KNOWLEDGE, ATTITUDE AND PRACTICE SURVEY AMONG GEORGIAN HEALTH CARE WORKERS TOWARDS BLOOD BORNE INFECTIONS.

The prevalence of viral hepatitis B and C in Georgia is among the highest in the region. US Centers for Disease Control and Prevention (CDC) has selected Georgia as a pilot country for hepatitis C elimination program. Since 2015, Georgia launched a multi-year program of HCV elimination, including treatment of infected individuals with Direct Acting Antivirals (DAAs) and implementation of prevention programs, including infection control in health care facilities. The objective of this study was to evaluate the attitude and knowledge of blood borne infections (HIV, HCV, HBV) among Georgian Health Care Workers (HCWs). HCWs were recruited from six participating multi-profile hospitals and dental care institutions in three large cities of Georgia (Batumi (Western Georgia), Rustavi (Eastern Georgia) and the capital city, Tbilisi). A self - administered questionnaire included sections regarding sociodemographic and professional characteristics; awareness of blood-borne infections; practice for transmission risk reduction and perceived educational interventions acceptable among HCWs. The selection of HCWs was done through simple random sampling from the list of staff as a sampling frame. HCW's survey results were compared to the one from Dental health care workers (DHCWs). The total number of surveyed individuals was 442. Among them, 246 (55.6%) were HCWs (physicians, nurses, physician assistants and residents) from different departments, including family medicine (38.6 %), surgery (21.7%), gynecology (23.4%) and intensive care (13.9%) and 196 DHCWs (44.6%). Only few respondents (15.6%) correctly identified the prevalence of HIV infection in Georgia. HCWs have better understanding about the prevalence of viral hepatitis compared to DHCWs (Prevalence of HBsAg was correctly identified by 33.2 % vs 22.3%; prevalence of HCV- by 18.9 % vs 17.3%). Knowledge regarding transmission risks of blood-borne infections (HIV, HCV, HBV) among HCWs is higher compared to DHCWS (for HIV 73% vs 45.3%, for HCV 49.2% vs 37.9% and for HBV 54.8% vs 33.7%) (p<0.005). Vast majority of DHCWs as well as HCWs believed that probability of transmission of blood-borne infections after contaminated needle stick is 50-70% (p<0.05). There was a poor knowledge on availability of post exposure prophylaxis (42.9% of HCWs compare to 36.1% DHCWs believed that HCV post-exposure prophylaxis is available) (p<0.005). The practice of using facemasks (81% vs 74.4% always use, respectively), protective clothes (96.8% vs 83.3% always use) and eyewears (46.9% vs 27.4% always use) was reported by DHCWs and HCWs. Some nosocomial risk events were reported by higher proportion of DHCWs, compared to HCWs and included accidental needle stick injuries (65.1% vs 45.5%) and blood splashes (48.3% vs 28.2%). Cuts with contaminated instruments was more common among HCWs compared to DCHWs (41.4% vs 35.1%) during medical procedures. The study suggests that level of knowledge on blood borne infections among both HCWs and DHCWs is not adequate. Data from this study can be utilized to design educational programs for Georgian HCWs/DHCWs to improve knowledge and practice about blood borne diseases.

KNOWLEDGE RELATED TO HIV/TB/HCV AMONG PRIMARY HEALTH CARE WORKERS AND THE INTEGRATED SCREENING IN KVEMO KARTLI REGION.

Integration of TB/HIV/HCV screening into primary health care has been implemented in Georgia since 2018. The aim of the program is to strengthen TB, HIV/HCV screening and early detection capabilities in the primary health care, as early detection and treatment are considered to be the most effective strategies to prevent these infections. The goal of the study was to evaluate and compare the baseline and follow-up knowledge about TB, HIV and HCV infectious among primary health care workers in Kvemo Kartli Region. The study instrument was a self-administered questionnaire. A total of 459 primary HCWs from Kvemo Kartli region were surveyed. The proportion of HCWs correctly knowing MDR TB definition increased from 34.6% to 82.8% and this difference was statistically significant (p<0.01). Nurses were less informed about HIV infection. Only 70.7% of them knew modes of HIV transmission, while 89.3% of physicians answered this question correctly (p<0.001). An assessment of knowledge among primary health care workers (PHC) providers is important, as they represent the first level of community contact with health care. The post-test after the training showed significant improvement in knowledge among trained HCWs. Follow-up knowledge and practice surveys are needed to understand the long-term impact of training on the rate screening referrals by PHC providers.

GENDER RELATED BARRIERS TO TUBERCULOSIS IN GEORGIA.

