introduced routine infant hepatitis B (HepB) vaccination in 2001 with >90% coverage over the last decade. In 2015, a nationwide serosurvey demonstrated an anti-hepatitis B core antibody (anti-HBc) prevalence of 25.9% and hepatitis B surface antigen (HBsAg) prevalence of 2.9% among adults ≥18 years. No prevalence data were available for children. In 2021, we assessed hepatitis B virus (HBV) infection prevalence among children and updated estimates for adults in a combined COVID-19, hepatitis C and hepatitis B serosurvey of persons aged ≥5 years. Method: We used a stratified, multi-stage cluster design. We collected data on demographics, medical and exposure history;we tested blood samples for anti-HBc and, if positive, for HBsAg. Nationally representative weighted proportions and 95% confidence intervals (CI) for anti-HBc and HBsAg were calculated. Participants aged 5–20 years had been eligible for routine HepB vaccination as infants. Results: Among children aged 5–17 years, 0.7% were anti-HBc+ and 0.03%were HBsAg+ (Table). Among adults ≥18 years, 21.7%were anti- HBc+ and 2.7%were HBsAg+. Anti-HBc prevalence increased with age from 1.3% among 18–23-year-olds to 28.6% among ≥60 years. HBsAg prevalence was lowest (0.2%) among 18–23-year-olds and highest (8.6%) among 35–39-year-olds. Males had higher HBsAg prevalence than females (3.6% versus 2.0%;p = 0.003). Anti-HBc prevalence was highest in Samegrelo-Zemo Svaneti, Adjara, and Imereti regions. Higher education and income were associated with lower anti-HBc, and unemployment-with higher HBsAg prevalence. (Table Presented) Conclusion: The impact of HepB vaccination in Georgia is demonstrated by a low HBsAg prevalence among children that is below the 0.5% European regional hepatitis B control target and meets the ≤0 .1% seroprevalence target for elimination of mother-to-child transmission of HBV. Chronic HBV infection remains a problem among adults born before routine infant HepB vaccination. Focusing efforts on screening, treatment, and preventive interventions among adults, along with sustaining high immunization coverage among children, can help Georgia achieve elimination of hepatitis B as public health threat by 2030.
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Background and aims: The National Hepatitis C Elimination Program has made notable progress in Georgia. However, in the setting of COVID-19 related limitations, the number of individuals registering in the treatment program has declined over time, from an average of 996 per month in 2019 to 339 per month in 2021. As of September 30, 2021, 75% (n = 2, 081, 548) of the adult population of Georgia has been screened for hepatitis C virus (HCV), but among antibody positive adults, 20, 913 (15%) had not completed a viremia test. In 2019, the National Center for Disease Control and Public Health Georgia piloted a project to link to care those individuals who screened positive for anti-HCV but had not completed a viremia test. After success of the initial pilot, the model will be scaled up across Georgia. Method: All anti-HCV positive adults (aged ≥18 years) who did not have record of viremia testing in the national HCV electronic database 3 months from the date of a positive result, and who were not registered in the HIV/AIDS program or with a correctional facility, were eligible for follow-up. Using the phone number listed in the database, individuals were contacted by phone or home visit by patient navigators (trained epidemiologists and primary healthcare physicians) and referred to HCV care and treatment. If the first attempt was unsuccessful, one repeat attempt was made to contact the individual. Incentives were provided to regional health personnel for each patient that was successfully linked to care, defined as presenting for viremia testing. Results: As of October 1, 2020, 18, 030 persons were not linked to care;patient navigators attempted to reach 8, 907 (49%) with phone numbers in the database;6, 718 (75%)were reached. The remaining 2, 189 could not be reached, had moved, or emigrated. Of those contacted, 1, 546 (23%) presented for viremia testing, and 811 (52%) were positive for HCV RNA or core antigen. Overall, 419 (52%) persons with chronic HCV infection were enrolled in the HCV treatment program as a result of this effort. Conclusion: Program-wide implementation of the piloted model showed that this can be scaled up and is effective for re-engaging people in care. The main challenge in Georgia remains linkage-tocare, which is essential to meet elimination goals. Innovative approaches are necessary to reinforce linkage to care. This is especially important during the COVID-19 pandemic when there is an increased need for programs that can re-engage people in HCV care.
