Photo by Zaza Macharashvili
Fogarty has supported efforts to build research capacity in
Georgia for two decades and scientists there are working on
eliminating hepatitis C from their country.
By Cathy Kristiansen
Georgia has launched a groundbreaking program to rid its population of hepatitis C - the first lower-middle-income country to tackle this challenge since a cure was discovered for the devastating disease. Leading the effort are a number of former Fogarty trainees, who are collaborating with the U.S. CDC and a pharmaceutical company that is donating its new drug.
As many as 150 million people globally are infected with the hepatitis C virus (HCV), resulting in about 500,000 deaths annually from cirrhosis or cancer of the liver, according to the WHO. Georgia reports one of the world's highest estimated HCV prevalence rates, reaching as much as 80 percent among its HIV-positive population, injection drug users and prisoners. The scientific team believes the country is an ideal candidate for HCV elimination with its small size and high prevalence of disease; strong governmental commitment; availability of modern diagnostic and treatment methods; and a cadre of well-trained personnel who are capable of planning and implementing such a complex initiative.
"It's a strikingly innovative program," said longtime Fogarty grantee, Dr. Jack A. DeHovitz, of SUNY Downstate Medical Center, who has trained Georgian scientists with Fogarty funding since 1996. "It's fair to say that without the Fogarty investment, this would not be happening."
Georgia's research strength to tackle this disease, HIV and other health burdens is founded on the steady build-up of capacity over the past two decades. Key support came from Fogarty's training programs and research projects orchestrated by four grantees - DeHovitz, Drs. Carlos del Rio and Henry M. Blumberg of Emory University, and Dr. Dale L. Morse, now at the CDC.
The group has together trained about 100 Georgian scientists, which was critical to developing the human resources required to eliminate HCV, del Rio noted. "Fogarty was the gel that allowed us to collaborate and help build a strong public health sector when it wasn't really in vogue." Georgia's research infrastructure had been devastated by a civil war that ended in 1993 and the first Fogarty support came only a few years later.
In 2014, a new medicine became available that, in combination with other drugs, cures nearly all HCV patients in 12 weeks. Georgian scientists saw this as an opportunity to eliminate the virus in their country. They partnered with the U.S. CDC to prepare the groundwork, such as conducting epidemiological studies, priming laboratory and health care capacity, and setting up an evaluation framework. Gilead Sciences, Inc. offered free supplies of its drugs Sovaldi and Harvoni, which would normally cost about $84,000 per patient.
"The knowledge and skills we gained during Fogarty-funded training are a very important contribution to the preparation of this intervention," said Dr. Maia Butsashvili, a hepatitis C project scientist, who obtained her doctoral degree in epidemiology with Fogarty support.
So far, the team has selected seven clinical sites and associated labs to pilot the program. They also developed a data management system to track patients and collect demographic, diagnostic, clinical and pharmacy information. By September, more than 10,000 patients with HCV had registered and about 3,000 had begun treatment.
Georgia faces many challenges in reaching the point of hepatitis C elimination, mainly due to the difficulty in identifying the virus before it causes symptoms and its rapid spread through injection drug use, noted the authors of a CDC report on the project. However, the government is addressing these through advocacy, communication, surveillance and prevention strategies, they added.
One of Georgia's first Fogarty trainees, Dr. Tengiz Tsertsvadze, is helping to guide the HCV effort. Tsertsvadze, now director of the infectious disease research center in Tbilisi and professor of medicine at Tbilisi State University, hopes his country's example will be a guide to others battling HCV. "Through best practices and lessons learned," he said, "the international community can follow Georgia's successful experience to significantly reduce the devastating burden of hepatitis C."
Related journal articles:
- High incidence of the hepatitis C virus recombinant 2k/1b in Georgia: Recommendations for testing and treatment
Hepatology Research, February 2015
- Evaluation of multiple measures of antiretroviral adherence in the Eastern European country of Georgia
Journal of the International AIDS Society, April 9, 2014
- Hepatitis c virus co-infection increases the risk of anti-tuberculosis drug-induced hepatotoxicity among patients with pulmonary tuberculosis
PLOS ONE, December 19, 2013
- Occupational exposure to body fluids among health care workers in Georgia
Occupational Medicine, December 2012 (published online August 6, 2012)
- Outcomes of Universal Access to Antiretroviral Therapy (ART) in Georgia
AIDS Research and Treatment, February 21, 2011
- Prevailing HCV genotypes and subtypes among HIV infected patients in Georgia
Georgian Medical News, December 2009
- Not all injection drug users are created equal: heterogeneity of HIV, hepatitis C virus, and hepatitis B virus infection in Georgia
Substance Use and Misuse, October 2008
- Risk factors and algorithms to identify hepatitis C, hepatitis B, and HIV among Georgian tuberculosis patients
International Journal of Infectious Diseases, January 2008
- Risk behaviors and HIV, hepatitis B, and hepatitis C seroprevalence among injection drug users in Georgia
Drug and Alcohol Dependence, April 2006