The morbidity and mortality burden of tuberculosis (TB) remains high in Georgia, including drug-resistant TB. A survey was conducted to identify potential gender-based barriers and contributing factors that might influence the timely diagnosis and treatment of TB among active and former TB patients. To assess TB-related stigma and discrimination, a quantitative study was conducted to identify gender-based barriers to the diagnosis and treatment of TB among current and former patients. The study subjects were selected by a simple random sampling method with a 1:1 gender ratio. Participation in the study was voluntary. Data were collected by individual, face-to-face interviews. The patients' registry of the National Center for Tuberculosis and Lung Disease was used as the sampling frame to select patients either currently on anti-tuberculous treatment as well as former TB patients, who completed or discontinued treatment. A total of 230 patients on current anti-tuberculosis treatment or former patients who have been treated for tuberculosis participated in the study. Half of the participants (115, 50%) were male. No significant gender difference was detected with respect to awareness and knowledge about tuberculosis. Stigma associated with TB was found to be higher among women than men. Compared to men, more female respondents than males reported a negative change in attitude from other people after their TB diagnosis (14.8% vs 8.7%, respectively). A higher proportion of women than men notified a family member upon deciding to visit a doctor due to TB symptoms and, similarly, more women were accompanied by a family member for the first physician visit related to tuberculosis. In Georgia, as in other countries around the world, men are more likely to be infected with TB than women. However, the stigma related to TB introduces barriers to service utilization. Barrier reduction programs should consider more comprehensive gender assessment and in-depth analysis of the epidemiological situation by economic status, living conditions, regions, employment status, and ethnicities. Effective interventions may reduce barriers and contribute to the timely diagnosis and treatment of TB.

AWARENESS OF CANCER SCREENING AMONG GEORGIAN PRIMARY CARE PHYSICIANS.

Despite the development of new diagnostic and treatment tools, cancer remains one of the leading public health challenges of developed and developing countries. According to the National Center for Disease control and Public Health (NCDC), incidence of all cancer cases in 2018 was 258.6 per 100.000 in Georgia. However, the national cancer screening program (available since 2006) has a low participation rate. In 2018, only 11.2% of eligible women were screened for cervical cancer and 8.6% had a mammogram. The coverage is even lower for colorectal cancer screening (1.5%). In 2019, NCDC launched an awareness campaign for cancer screening aiming to inform citizens about the importance of cancer screening and to provide updated information to primary care physicians to promote the cancer screening among their patients. Primary care workers (PCW) from three regions of Georgia were surveyed to assess their awareness regarding cancer and the cancer screening program before and after the educational courses. Data were collected using a self-administered questionnaire with 27 questions. The statistical software package, SPSS version 23, was used for data processing and analyses. A total of 129 primary care workers were enrolled, of whom 55.1% did not know that breast cancer screening is offered every two years by the national screening program. Only 61.1% correctly identified the eligible age groups for colorectal cancer screening. Almost half of PCWs (46.0%) did not know that low-risk HPV strains are associated with genital warts. Low engagement of PHC workers in cancer screening may explain the low participation rate in the state cancer screening program. Even though baseline knowledge was significantly improved after training courses, follow-up knowledge and practice surveys are needed to understand the long-term impact of training on the rate of referrals for cancer screening by PHC providers.

KNOWLEDGE OF GEORGIAN POPULATION TOWARDS AIR POLLUTION AND HEALTH EFFECTS OF LEAD CONTAMINATION.

The goal of this study was to assess the level of knowledge about air pollution and the health effects of lead exposure among the population of Georgia. In 2019, a project entitled "Protect Environment" was conducted by the National Center for Disease Control and Public Health and the Health Research Union. The online survey was carried out using a Facebook advertisement, which included the title, body text, the banner, and a link to the questionnaire. The target population was the entire country and the language used was Georgian. We collected information on knowledge about health problems caused by polluted air, diverse environmental pollutants (such as the smoke of burning leaves, cigarette butts and smoke, effects of lead), and the effectiveness of a face mask to filter pollutants. Finally, we assessed awareness of the informational website www.air.gov.ge. The study was conducted over 3 days among 349 respondents in October 2019. Most (90.3%) of the respondents correctly answered the question related to air pollution causing different types of diseases, a similar proportion were concerned about the impact of environmental pollution and the impact of exposure to lead (76.8%). These findings indicate the importance of promoting educational websites that provide detailed information about various contaminants, as well as different preventive measures to mitigate environmental pollution. This study provides important information about the level of awareness among the Georgian population regarding air pollution and lead poisoning, research which is still very nascent. These findings should inform the development of educational campaigns to raise awareness about air pollution.

AWARENESS AND ATTITUDE TOWARDS COVID-19 AMONG STUDENTS OF MEDICAL UNIVERSITIES IN TBILISI, GEORGIA.

