ABSTRACT
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
ABSTRACT
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.
ABSTRACT
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.