Georgia's HCV Elimination Program is a Worldwide Model

The Georgia HCV Elimination Program, the first of its kind, is being heralded as a model for other countries that face a high rate of HCV infection.

Working with the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and other international healthcare partners, the country of Georgia in April of 2015 launched a program aimed at eradicating hepatitis C virus (HCV) infection among its citizens. The pioneering Georgia HCV Elimination Program is being heralded as a model for other countries that face a high rate of HCV infection. Almost 8% of the 3.7 million people in Georgia have HCV—one of the highest rates in the world—largely due to poor infection-control procedures in healthcare settings and a significant segment of the population that injects drugs without taking proper safety precautions.

“Georgia’s hepatitis C elimination program, the first of its kind in the world, can provide information and experience that will assist similar goal-setting and programmatic efforts in other countries,” says CDC epidemiologist Muazzam Nasrullah, MD, MPH, PhD. The goal is to reduce the prevalence of HCV by 90% by the year 2020.

The program was rolled out with four treatment centers, all located in the capital city of Tbilisi. One year later the program features 17 treatment centers nationwide, including a staff of 95 infectious-disease specialists, gastroenterologists, and other physicians. Patients are able to get HCV blood antibody testing, tests to determine their viral load, and tests to determine which of the six major recognized genotypes of HCV they carry, as that determines which treatment they receive. Payment is on a sliding scale, with the government or the Georgian Ministry of Labor, Health, and Social Affairs picking up the balance of the costs. Antiviral treatments are provided free by Gilead Sciences, a California-based biopharmaceutical firm.

The endeavor has been a success from the beginning, with the good results continuing more than a year later. “The initial phase of the program focused on providing free, curative HCV treatment to infected persons with advanced liver disease,” says Dr. Nasrullah. “By April 2016, a total of 27,392 HCV-infected persons registered for the program, 31% started treatment, 69% completed treatment, and 83% of those who completed treatment were cured of HCV.”

As the program continues and more Georgians with HCV take advantage, administrators anticipate that participants will be able to receive even newer direct-acting antiviral drugs that are not dependent on particular HCV genotypes. This should expedite diagnosis and treatment, allowing even more participants to benefit.

As promising as the Georgia HCV Elimination Program is, there obstacles still exist, say the country’s health officials. Although efforts to help those individuals who are infected with HCV are ramping up, measures to prevent the transmission of HCV in the first place are lagging. The country is sorely in need of a quality-assurance and quality-control system for its laboratories and treatment centers. More effective data-collection procedures are warranted. And the program, so far, has mainly helped those who already knew they were infected with HCV, while most individuals with the virus are unaware that they have it. To that end, Georgia is working on a system that will ensure more people are tested, informed of their results, and offered treatment if they are HCV-positive.

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.