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OBJECTIVES: In 2015, the Republic of Georgia initiated a National Hepatitis C Elimination Program, with a goal of 90% reduction in prevalence of chronic hepatitis C virus (HCV) infections by 2020. In this article, we explore the impact of the COVID-19 pandemic on the 2020 hepatitis C cascade of care in Georgia. STUDY DESIGN: Retrospective analytic study. METHODS: We used a national screening registry that includes hospitals, blood banks, antenatal clinics, harm reduction sites, and other programs and services to collect data on hepatitis C screening. A separate national treatment database was used to collect data on viremia and diagnostic testing, treatment initiation, and outcome including testing for and achieving sustained virologic response (SVR). We used these databases to create hepatitis C care cascades for 2020 and 2019. Bivariate associations for demographic characteristics and screening locations per year and care cascade comparisons were assessed using a chi-squared test. RESULTS: In 2020 compared to 2019, the total number of persons screened for HCV antibodies decreased by 25% (from 975,416 to 726,735), 59% fewer people with viremic infection were treated for HCV infection (3188 vs. 7868), 46% fewer achieved SVR (1345 vs. 2495), a significantly smaller percentage of persons with viremic infection initiated treatment for HCV (59% vs. 62%), while the percentage of persons who achieved SVR (99.2% vs. 99.3%) remained stable. CONCLUSIONS: The COVID-19 pandemic had a negative impact on the hepatitis C elimination program in Georgia. To ensure Georgia reaches its elimination goals, mitigating unintended consequences of delayed diagnosis and treatment of hepatitis C due to the COVID-19 pandemic are paramount.
Subject(s)
COVID-19 , Hepatitis C, Chronic , Hepatitis C , Antiviral Agents/therapeutic use , COVID-19/epidemiology , Female , Georgia/epidemiology , Georgia (Republic)/epidemiology , Hepacivirus , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Hepatitis C, Chronic/diagnosis , Hepatitis C, Chronic/drug therapy , Hepatitis C, Chronic/epidemiology , Humans , Pandemics , Pregnancy , Retrospective StudiesABSTRACT
Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumatic Stress Disorder (PTSD) or anxiety, while 15-30% had symptoms of depression. Interventions supporting family members have reduced burden of these symptoms. COVID-19 has resulted in prolonged ICU stays, high morbidity/mortality, and hospital policies severely limiting family presence at the bedside. We hypothesized the combination of prolonged critical illness and the necessary reduction of family presence would lead to high rates of PTSD, anxiety, and depression;likely higher than observed in previous studies. Methods: This was a multicenter study including 12 US hospitals, 8 academic and 4 community-based hospitals. A consecutive sample of family members of all patients with COVID-19 receiving ICU admission during the spring US peak in 2020 were called 3-4 months after the patients' ICU admission, except for New York City hospitals where a random sample was generated given the large number of hospitalizations. Consented participants completed the Impact-of- Events Scale-6 (IES-6;scored 0-30, higher scores indicate more symptoms of PTSD), Hospital-Anxiety- Depression Score (HADS, scored 0-20 for anxiety and 0-20 for depression, higher scores indicate more symptoms), and a subset of questions from Family-Satisfaction in the ICU-27 (FS-ICU27;scored on a Likert scale 1 to 5, with higher scores indicating more positive responses) selected as most likely impacted by restrictive family presence.Results: There were 945 eligible family members during the study period. Of those, 594 were contacted and 269 (45.3%) consented and completed surveys. The mean IES-6 score was 12.6 (95% CI 11.8- 13.4) with 65.4% having a score of 10 or greater, consistent with high levels of symptoms of PTSD. The mean score on the HADS-anxiety was 9.4 (95% CI 8.8-10.1) with 59.5% having a score of 8 or greater, consistent with high levels of symptoms of anxiety. Finally, the mean score for the HADS-depression was 8.0 (95% CI 7.3-8.7) with 47.6% having scores of 8 or greater, consistent with high level of symptoms of depression. The mean response for the FSICU27 questions of “I felt I had control” was 3.5 (95% CI 3.3-3.6), “I felt supported” was 3.8 (95% CI 3.6-4.0), and “I felt included” was 4.3 (95% CI 4.2-4.4).Conclusion: The consequences of a family member admitted to the ICU with COVID-19 infection are significant. We identify rates of PTSD, anxiety, and depression higher than recorded in non-COVID population. Further analysis is warranted to understand modifiable risk factors for developing these symptoms.
