Research Article: On the way to Hepatitis C elimination in the Republic of Georgia—Barriers and facilitators for people who inject drugs for engaging in the treatment program: A formative qualitative study

Date Published: April 29, 2019

Publisher: Public Library of Science

Author(s): Ivdity Chikovani, Danielle C. Ompad, Maia Uchaneishvili, Lela Sulaberidze, Ketevan Sikharulidze, Holly Hagan, Nancy L. Van Devanter, Jason Blackard.


Hepatitis C virus (HCV) infection is a significant public health concern worldwide. Georgia is among the countries with a high burden of HCV infection. People who inject drugs (PWID) have the highest burden of infection in Georgia. In 2015, the Government of Georgia, with partners’ support, initiated one of the world’s first Hepatitis C Elimination Programs. Despite notable progress, challenges to achieving targets persist. This qualitative study is aimed to better understand some of the barriers and facilitators to HCV testing and treatment services for PWID to inform HCV treatment policies and practices. The study instrument examined social, structural, and individual factors influencing HCV testing and treatment practices. We started with key informant interviews to guide the study instrument development and compare the study findings against health care planners’ and health care providers’ views. Forty PWID with various HCV testing and treatment experiences were recruited through the snowball method. The study found that along with structural factors such as political commitment, co-financing of diagnostic and monitoring tests, and friendly clinic environments, knowledge about HCV infection and elimination program benefits, and support from family and peers also play facilitating roles in accessing testing and treatment services. On the other hand, inability to co-pay for diagnostic tests, fear of side effects associated with treatment, poor knowledge about HCV infection, and lack of social support hampered testing and treatment practices among PWID. Findings from this study are important for increasing the effectiveness of this unique program that targets a population at high risk of HCV infection.

Partial Text

Hepatitis C virus (HCV) infection is a significant public health concern worldwide. An estimated 13 million people are infected with HCV in the European region [1]. People who inject drugs (PWID) are the main drivers of the HCV epidemic. It has been estimated that 64.7% (56.6% -72%) of PWID are exposed to HCV in Eastern Europe, which has the highest prevalence across the regions [2]. Georgia is among the countries with a high burden of HCV infection. A national population based survey conducted in 2015 found that 7.7% of the general population is anti-HCV positive and 5.4% are HCV RNA positive [3]. The study also revealed that use of injection drugs accounted for more than one third of cases among the general population [4]. Similar to other countries, PWID in Georgia are particularly vulnerable to HCV infection due to risky behaviors and exposure to structural and environmental risk factors. Approximately 65%-75% of PWID in Georgia are HCV antibody positive [5].

In total, 40 current PWID participated in the study. Eight respondents had already completed HCV treatment, ten respondents were currently being treated for HCV, eighteen respondents were not involved in the program of which seven were not aware of their HCV status, and four respondents were on the waiting list for HCV treatment. The study failed to recruit any respondent who initiated and interrupted treatment. Demographic characteristics of the sample are presented in Table 2.

Georgia is poised to provide treatment to more than 120,000 individuals with chronic HCV infection, with the ultimate goal of reducing prevalence of HCV infection by 90% [8]. This is an unprecedented approach to implementing HCV treatment on such a large scale. From April 2015 through March 2018, Georgia’s HCV Elimination Program has managed to enroll 45,000 chronic HCV patients in treatment, of whom 29,000 achieved cure (i.e., sustained virologic response) [14].

Our study is subject to several limitations. Although the study attempted to recruit female PWID, we were only able to enroll one female participant. In general recruitment of female PWID is challenging in Georgia due to lower prevalence of drug injection among females compared to males and high levels of stigma towards women who inject drugs leading them to be one of the most hidden subgroups [15,19]. The study also failed to enroll the PWID with a history of treatment interruption therefore our sample excludes views of this subset.

This study provides important insights into the implementation of the Hepatitis C Elimination Program in Georgia and also highlights barriers and facilitators to HCV treatment initiation and completion. The Georgian program should enhance its outreach to PWID communities to encourage HCV testing and use of harm reduction services as well as to provide education about HCV and HCV treatment. This can be accomplished by continuing to leveraging PWID relationships with CSOs.




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