Historical epidemiology of hepatitis C virus in select countries-volume 4.

Due to the introduction of newer, more efficacious treatment options, there is a pressing need for policy makers and public health officials to develop or adapt national hepatitis C virus (HCV) control strategies to the changing epidemiological landscape. To do so, detailed, country-specific data are needed to characterize the burden of chronic HCV infection. In this study of 17 countries, a literature review of published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates was conducted, and inputs were validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Hong Kong to 2.4% in Taiwan, while the largest viraemic populations were in Nigeria (2 597 000 cases) and Taiwan (569 000 cases). Diagnosis, treatment and liver transplant rates varied widely across the countries included in this analysis, as did the availability of reliable data. Addressing data gaps will be critical for the development of future strategies to manage and minimize the disease burden of hepatitis C.

Strategies to manage hepatitis C virus infection disease burden-Volume 4.

The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 17 countries in Africa, Asia, Europe, Latin America and the Middle East, and interventions for achieving the Global Health Sector Strategy on viral hepatitis targets-"WHO Targets" (65% reduction in HCV-related deaths, 90% reduction in new infections and 90% of infections diagnosed by 2030) were considered. Scaling up treatment and diagnosis rates over time would be required to achieve these targets in all but one country, even with the introduction of high SVR therapies. The scenarios developed to achieve the WHO Targets in all countries studied assumed the implementation of national policies to prevent new infections and to diagnose current infections through screening.

The present and future disease burden of hepatitis C virus infections with today's treatment paradigm: Volume 4.

Factors influencing the morbidity and mortality associated with viremic hepatitis C virus (HCV) infection change over time and place, making it difficult to compare reported estimates. Models were developed for 17 countries (Bahrain, Bulgaria, Cameroon, Colombia, Croatia, Dominican Republic, Ethiopia, Ghana, Hong Kong, Jordan, Kazakhstan, Malaysia, Morocco, Nigeria, Qatar and Taiwan) to quantify and characterize the viremic population as well as forecast the changes in the infected population and the corresponding disease burden from 2015 to 2030. Model inputs were agreed upon through expert consensus, and a standardized methodology was followed to allow for comparison across countries. The viremic prevalence is expected to remain constant or decline in all but four countries (Ethiopia, Ghana, Jordan and Oman); however, HCV-related morbidity and mortality will increase in all countries except Qatar and Taiwan. In Qatar, the high-treatment rate will contribute to a reduction in total cases and HCV-related morbidity by 2030. In the remaining countries, however, the current treatment paradigm will be insufficient to achieve large reductions in HCV-related morbidity and mortality.

Evaluation of state opioid substitution treatment program in Georgia.

AIMS: Evaluation of State Opioid Substitution Treatment OST (methadone and buprenorphine/naloxone- Addnok-N) program in Georgia and optimization of the routine measurement instrument. Patients were recruited from 4 Tbilisi and 5 regional State Programs in May-October 2013. 2 structured self-questionnaires (one - anonymous for sensitive questions) were developed for patients to assess demographics, retention in treatment, mean drug dose, HIV and Hepatitis C and B status, illicit drug and alcohol use, social activities, crime involvement, health status, HIV risk behavior, treatment compliance and satisfaction. 608 patients (7 females) were surveyed (512 - on Methadone, 96 - on buprenorphine/naloxone). 337 (1 female) patients completed an anonymous questionnaire. Mean age - 39.43±8.7 (21-65 years). 10 (1.64%) respondents were HIV positive; 448 (73.68%) - HCV+ and 24 (3.95%) - HBV+; average methadone dose - 39.27±22.2mg; buprenorphine/naloxone - 7.4±3.6 mg; 64 (40%) of employed began working while in program; 365 (60%) have been in treatment for less than 1 year, and 146 (24%) - for 1-3 years vs. 258 (51%) out of 506 patients surveyed in 2011. 494 (81.2%) reported improvement of social status and 508 (83.5%) - of health status. 305 (90.5%) out of 337 reported no- and 30 (8.9%) - reduction of criminal activity. 467 (76.81%) patients attended individual and 200 (32.9%)-group psychotherapy sessions with various frequencies. The common adverse events: sleep disturbances - 48.84%; weakness - 50.82%; mood disturbances - 42.44%, and heaviness - 36.35%. 257 (46%) reported using of alcohol; 16 - opioids; 29 - sedative/hypnotics; 8 - marijuana and 1 - ATS past 30 days; 55 - drug injection and 11 - sharing of any injection equipment past 6 months. State OST program is effective in Georgia in terms of reduction of illegal drug use, injection risk behavior and criminal activity, and on the other hand - improving of social activity and general health. Treatment retention is less as compared with 2011 survey.

