Hepatitis C prevalence and risk factors in Georgia, 2015: setting a baseline for elimination

Abstract

Background: The country of Georgia launched the world's first Hepatitis C Virus (HCV) Elimination Program in 2015 and set a 90% prevalence reduction goal for 2020. We conducted a nationally representative HCV seroprevalence survey to establish baseline prevalence to measure progress toward elimination over time.

Methods: A cross-sectional seroprevalence survey was conducted in 2015 among adults aged ≥18 years using a stratified, multi-stage cluster design (n = 7000). Questionnaire variables included demographic, medical, and behavioral risk characteristics and HCV-related knowledge. Blood specimens were tested for antibodies to HCV (anti-HCV) and HCV RNA. Frequencies were computed for HCV prevalence, risk factors, and HCV-related knowledge. Associations between anti-HCV status and potential risk factors were calculated using logistic regression.

Results: National anti-HCV seroprevalence in Georgia was 7.7% (95% confidence interval (CI) = 6.7, 8.9); HCV RNA prevalence was 5.4% (95% CI = 4.6, 6.4). Testing anti-HCV+ was significantly associated with male sex, unemployment, urban residence, history of injection drug use (IDU), incarceration, blood transfusion, tattoos, frequent dental cleanings, medical injections, dialysis, and multiple lifetime sexual partners. History of IDU (adjusted odds ratio (AOR) = 21.4, 95% CI = 12.3, 37.4) and blood transfusion (AOR = 4.5, 95% CI = 2.8, 7.2) were independently, significantly associated with testing anti-HCV+ after controlling for sex, age, urban vs. rural residence, and history of incarceration. Among anti-HCV+ participants, 64.0% were unaware of their HCV status, and 46.7% did not report IDU or blood transfusion as a risk factor.

Conclusions: Georgia has a high HCV burden, and a majority of infected persons are unaware of their status. Ensuring a safe blood supply, implementing innovative screening strategies beyond a risk-based approach, and intensifying prevention efforts among persons who inject drugs are necessary steps to reach Georgia's HCV elimination goal.

Keywords: Georgia; Global health security; HCV; HCV elimination; HCV prevention; Hepatitis C virus.

Fig. 1

Anti-HCV prevalence in major cities and regions of Georgia. The highest regional anti-HCV prevalence was found in Samegrelo-Zemo Svaneti region in northwest Georgia (10.9%), particularly in the city of Zugdidi (14.0%, nearly double the national prevalence of 7.7%). In general, anti-HCV prevalence was higher in cities than in the surrounding rural areas. [Notes: *Anti-HCV prevalence estimates were not calculated for Guria region, Mtskheta-Mtianeti region, Racha-Lechkumi/Kvemo Svaneti region, or Samtskhe-Javakheti region due to insufficient sample size. **The occupied territories of Abkhazia and Samachablo (South Ossetia) were not included in the survey]

Fig. 2

Anti-HCV prevalence by age and sex. Anti-HCV prevalence was approximately three times higher among men vs. women overall (12.1% vs. 3.8%) and varied by age; among men, prevalence peaked at 22.7% in the 40–49 age group, while it increased steadily with age among women to a maximum of 5.4% among those ≥60 years of age. [Note: *Differences in anti-HCV prevalence between male and female respondents were statistically significant in asterisked categories using Rao-Scott Chi-square tests (p < 0.05)]

Fig. 3

Self-reported cascade of HCV care among laboratory-confirmed anti-HCV positive participants. Among the 433 survey participants who tested anti-HCV positive, 156 (36.0%) already knew their HCV status prior to the survey. Among participants aware of their HCV infection, 50 (32.1%) reported initiating treatment prior to the survey, 32 (64.0%) of those who began treatment reported completing it, and 6 (18.8%) of those who completed treatment reported being cured