Abstract
BackgroundThe country of Georgia has a high burden of chronic hepatitis C virus (HCV) infection, and prisoners are disproportionately affected. During 2013, a novel program offering no cost screening and treatment of HCV infection for eligible prisoners was launched.MethodsThe HCV treatment program implemented a voluntary opt-in anti-HCV testing policy to all prisoners. Anti-HCV positive persons received HCV RNA and genotype testing. Transient elastography was also performed on prisoners with positive HCV RNA results. Prisoners with chronic HCV infection who had ≥F2 Metavir stage for liver fibrosis and a prison sentence ≥ 6 months were eligible for interferon-based treatment, which was the standard treatment prior to 2015. We conducted an evaluation of the HCV treatment program among prisoners from the program’s inception in December 2013 through April 2015 by combining data from personal interviews with corrections staff, prisoner data in the corrections database, and HCV-specific laboratory information.ResultsOf an estimated 30,000 prisoners who were incarcerated at some time during the evaluation period, an estimated 13,500 (45%) received anti-HCV screening, of whom 5175 (38%) tested positive. Of these, 3840 (74%) received HCV RNA testing, 2730 (71%) tested positive, and 880 (32%) met treatment eligibility. Of these, 585 (66%) enrolled; 405 (69%) completed treatment, and 202 (50%) achieved a sustained virologic response at least 12 weeks after treatment completion.ConclusionsHCV infection prevalence among Georgian prisoners was high. Despite challenges, we determined HCV treatment within Georgian Ministry of Correction facilities was feasible. Efforts to address HCV infection among prison population is one important component of HCV elimination in Georgia.
Highlights
The country of Georgia has a high burden of chronic hepatitis C virus (HCV) infection, and prisoners are disproportionately affected
Data were obtained from three sources: 1) Personal communication and interviews with Georgia Ministry of Corrections (MOC) officials; 2) A database maintained by the Georgian Ministry of corrections (MOC) that contains prisoner demographic information; and anti-HCV positive prisoners had additional blood samples sent to a laboratory, where a 3) database maintained by the Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIR) in Tbilisi that contains laboratory information from prisoners (HCV Hepatitis C virus ribonucleic acid (RNA) result, HCV genotype, aspartate aminotransferase [Aspartate aminotransferase (AST)], alanine aminotransferase [Alanine aminotransferase (ALT)], and platelet count)
The total number of prisoners housed by MOC during the evaluation period was difficult to ascertain, but the MOC estimates 30,000 persons were in the prison system at some time during the evaluation period
Summary
The country of Georgia has a high burden of chronic hepatitis C virus (HCV) infection, and prisoners are disproportionately affected. There are an estimated 71 million people infected with hepatitis C virus (HCV) and 399,000 associated deaths annually worldwide [1, 2]. Georgia is a lower-middle income country located in Eastern Europe, with a population of 3.7 million people and has one of the highest prevalence rates of HCV infection in the world [3]. A recent national serosurvey in 2015 estimated a 7.7% anti-HCV prevalence [5]. Estimates of anti-HCV prevalence among high-risk groups include: 57–92% among people who inject drugs (PWID), 17% among men who have sex with men, and 4–12% among health care workers [6]. Anti-HCV prevalence among prisoners in most countries is significantly higher than the prevalence in the general population [7,8,9]
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