Three years of progress towards achieving hepatitis C elimination in the country of Georgia, April 2015 - March 2018.

Abstract

BACKGROUND\nIn April 2015, in collaboration with U.S. CDC and Gilead Sciences, Georgia embarked on the world s first hepatitis C elimination program. We aimed to assess progress towards elimination targets after three years since the beginning of the elimination program.\n\n\nMETHODS\nWe constructed an HCV care cascade for adults in Georgia, based on the estimated 150,000 persons age ≥ 18 years with active HCV infection. All patients who were screened or entered the treatment program during April 2015 - March 2018 were included in the analysis. Data on the number of persons screened for HCV was extracted from the national HCV screening database. For treatment component we utilized data from the Georgia National HCV treatment program database. Available treatment options included sofosbuvir (SOF) and ledipasvir/sofosbuvir (LDV/SOF) based regimens.\n\n\nRESULTS\nSince April 2015, a cumulative 974,817 adults were screened for HCV antibodies, 86,624 persons tested positive, of which 61,925 underwent HCV confirmatory testing. Among estimated 150,000 adults living with chronic hepatitis C in Georgia, 52,856 (35.1%) were diagnosed, 45,334 (30.2%) initiated treatment with DAA, and 29,090 (19.4%) achieved sustained virologic response (SVR). Overall 37,256 persons were eligible for SVR assessment, of these only 29,620 (79.5%) returned for evaluation. In the per-protocol analysis, SVR rate achieved was 98.2% (29,090/29,620), and 78.1% (29,090/37,256) in the intent-to-treat analysis.\n\n\nCONCLUSIONS\nGeorgia has made substantial progress in the path towards eliminating hepatitis C. Scaling-up testing and diagnosis, along with effective linkage to treatment services are needed to achieve the goal of elimination.