Research Open Access
Like 0



Between May 2015 and February 2022, 77,168 hepatitis C virus (HCV)-infected people in Georgia have been treated through an HCV elimination programme. To project the programme’s long-term impacts, an HCV infection model was initially developed, based on data from surveys among people who inject drugs and a national serosurvey in 2015.


Accounting for follow-up surveys in 2021, we validate and update projections of HCV infection prevalence and incidence.


We assessed the initial model projections’ accuracy for overall prevalence, by age, sex, and among people who ever injected drugs, compared with 2021 serosurvey data. We used 2021 results to weight model fits and to recalculate the national programme’s impact leading up to March 2022 on HCV infection incidence rates. Cases and deaths averted were estimated. The impact of reduced treatment rates during the COVID-19 pandemic was assessed.


The original model overpredicted adult (≥ 18 years old) chronic HCV infection prevalence for 2021 (2.7%; 95% credible interval (CrI): 1.9–3.5%) compared with a 2021 serosurvey (1.8%; 95% confidence interval (CI): 1.3–2.4%). Weighted model projections estimated a 60% decrease in HCV infection incidence by March 2022, with an absolute incidence of 66 (95% CrI: 34–131) per 100,000 person-years (overall population). Between May 2015 and March 2022, 9,186 (95% CrI: 5,396–16,720) infections and 842 (95% CrI: 489–1,324) deaths were averted. The COVID-19 pandemic resulted in 13,344 (95% CrI: 13,236–13,437) fewer treatments and 438 (95% CrI: 223-744) fewer averted infections by March 2022.


Results support the programme’s high effectiveness. At current treatment rate (406/month), 90% reductions in prevalence and incidence in Georgia are achievable by 2030.


Article metrics loading...

Loading full text...

Full text loading...



