Assessment of Viral and Clinical Characteristics Among Patients With Chronic Hepatitis B Virus Infection in Georgia.

Background: Hepatitis B virus infection (HBV) is one of the major healthcare problems in Georgia. To achieve viral hepatitis elimination, gaps in diagnosis and management of chronic HBV infection need to be addressed. The aim of our study was to collect data on clinical and viral characteristics of patients with chronic HBV infection to estimate the proportion of patients who may need antiviral treatment. Methods: All relevant deidentified data about demographic, clinical, and viral characteristics were extracted from patients' medical records. Descriptive statistical analyses were done for univariate assessment of demographic, virologic, and clinical characteristics. Chi-square test was used to assess the associations between HBV-DNA level, HBeAg, alanine aminotransferase (ALT), and liver fibrosis. Results: In total, 96% (124/129) of patients with chronic HBV infection are HBeAg-negative; 84% (145/173) had no or mild fibrosis, and 3% (6/162) had advanced liver fibrosis/cirrhosis. Sixty-five out of 126 (51%) patients were classified as HBeAg-positive or HBeAg-negative chronic HBV infection (without hepatitis); 11 (9%) as chronic hepatitis B; 46 (37%) had not classified in any of the known HBV phases, while 30 of them (24% out of total) had high viral load and normal ALT. Statistically significant association was seen between high HBV-DNA and HBeAg-positivity (P = .043). High ALT level was also associated with liver fibrosis (P = .015). Significant positive correlation between age and the presence of moderate or advanced liver fibrosis was observed (P = .002). Conclusion: This is the first study about the clinical and viral characteristics of patients with chronic HBV infection in Georgia. The vast majority were HBeAg-negative, only 3% had advanced liver diseases; about half of patients had inactive diseases. However, one out of four patients had a high viral load but normal ALT. By the evaluation of HBV phases, we estimated that 12%-36% of patients with chronic HBV monoinfection require antiviral treatment.

Seroconversion of hepatitis B vaccine among patients from outpatient clinic in Georgia.

Introduction: Hepatitis B virus (HBV) is a serious global health challenge with vaccination being the most effective preventive measure. However, several risk-factors may impact HBV vaccine immunogenicity. We aimed to evaluate the immunogenicity of the HBV vaccine. Methods: Participants' socio-demographic data were obtained from medical records. Anti-HBs testing was performed. Descriptive and bivariate analyses were performed. Results: Among 431 participants, 62.2 % (n = 268) were males. In all, 43.2 % (n = 186) had normal weight, 24.8 % (n = 107) were overweight, and 17.6 % (n = 76) had obesity. Seroconversion after 3-dose HBV vaccination was 74.7 %. Participants with normal weight had higher seroprevalence (n = 156/186, 83.9 %), compared with those with overweight (n = 72/107, 67.3 %) or obesity (n = 48/76, 63.2 %) (Normal weight vs overweight: aOR = 2.44, 95 % CI: 1.38-4.32 and normal weight vs obesity: aOR = 2.97, 95 % CI:1.61-5.47). Conclusion: BMI is an independent factor impairing the vaccine response. These findings urge for more tailored vaccination strategies with focus on higher risk populations.

Barriers of linkage to HCV viremia testing among people who inject drugs in Georgia.

BACKGROUND: People who inject drugs (PWID) in Georgia have a high prevalence of hepatitis C virus antibody (anti-HCV). Access to care among PWID could be prioritized to meet the country's hepatitis C elimination goals. This study assesses barriers of linkage to HCV viremia testing among PWID in Georgia. METHODS: Study participants were enrolled from 13 harm reduction (HR) centers throughout Georgia. Anti-HCV positive PWID who were tested for viremia (complete diagnosis [CD]), were compared to those not tested for viremia within 90 days of screening anti-HCV positive (not complete diagnosis [NCD]). Convenience samples of CD and NCD individuals recorded at HR centers using beneficiaries' national ID were drawn from the National HCV Elimination Program database. Participants were interviewed about potential barriers to seeking care. RESULTS: A total of 500 PWID were enrolled, 245 CD and 255 NCD. CD and NCD were similar with respect to gender, age, employment status, education, knowledge of anti-HCV status, and confidence/trust in the elimination program (p > 0.05). More NCD (13.0%) than CD (7.4%) stated they were not sufficiently informed what to do after screening anti-HCV positive (p < 0.05). In multivariate analysis, HCV viremia testing was associated with perceived affordability of the elimination program (adjusted prevalence ratio = 8.53; 95% confidence interval: 4.14-17.62). CONCLUSIONS: Post testing counselling and making hepatitis C services affordable could help increase HCV viremia testing among PWID in Georgia.

