Hepatitis C among people who inject drugs in Tbilisi, Georgia: an urgent need for prevention and treatment

Abstract

Background: Drug use and hepatitis C virus (HCV) are both major public health issues in Georgia. However, the access to HCV prevention and care is still very limited in the country. This study was conducted to examine the HCV epidemic among people who inject drugs (PWID) in Tbilisi and to assess the treatment needs of this most-at-risk population.

Methods: Respondent-driven-sampling was used to obtain a sample of PWID in Tbilisi. Each participant was interviewed face-to-face and underwent an HCV antibody-based rapid diagnostic test. If a test was positive, a further evaluation was performed, including direct detection of HCV by PCR, genotyping and liver fibrosis assessment by transient elastography. People needing urgent treatment were defined as those who were currently infected and had severe liver fibrosis (liver stiffness above 10kPa). Prevalences were calculated crude and then weighted to adjust for the sampling method. Risk factors for liver fibrosis were studied using generalized linear models.

Results: A total of 216 PWID were recruited in October 2012. The mean age was 39.6 and 7.9% were female. HCV antibodies were found in 91.9% of the participants and 82.0% had a chronic infection. Among the chronically infected participants, genotype 3 was predominant (66.9%) and 10.4% had viruses from two different genotypes. Severe liver fibrosis was found in 24.2% of the infected participants (only in men) and was significantly associated with the duration of drug use and coinfection with hepatitis B.

Conclusion: Georgian PWID are very exposed to HCV and have high levels of severe liver fibrosis. Hence, harm reduction services should be scaled-up in Georgia and HCV treatment programmes should be implemented straight away and should include active drug users. Other risk factors for liver fibrosis, such as hepatitis B, should be specifically addressed in this population.

Keywords: Drug users; Hepatitis C; Liver fibrosis; Respondent-driven sampling; Treatment needs.