Results from a nationwide hepatitis C serosurvey and progress towards HCV elimination in the country of Georgia

ABSTRACT

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.