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. 2023 Jul;28(30):2200952.
doi: 10.2807/1560-7917.ES.2023.28.30.2200952.

Insights from a national survey in 2021 and from modelling on progress towards hepatitis C virus elimination in the country of Georgia since 2015

Josephine G Walker  1 , Irina Tskhomelidze  2 , Shaun Shadaker  3 , Maia Tsereteli  4 , Senad Handanagic  3 , Paige A Armstrong  3 , Amiran Gamkrelidze  4 , Peter Vickerman  1
Affiliations

Insights from a national survey in 2021 and from modelling on progress towards hepatitis C virus elimination in the country of Georgia since 2015

Josephine G Walker et al. Euro Surveill. 2023 Jul.

Abstract

BackgroundBetween May 2015 and February 2022, 77,168 hepatitis C virus (HCV)-infected people in Georgia have been treated through an HCV elimination programme. To project the programme's long-term impacts, an HCV infection model was initially developed, based on data from surveys among people who inject drugs and a national serosurvey in 2015.AimAccounting for follow-up surveys in 2021, we validate and update projections of HCV infection prevalence and incidence.MethodWe assessed the initial model projections' accuracy for overall prevalence, by age, sex, and among people who ever injected drugs, compared with 2021 serosurvey data. We used 2021 results to weight model fits and to recalculate the national programme's impact leading up to March 2022 on HCV infection incidence rates. Cases and deaths averted were estimated. The impact of reduced treatment rates during the COVID-19 pandemic was assessed.ResultsThe original model overpredicted adult (≥ 18 years old) chronic HCV infection prevalence for 2021 (2.7%; 95% credible interval (CrI): 1.9-3.5%) compared with a 2021 serosurvey (1.8%; 95% confidence interval (CI): 1.3-2.4%). Weighted model projections estimated a 60% decrease in HCV infection incidence by March 2022, with an absolute incidence of 66 (95% CrI: 34-131) per 100,000 person-years (overall population). Between May 2015 and March 2022, 9,186 (95% CrI: 5,396-16,720) infections and 842 (95% CrI: 489-1,324) deaths were averted. The COVID-19 pandemic resulted in 13,344 (95% CrI: 13,236-13,437) fewer treatments and 438 (95% CrI: 223-744) fewer averted infections by March 2022.ConclusionResults support the programme's high effectiveness. At current treatment rate (406/month), 90% reductions in prevalence and incidence in Georgia are achievable by 2030.

Keywords: elimination; modelling; program evaluation; viral hepatitis.

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Conflict of interest statement

Conflict of interest: JGW and PV have received an investigator sponsored research grant from Gilead Sciences, which funded this work. The funder played no role in the design of the study, the analysis or interpretation of the data, or the decision to publish.

Figures

Figure 1
Figure 1
Model projections for original and weighted/filtered projections of chronic hepatitis C prevalencea compared with 2021 serosurvey resultsb, by population group including (A) total adults (B) women, (C) men, (D), adults who ever injected drugs and (E–H) age categories, Georgia, 2021
Figure 2
Figure 2
Comparison of model characteristics including (A) chronic hepatitis C prevalence, (B, C) number of cirrhotic HCV infections and PWID, (D) incidence of hepatitis C in the general population and (E) total population size, under different weighting measures, Georgia, 2015 and 2021
Figure 3
Figure 3
Number of individuals initiating treatment for hepatitis C per montha and average numbers of treatments over certain periodsb, Georgia May 2015–February 2022
Figure 4
Figure 4
(A) Adult chronic hepatitis C prevalence and (B) overall incidence of hepatitis C over time with different treatment rates, estimated from filtered model fits, Georgia, 2015–2030
See this image and copyright information in PMC

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