Generational differences in current sexual behavior among Georgian reproductive-aged women.

Background: Following the collapse of the Soviet Union, there was a pronounced change in the availability of modern contraceptive methods and an accompanying shift in the knowledge and attitudes of Georgian women related to sexual behaviors. This study describes differences in sexual behaviors, condom use and family planning practices among several generations of reproductive-aged Georgian women. Methods: Study participants were recruited from three large cities in Georgia. Women >25 years were recruited from the Cervical Cancer Screening National Program by consecutive sampling; those <25 years were recruited from universities using random sampling. Data collection included self-administered, anonymous surveys. Bivariate analyses were conducted and adjusted prevalence ratios (PR) with 95% confidence intervals were computed. Results: Among the 350 participants, independent predictors of age at first sexual intercourse were age (aPR 0.27; 95% CI 0.12-0.57), level of education (aPR 0.23; 95% CI: 0.11-0.44), marital status (aPR 2.8;95% CI:1.3-6.0) and religion (aPR 4.01; 95% CI:1.17-13.68). Younger women were more likely to have a premarital sexual relationship compared to older women (RR=0.85; 95% CI: 0.80-0.89); older women were also significantly more likely to use family planning methods with a current partner (RR=2.15; 95% CI: 1.48-3.13). Similarly, advanced education was associated with family planning (RR=1.66; CI: 1.13-2.45). Conclusions: This study describes clear generational differences in current sexual behavior among Georgian women of reproductive age and these differences, especially in age at first sexual intercourse, premarital sexual relationship and use of contraceptive methods, are influenced by age, level of education, marital status and religion. This information is vital to designing contextually appropriate strategies to prevent sexually transmitted infections.

Seroprevalence and awareness of human papillomavirus infection and cervical cancer screening results among reproductive-aged Georgian women.

INTRODUCTION: As is the case in many developing countries, more than half of the new cervical cancer cases in Georgia are late-stage diagnoses, thus reducing the opportunity for effective treatment. A state cancer screening programme was launched in Tbilisi in 2006; 5 years later the programme had expanded to other regions in Georgia. METHODS: This study was designed to estimate awareness about human papillomavirus (HPV), cervical cancer screening, the HPV vaccine, and the seroprevalence of HPV infection among reproductive-aged Georgian women. Study participants were recruited from four women's consultation centres in different regions of Georgia. Data were collected through interviewer-administered questionnaires and HPV seroprevalence was assessed for HPV types 6/11/16/18. RESULTS: Of the 500 study participants, 52.0% were aware of HPV and 36.4% stated that the main cause of cervical cancer is HPV. Of those aware of HPV, 78% reported attending for cervical cancer screening at least once during their lifetime. Half (50.8%) of all respondents were unaware of the HPV vaccine. Of the women who agreed to be tested for anti-HPV antibodies (n=317), 21.1% were positive. Women reporting no condom use were more likely to have HPV antibodies (prevalence ratio 2.77; 95% confidence interval 1.79-4.27). Awareness of cervical cancer screening was significantly associated with HPV seropositivity. With multivariate analysis, both absence of condom use and lack of knowledge about cervical cancer screening were independently associated with HPV seropositivity. CONCLUSION: More comprehensive public awareness campaigns should be developed to raise awareness about HPV screening and prevention.