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- Amiran Gamkrelidze [2]
- Irina Tskhomelidze [2]
- Maia Tsereteli [2]
- Shaun Shadaker [2]
- Francisco Averhoff [1]
- Gavin Cloherty [1]
- Giorgi Chakhunashvili [1]
- Jan Drobeniuc [1]
- Josephine G. Walker [1]
- Khatuna Zakhashvili [1]
- Lia Gvinjilia [1]
- Maia Alkhazashvili [1]
- Nazibrola Chitadze [1]
- Nino Khetsuriani [1]
- Paata Imnadze [1]
- Paige A Armstrong [1]
- Paige A. Armstrong [1]
- Peter Vickerman [1]
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- 1Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, United States [1]
- 1Population Health Sciences, University of Bristol, Bristol, United Kingdom [1]
- 2National Center for Disease Control and Public Health of Georgia (NCDC), Tbilisi, Georgia [1]
- 2Task Force for Global Health, Tbilisi, Georgia [1]
- 3Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, United States [1]
- 3Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, United States [1]
- 4National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia [1]
- 4The Task Force for Global Health, Tbilisi, Georgia [1]
- 5Eastern Europe and Central Asia Regional Office, Centers for Disease Control and Prevention (CDC), Tbilisi, Georgia [1]
- 6 Abbott Diagnostics, Abbott Park, IL, United States [1]
- 7Abbott Pandemic Defense Coalition, Abbott Park, IL, United States [1]
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Between May 2015 and February 2022 77168 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.
Accounting for follow-up surveys in 2021 we validate and update projections of HCV infection prevalence and incidence.
We 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.
The 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 100000 person-years (overall population). Between May 2015 and March 2022 9186 (95% CrI: 5396–16720) infections and 842 (95% CrI: 489–1324) deaths were averted. The COVID-19 pandemic resulted in 13344 (95% CrI: 13236–13437) fewer treatments and 438 (95% CrI: 223-744) fewer averted infections by March 2022.
Results support the programme’s high effectiveness. At current treatment rate (406/month) 90% reductions in prevalence and incidence in Georgia are achievable by 2030.
Georgia has adopted the World Health Organization European Region’s and global goals to eliminate viral hepatitis. A nationwide serosurvey among adults in 2015 showed 2.9% prevalence for hepatitis B virus (HBV) surface antigen (HBsAg) and 25.9% for antibodies against HBV core antigen (anti-HBc). HBV infection prevalence among children had previously not been assessed.
We aimed to assess HBV infection prevalence among children and update estimates for adults in Georgia.
This nationwide cross-sectional serosurvey conducted in 2021 among persons aged ≥ 5 years used multi-stage stratified cluster design. Participants aged 5–20 years were eligible for hepatitis B vaccination as infants. Blood samples were tested for anti-HBc and if positive for HBsAg. Weighted proportions and 95% confidence intervals (CI) were calculated for both markers.
Among 5–17 year-olds (n = 1473) 0.03% (95% CI: 0–0.19) were HBsAg-positive and 0.7% (95% CI: 0.3–1.6) were anti-HBc-positive. Among adults (n = 7237) 2.7% (95% CI: 2.3–3.4) were HBsAg-positive and 21.7% (95% CI: 20.4–23.2) anti-HBc-positive; HBsAg prevalence was lowest (0.2%; 95% CI: 0.0–1.5) among 18–23-year-olds and highest (8.6%; 95% CI: 6.1–12.1) among 35–39-year-olds.
Hepatitis B vaccination in Georgia had remarkable impact. In 2021 HBsAg prevalence among children was well below the 0.5% hepatitis B control target of the European Region and met the ≤ 0.1% HBsAg seroprevalence target for elimination of mother-to-child transmission of HBV. Chronic HBV infection remains a problem among adults born before vaccine introduction. Screening treatment and preventive interventions among adults and sustained high immunisation coverage among children can help eliminate hepatitis B in Georgia by 2030.