Needs assessment and treatment compliance at state opioid substitution treatment programes in Georgia.

AIMS: conduct needs assessments and treatment compliance evaluations in MMT and Suboxone Substitution State Programs in Georgia (Republic of). 506 patients (2 females) were surveyed (92% on Methadone, 8% on Suboxone) from 6 Tbilisi and 4 regional State Programs in 2011 November. Mean age - 40±8,56 (22-65) year; 254 (51.4%) were in treatment for 1-3 year. Evaluation was carried out on the base of structured self-questionnaire that covers demographics, drug use history, general drug use trends, psychotherapeutic sessions' acceptance and open label question regarding treatment challenges and satisfaction. 305 (60.3%) attended individual and 57 (11.3%) group psychotherapy sessions with 50.79% attending once/month or rare. The main reason given for therapy non-attendance - no needs for it (29.48%); the main drugs before admission - heroin (80.04%), buprenorphine (53.49%); Main drugs used in Georgia nowadays - desomorphine ("crocodile"), alcohol and marihuana. Commonly used drugs by program patients (136 positive answers) - alcohol-13.62%, marihuana-10.39%, pregabalin - 8.17%, opioids- 6.62% (mostly-"crocodile"), home-made stimulants-6.23%, sedatives -5.45%. 55.4% are extremely satisfied with treatment, 82.4% - with program staff. Patients' main wishes- free of charge programs (46.4%) and provide take-home doses (22.07%). Methadone and Suboxone ST are being well accepted in Georgia and appear to be reducing illegal opioid use. However, the psychotherapeutic sessions' attendance is very low.

Evaluation of the quality of life (Whoqol-Bref) among methadone and suboxone substitution state program patients and healthy volunteers in Georgia.

AIMS: to evaluate QOL patients being treated with methadone and Suboxone in State-sponsored programs in Georgia. The WHOQOL-BREF (26 questions) version was administered to patients in State substitution program and healthy volunteers to assess their overall function and life satisfaction in physical, mental, social health, and environment domains. Domain scores were calculated and converted to 4-20 and 0-100 scales, identical to the WHOQOL-100. 485 patients (309 from 6 Tbilisi and 176 from 5 regional centers) and 50 healthy volunteers (13 male, 37 female) were surveyed. Significant differences were observed between new admitted patients (0-3 month) and healthy controls by mean physical (47.5 vs. 51.94; CI 95%); psychological (55.0 vs. 60.50; CI 95%) and environmental (46.2 vs. 52.2; CI 95%) domains, but not by social relationships or between Tbilisi and regions. The Social domain scores were raised in accordance with time spent in treatment reaching a maximum improvement within 1-3 years (social- 72.8 vs. 67.7; CI 95%), further with few descending tends round the healthy people's scores. These pilot data show decrements in QOL among patients entering maintenance treatment with improvements in the course of maintenance treatment. It is possible that the increased indicators in social domain up to especially high level within the first 3 years is the result of subjective factors, with the subsequent return to healthy community level.

[The level of fluoxetine in blood plasma and washed from eritrizite supernatant].

Antidepressant Fluoxetine and their major therapeutically active metabolite Norfluoxetine was monitored in albumene and glicoproteene of blood plasma and washed from eritrozite supernatant. In paper we describe rapid and reliable method using high-performance liquid chromatography for simultaneous measurement of plasma and supernatant concentration of Fluoxetine and Norfluoxetine. The described method has been successfully used in clinical and laboratory cases. Large interindividual variations in plasma and supernatan concentrations of Fluoxetine and their major metabolite have been shown. In albumene fractions of blood plasma the level of Fluoxetine is more higher then in supernatant. A successful development of the clinico-pharmacokinetic direction at the present stage is due to improvement and standardization of methods of clinical and pharmacokinetic examination which help to ensure a reliable pretreatment identification of patients potentially sensitive to pharmacotherapy with antidepressants.

[The influence of fluoxetine on noradrenergetic neurotransmitters of brain cortex].

The aim of this work was to evaluate the hypothesis that the second-generation antidepressant, might play a role in controlling the activity of noradrenalergic neurotransmitters. The paper details the pharmacological profile of antidepressant drug Fluoxetive with high affinity for 5-HT receptor, and explains how the antidepressant activity chances noradrenalin reuptake inhibitor-medications. Brain cortexes of 20 rabbits were analyzed by high-performance liquid chromatography. The conducted quantitative and qualitative analyzes show that antidepressant activity of Fluoxetine could be mediated by the synergistic effects on the serotoninergic and noradrenergic receptor pathways. Major depressive disorders are heterogeneous monoamine condition. Our studies have demonstrated fluoxetine efficacy and safety for treatment of major depressive disorders.