  1. Hagan LM, Kasradze A, Salyer SJ, Gamkrelidze A, Alkhazashvili M, Chanturia G, et al. Hepatitis C prevalence and risk factors in Georgia, 2015: setting a baseline for elimination. BMC Public Health. 2019;19(S3) Suppl 3;480.  https://doi.org/10.1186/s12889-019-6784-3  PMID: 32326913 
  2. Blach S, Zeuzem S, Manns M, Altraif I, Duberg A-S, Muljono DH, et al. , Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2(3):161-76.  https://doi.org/10.1016/S2468-1253(16)30181-9  PMID: 28404132 
  3. Grebely J, Larney S, Peacock A, Colledge S, Leung J, Hickman M, et al. Global, regional, and country-level estimates of hepatitis C infection among people who have recently injected drugs. Addiction. 2019;114(1):150-66.  https://doi.org/10.1111/add.14393  PMID: 30035835 
  4. World Health Organization. Global Health Sector Strategy on Viral Hepatitis, 2016-2021. World Health Assembly: Geneva; 2016. p. 53.
  5. Nasrullah M, Sergeenko D, Gvinjilia L, Gamkrelidze A, Tsertsvadze T, Butsashvili M, et al. The Role of Screening and Treatment in National Progress Toward Hepatitis C Elimination - Georgia, 2015-2016. MMWR Morb Mortal Wkly Rep. 2017;66(29):773-6.  https://doi.org/10.15585/mmwr.mm6629a2  PMID: 28749925 
  6. Gamkrelidze A, Shadaker S, Tsereteli M, Alkhazashvili M, Chitadze N, Tskhomelidze I, et al. Nationwide hepatitis C serosurvey and progress towards HCV elimination in the country of Georgia, 2021. J Infect Dis. 2023;jiad064.  https://doi.org/10.1093/infdis/jiad064  PMID: 36932731 
  7. Georgia Hepatitis Elimination Program Progress Report, 2020-2021. 2022, Ministry of Internally Displaced Persons from the Occupied Territories Labour, Health, and Social Affairs of Georgia: Tbilisi, Georgia.
  8. Walker JG, Kuchuloria T, Sergeenko D, Fraser H, Lim AG, Shadaker S, et al. Interim effect evaluation of the hepatitis C elimination programme in Georgia: a modelling study. Lancet Glob Health. 2020;8(2):e244-53.  https://doi.org/10.1016/S2214-109X(19)30483-8  PMID: 31864917 
  9. Gamkrelidze A, Handanagic S, Shadaker S, Turdziladze A, Tsereteli M, Getia V, et al. The impact of COVID-19 pandemic on the 2020 hepatitis C cascade of care in the Republic of Georgia. Public Health. 2022;205:182-6.  https://doi.org/10.1016/j.puhe.2022.01.040  PMID: 35305459 
  10. Kish L. A Procedure for Objective Respondent Selection within the Household. J Am Stat Assoc. 1949;44(247):380-7.  https://doi.org/10.1080/01621459.1949.10483314 
  11. Shepherd J, Jones J, Hartwell D, Davidson P, Price A, Waugh N. Interferon alpha (pegylated and non-pegylated) and ribavirin for the treatment of mild chronic hepatitis C: a systematic review and economic evaluation. Health Technol Assess. 2007;11(11):1-205, iii.  https://doi.org/10.3310/hta11110  PMID: 17346498 
  12. Chikovani I, Shengelia N, Sulaberidze L, Sirbiladze T, Tavzarashvili L. HIV risk and prevention behaviors among People Who Inject Drugs in seven cities of Georgia. Tbilisi, Georgia: Curatio International Foundation 2015. [Accessed 27 Nov 2019]. Available from: http://curatiofoundation.org/wp-content/uploads/2018/02/PWID-IBBS-Report-2017-ENG.pdf
  13. Kuniholm MH, Aladashvili M, Del Rio C, Stvilia K, Gabelia N, Chitale RA, et al. Not all injection drug users are created equal: heterogeneity of HIV, hepatitis C virus, and hepatitis B virus infection in Georgia. Subst Use Misuse. 2008;43(10):1424-37.  https://doi.org/10.1080/10826080802108293  PMID: 18696377 
  14. Bemoni Public Union and Curatio International Foundation. Population Size Estimation of People who Inject Drugs in Georgia 2014. 2015; 1-51. [Accessed 7 Dec 2017]. Available from: http://curatiofoundation.org/wp-content/uploads/2016/05/PWIDs-PSE-Report-2015_ENG.pdf
  15. Dolmazashvili E, Sharvadze L, Abutidze A, Chkhartishvili N, Todua M, Adamia E, et al. Treatment of hepatitis C in primary health care in the country of Georgia. Clin Liver Dis (Hoboken). 2022;20(5):175-8.  https://doi.org/10.1002/cld.1260  PMID: 36447909 
  16. Butsashvili M, Kamkamidze G, Kajaia M, Gvinjilia L, Kuchuloria T, Khonelidze I, et al. Integration of hepatitis C treatment at harm reduction centers in Georgia-Findings from a patient satisfaction survey. Int J Drug Policy. 2020;84:102893.  https://doi.org/10.1016/j.drugpo.2020.102893  PMID: 32739613 
  17. R Core Team. R: A Language and Environment for Statistical Computing. 2023, R Foundation for Statistical Computing: Vienna, Austria.
  18. World Health Organization (WHO). Interim guidance for country validation of viral hepatitis elimination: Technical report. Geneva: WHO; 2021.
  19. Blach S, Kondili LA, Aghemo A, Cai Z, Dugan E, Estes C, et al. Impact of COVID-19 on global HCV elimination efforts. J Hepatol. 2021;74(1):31-6.  https://doi.org/10.1016/j.jhep.2020.07.042  PMID: 32777322 
  20. Averhoff F, Shadaker S, Gamkrelidze A, Kuchuloria T, Gvinjilia L, Getia V, et al. Progress and challenges of a pioneering hepatitis C elimination program in the country of Georgia. J Hepatol. 2020;72(4):680-7.  https://doi.org/10.1016/j.jhep.2019.11.019  PMID: 31811882 
  21. Chikovani I, Ompad DC, Uchaneishvili M, Sulaberidze L, Sikharulidze K, Hagan H, et al. 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. PLoS One. 2019;14(4):e0216123.  https://doi.org/10.1371/journal.pone.0216123  PMID: 31034530 
  22. Klepac P, Metcalf CJ, McLean AR, Hampson K. Towards the endgame and beyond: complexities and challenges for the elimination of infectious diseases. Philos Trans R Soc Lond B Biol Sci. 2013;368(1623):20120137.  https://doi.org/10.1098/rstb.2012.0137  PMID: 23798686 
  23. Hassanin A, Kamel S, Waked I, Fort M. Egypt’s Ambitious Strategy to Eliminate Hepatitis C Virus: A Case Study. Glob Health Sci Pract. 2021;9(1):187-200.  https://doi.org/10.9745/GHSP-D-20-00234  PMID: 33795369 
  24. Blach S, Terrault NA, Tacke F, Gamkrelidze I, Craxi A, Tanaka J, et al. , Polaris Observatory HCV Collaborators. Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study. Lancet Gastroenterol Hepatol. 2022;7(5):396-415.  https://doi.org/10.1016/S2468-1253(21)00472-6  PMID: 35180382 
  25. Artenie A, Stone J, Fraser H, Stewart D, Arum C, Lim AG, et al. , HIV and HCV Incidence Review Collaborative Group. Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(6):533-52.  https://doi.org/10.1016/S2468-1253(23)00018-3  PMID: 36996853 
  26. Bouscaillou JKT, Le Pluart D, Butsashvili M, Labartkava K, Kamkamidze G, Inaridze I, et al. Low HCV Reinfection Rate After Treatment In People Who Infect Drugs (PWID) From A Prospective Cohort In Tbilisi, Georgia. 2018. Available from: https://www.inhsu.org/resource/low-hcv-reinfection-rate-after-treatment-in-people-who-infect-drugs-pwid-from-a-prospective-cohort-in-tbilisi-georgia/
  27. Health Research Union. Integrated Bio-Behavioral Surveillance Survey among People Who Inject Drugs. 2022: Tbilisi, Georgia.
  28. Artenie A, Luhmann N, Lim AG, Fraser H, Ward Z, Stone J, et al. Methods and indicators to validate country reductions in incidence of hepatitis C virus infection to elimination levels set by WHO. Lancet Gastroenterol Hepatol. 2022;7(4):353-66.  https://doi.org/10.1016/S2468-1253(21)00311-3  PMID: 35122713 
  29. Lim AG, Scott N, Walker JG, Hamid S, Hellard M, Vickerman P. Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis. PLoS Med. 2021;18(10):e1003818.  https://doi.org/10.1371/journal.pmed.1003818  PMID: 34665815 
  30. Lim AG, Walker JG, Mafirakureva N, Khalid GG, Qureshi H, Mahmood H, et al. Effects and cost of different strategies to eliminate hepatitis C virus transmission in Pakistan: a modelling analysis. Lancet Glob Health. 2020;8(3):e440-50.  https://doi.org/10.1016/S2214-109X(20)30003-6  PMID: 32087176 
  31. Scott N, Win TM, Tidhar T, Htay H, Draper B, Aung PTZ, et al. Hepatitis C elimination in Myanmar: Modelling the impact, cost, cost-effectiveness and economic benefits. Lancet Reg Health West Pac. 2021;10:100129.  https://doi.org/10.1016/j.lanwpc.2021.100129  PMID: 34327345 

Data & Media loading...

Supplementary data

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error