On December 31st, 2019, a disease, now known as COVID-19, caused by novel coronavirus was detected in Wuhan, China. Since then, new cases of COVID-19 emerge all over the world each day, having a fatal outcome chiefly in those who belong to high risk groups. In order to prevent the disease spread, health regulations have been brought in by the authorities. They have become obligatory to follow in numerous countries, including Georgia, which confirmed its first case in Tbilisi on February 26. During the pandemic, it is crucial for people, especially health care workers to have access to reliable information regarding the disease and its spread. One of the most important groups in this field are the medical students. The purpose of this study was to evaluate awareness and attitude towards COVID-19 among medical students in Tbilisi, Georgia. An online survey was conducted using Google forms and posted in Facebook groups. There were 18 questions in total and the language used was Georgian. All questions were marked as "required" to encourage completion. In total, 178 participants completed the questionnaire from 4 different medical universities of Tbilisi. Answers were compared to a study done locally among the Georgian population regarding knowledge and attitude towards COVID-19, as well as a survey conducted among Iranian medical students concerning the same topic. Our results showed that majority of participants had a high degree of knowledge about the coronavirus transmission, high proportion of students reported practicing social distancing, however some students struggled with distinguishing between coronavirus and influenza. This is the first study estimating COVID-19 knowledge among medical students in Georgia, however it needs further research to assess the situation in other medical universities and attain a larger sample to see a more accurate picture. It would also be interesting to conduct an updated version of the survey, in order to evaluate whether there has been an increase in awareness about this subject.

KNOWLEDGE RELATED TO THE NOVEL CORONAVIRUS (SARS-COV-2) AMONG GEORGIAN POPULATION.

Georgia confirmed its first case of SARS-COV-2 infection on February 26, 2020. Despite the government's proactive measures during the early stages of the epidemic, number of new infections of SARS-COV-2 is increasing and by March 31, a total of 110 cases have been reported. Limited understanding about epidemics can lead to panic and disrupt public health efforts to contain transmission. Thus, it is very important to understand the perceptions of the population regarding the disease and perceived level of government preparedness to fight against the spread of infection. This study reports results of a survey designed to understand attitudes and knowledge regarding SARS-COV-2 virus among Georgian population, including health care workers (HCWs). The online survey was conducted using a Facebook advertisement. The target was the whole country and the language used was Georgian. We collected information on demographic data, knowledge of symptoms and transmission modes of coronavirus, perceived differences between coronavirus and influenza, availability of antiviral medication and vaccination. We also included questions to capture the Georgian population's perceptions about government preparedness to combat the new coronavirus. The survey was open for three days (March 2-4, 2020). 5228 participants completed the survey. Of these, 40.3% were 25-45 years old and 58.2% were female. 20.7% of respondents had university degree and 10.3% were HCWs. For 25.8% of respondents, COVID-19 and influenza are the same diseases; 10.9% did not know if they are different. The majority correctly identified the transmission route and symptoms (96.9% and 98.0%, respectively). Regarding physical distancing, 13.2% indicated they would attend public events if needed even if they had COVID-19 symptoms. 19.1% think that Georgia is ready for COVID 19 epidemic, while according to 55% the county is not ready, but HCWs are trying hard to respond to this challenge properly. For 18% response is inadequate. There was no difference in knowledge between HCWs, non-HCWs and unemployed. 20% of HCWs as well as other study subjects believe that SARS-COV-2 vaccine and medications do exist but are simply not available in Georgia. One in five Georgians believe that there is a vaccine and medication to treat coronavirus, but that it is not available in the country. Given that information regarding coronavirus is changing very rapidly, the need to reach people with time-sensitive educational messages as well as prevention strategies is vital. Three months have elapsed since discovery of the novel coronavirus causing severe acute respiratory syndrome and classified as SARS-COV-2.

CONFIDENCE IN THE GEORGIA NATIONAL HCV ELIMINATION PROGRAM AMONG WOMEN OF REPRODUCTIVE AGE.