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RATIONALE: Currently, there are over 20,000 COVID-19 positive patients requiring intensive care unit (ICU) care in the United States (US). Even prior to the pandemic, up to 30% of family members of ICU patients experience post-traumatic stress disorder and up to 50% sustain potentially prolonged anxiety and/or depression. Although family bedside engagement improves both short-and long-term outcomes for patients and their families, nationwide social distancing recommendations have curtailed hospital visitation, potentially heightening the risk of stress-related disorders in these family members. The goal of this analysis is to explore the experiences of physically distanced family members of COVID-19 ICU patients in order to inform future best practices. Methods: This qualitative analysis is part of a multisite, observational, mixed-methods study of 12 US hospitals. Qualitative interviews were conducted with 75 participants from five sites;14 interviews were analyzed in this preliminary analysis. Adult family members of COVID-19 positive patients admitted to the ICU from March-June 2020 were interviewed three months post-discharge. After sequential screening by site coordinators, participants were contacted by the qualitative team until all interviews (10-15 per site) were completed. Qualitative interviews explored the illness stories, communication perceptions, and explored stressors. Thematic analysis was applied to the verbatim transcripts of the phone interviews. Four coders utilized an iteratively-developed codebook to analyze transcripts using a round-robin method with two analysts per transcript. Discrepant codes were adjudicated by a third analyst to attend to inter-rater reliability. Results: Five preliminary themes and seven subthemes emerged (Table 1). Positive communication experiences were more common than negative ones. Communication themes were: 1) Participants were reassured by proactive and frequent communication, leaving them feeling informed and included in care;and 2) Mixed feelings were expressed about the value of video-conferencing technology. Themes from the emotional and stress experiences were: 3) Profound sadness and distress resulted from isolation from patients, clinicians, and supportive family;4) Stress was amplified by external factors;and 5) Positive experiences centered upon appreciation for healthcare workers and gratitude for compassionate care. Conclusion: Incorporating the voices of family members during the COVID-19 pandemic establishes a foundation to inform family-centered, best practice guidelines to support the unique needs of family members who are physically distant from their critically ill and dying loved ones.
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Aims To compare time-to-endoscopy in admissions with UGIB during COVID restrictions (March-June 2020) with those inPre-COVID-times (March-June 2019).To assess outcomes in patients admitted with UGIB in non-COVID-19 and COVID-19times. Methods Retrospective HIPE coding from an academic teaching hospital over 12 months 2019-20 was used. All patientsadmitted with codes hematemesis, UGIB etc. were included, with data obtained from their electronic health records. Results Admissions with UGIB March-June 2019 were compared with those of March-June 2020: 21 patients (12-female)underwent gastroscopy in first arm compared to 25 patients (12-female) in the second arm. Average time to endoscopyduring March-June 2020 (COVID-19 pandemic restrictions) was improved at 19.9 h versus 45.57 h during March-June 2019(p-value 0.003). Average GBS score at 6.9 was higher but not significant in admissions during COVID restrictions comparedwith 4.9 in admissions pre-COVID (p-value 0.31). Conclusions Our study reveals no negative impact of COVID-19 pandemic on access to endoscopy in a cohort ofsymptomatic upper GI bleed with higher GBS;rather, we demonstrated improved times. This study further validates the useof GBS in clinical setting.
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Telehealth is a promising approach to promoting access to care and can facilitate public health mitigation strategies and help prevent transmission of SARS-CoV-2 and other respiratory illnesses, while supporting continuity of care. Although CMS's change of its telehealth provisions enabled health centers to expand telehealth by aligning guidance and leveraging federal resources, sustaining expanded use of telehealth services might require additional policies and resources. During 11-17 July, 2020, 963 (95.4%) of 1,009 Health Resources and Services Administration-funded health centers that responded to a voluntary weekly survey reported providing telehealth services. Health centers in urban areas were more likely to provide >30% of visits virtually than were those in rural areas. Compared with health centers that reported full staffing capacity, the prevalence of reporting >30% telehealth visits was 22% higher among those reporting 5% staff absence and was 63% higher among health centers reporting 10% staff absence. No association was detected between the percentage of telehealth visits and PPE shortages for the week following the survey (the week ending July 24), nor was an association found between the percentage of telehealth visits and the change in the number of weekly visits from 2019.