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.

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

doi:10.1371/journal.pone.0216123

Ivdity Chikovani, Nancy L. Van Devanter + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0216123

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Abstract

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.

Highlights

Hepatitis C virus (HCV) infection is a significant public health concern worldwide
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
Our study provides a better understanding of People who inject drugs (PWID) in the context of seeking and adhering to HCV treatment, which is critical to improving treatment uptake and retention

Summary

Introduction

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. The study revealed that use of injection drugs accounted for more than one third of cases among the general population [4]. PWID in Georgia are vulnerable to HCV infection due to risky behaviors and exposure to structural and environmental risk factors. 65%-75% of PWID in Georgia are HCV antibody positive [5]

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Conclusion