Georgia is among the countries with a very high prevalence of hepatitis C virus (HCV) infection. The recent availability of highly effective, direct-acting antivirals (DAAs) capable of curing >90% of persons treated has made HCV elimination a possibility. All adult citizens infected with HCV are eligible to receive free DAAs through the Georgia National HCV Elimination Program (Program). From April 2015 to December 2018, 54,087 persons were enrolled in the Program throughout the country. However, more than 20,000 individuals are aware of their HCV antibody positive status but did not have HCV RNA testing, a necessary step to determine treatment needs. We hypothesized that a reason for hesitance to enroll in the Program may be a low level of trust of the Program. A cross-sectional study was conducted in Tbilisi, the capital of Georgia. Reproductive aged women were randomly selected from three maternity care centers during prenatal care. The self-administered questionnaire included questions on socio-demographic information, knowledge about HCV infection and trust in the Program. A total of 2185 women of reproductive age were enrolled in the study. The mean age was 28.5 (age range: 17-46) years. The majority of the study participants (76.4%) had a university degree. The vast majority of study participants (>95%) were married and 95.1% were Georgian ethnicity. Almost 90% of the participants were aware of their HCV infection status. Most women (85.3%) had heard of HCV elimination program in Georgia; 74.6% stated that they trust the Program. However, almost 10% of surveyed women stated they would refuse to get enrolled in the Program if their anti-HCV test result is positive. Trust in the Program was higher among women aged >25 years (80.7%) compared to younger women (68.4%) (p<0.0001). Level of education was also associated with trust to the program: more women with higher education level reported that they trust the Program (78.7%) compared to women with lower education level (68.5%) (p<0.0001). Trust in the Georgia National HCV Elimination Program is not sufficiently high among women of reproductive age in Georgia. Effective educational campaigns are needed to improve trust to the Program for this targeted group.

SELF-PERCEIVED HEALTH STATUS AND ILLNESSES AMONG INTERNALLY DISPLACED PEOPLE IN GEORGIA.

Georgia had several waves of internally displaced people (IDPs) as a result of military conflicts on the territories of Abkhazia and Samachablo starting from 1990's with the latest large wave in 2008. Most of the IDPs live in compact settlements, such as old administrative buildings or specially constructed camps. In both cases, living conditions and social-economic status of IDPs are below Georgia's national average. There is extremely limited data on the health status of the IDPs in Georgia. Health Research Union (HRU) with support from ELRHA/R2HC program conducted a survey to study health service utilization and expenditures among IDPs, and measure the effect of targeted intervention versus untargeted, integrated approach to health financing. The aim of the current study was to analyze the self-reported health status among IDPs on the basis of the data collected through this survey. The survey was carried out among IDPs currently living in Georgia mainly residing in compact settlements. Sampling from the target population was performed by a multi-stage cluster sampling approach. In total 1.319 households with 4,359 household members were recruited and interviewed for the survey. Male accounted for almost 55% of all household members in the survey. Slightly less than half of respondents were married; children under the age of 15 constituted 23% of all IDPs surveyed. In total, 40% of all respondents (1729 persons) report being chronically ill and identify a wide range of conditions. Of them 532 report having 2 or more chronic diseases. About a third of occurrences (29%) of chronic diseases is attributed to cardiovascular diseases. Musculoskeletal and gastrointestinal diseases (each) constitute 13% of all occurrences of chronic diseases. During last 24 months 129 household members gave birth. The prevalence of chronic diseases among adult population increases as the age advances with the highest rate among those aged above 65 with 84% reporting having at least one chronic disease. Self-perceived overall health status was characterized as excellent, very good and good by 53%, as fair by 32% and as poor and very poor by 16% of the respondents. The conducted research was the first wide-scale study of the health status among internally displaced people in Georgia. These data may contribute to better understand the problems in this vulnerable population and evaluate impact of the implementation of the different models of the health care including targeted health insurance for IDPs.

KNOWLEDGE, ATTITUDE TOWARD DISEASE AND PRACTICE SURVEY ON DIABETES IN GARDABANI DISTRICT.

In 2014-2016, the Georgia Red Cross Society (GRCS) implemented a project to improve diabetes prevention, detection and care in rural Georgia, namely in the Gardabani district. The KAP survey was conducted to determine current levels of knowledge, attitudes and practices regarding diabetes among the general population in the Gardabani district. We compared current findings with baseline results from a 2014 survey to identify trends. A cross sectional study design with multi-stage random sampling was used to select participants. Data were collected at households through face-to-face individual interviews using a specially designed questionnaire. In total, 716 individuals were surveyed, the majority of whom (98.9%) were aware of diabetes. Most respondents (85.3%) believed that diabetes can be prevented and correctly identified measures of diabetes prevention. Compared to the previous survey, the level of knowledge regarding risk factors, symptoms and complication of diabetes had improved significantly. Knowledge of diabetes prevention correlated positively with individuals having a higher education level (62.6% vs. 50.8%; p=0.05), higher family income (62.2% vs. 53.5%; p=0.03) and residing in rural settlements (58.6% vs. 25%; p<0.001). Knowledge of diabetes management was significantly associated with type of residence (rural 50.3% vs. urban 28.4%; p<0.001) and family income (high family income 52.3% vs. low family income 45.5%; p=0.05). Respondents identifying GRCS as a source of information tended to have a higher awareness of diabetes prevention and management. Knowledge of diabetes has significantly improved among the general population of the Garabani district from 2014 to 2016. The development and implementation of similar public health programs to increase the level of awareness and knowledge about diabetes is required in other parts of Georgia to improve control and management of the disease throughout the country.