Author: M Butsashvili, G Kamkamidze, M Kajaia, L Gulbiani, L Gvinjilia, T Kuchuloria, A Gamkrelidze, E Adamia, M Nasrullah, F Averhoff

Theme: Models of Care Year: 2019

Background: Georgia embarked on hepatitis C elimination in April 2015. People who inject drugs (PWID)
represent a major share of hepatitis C burden in the country. Ensuring access to treatment for HCV
infected PWID is needed to reach elimination goals. Integration of treatment services into harm
reduction (HR) settings could facilitate access for HCV infected PWID.
Description of model of care: The Ministry of Health established a working group for integration of
hepatitis C treatment services into HR settings in early 2018. Four pilot HR centers were selected to
implement hepatitis C integrated treatment: one oral substitution therapy (OST) site in Tbilisi and three
needle syringe programs (NSP)-one each in Tbilisi, Zugdidi, and Batumi. Three sites conduct HCV
antibody screening and have HCV RNA testing (using GeneXpert) available on-site. A simplified
laboratory testing algorithm was introduced, and patients having FIB4>1.45 are referred to specialized
clinics for treatment while patients with FIB4<1.45 are treated at HR center. Sofosbuvir/ledipasvir (for genotype1) and sofosbuvir/velpatasvir (for genotype 2/3) regimens are used for treatment. We analyzed data from HR program and the national treatment program. In addition, providers at pilot sites were surveyed to assess acceptability of treatment integration. Results: During the first two months of treatment services at HR sites, 155 clients tested HCV RNA positive, of whom 44(28.4%) had FIB4>1.45 and were referred to specialized clinics and 111 patients
(71.6%) began treatment at HR centers. No patients had completed treatment as of March 2019.
Overall, 62 HR staff were surveyed. The majority of respondents (n=60; 96.7%) were supportive of
hepatitis C treatment integration into HR centers. The most common reason cited for why they favored
treatment integration was “patient/client convenience,” reported by 57/60(95%) of respondents.

Conclusion: Integration of hepatitis C care with HR services is likely feasible at HR centers and it is highly
acceptable for personnel who provide HR services.

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