GENDER RELATED BARRIERS AMONG HIV INFECTED INDIVIDUALS.

Late detection of HIV infection still remains serious problem for Georgia. During the last years prevalence and late detection of HIV infection is increasing among females and therefore, attempts to implement services adapted to female needs have significantly increased. It is essential to conduct research to create a basis for country's national response of HIV infection to become more gender sensitive. The goal of our study was to conduct survey among HIV-positive individuals to identify potential gender-based barriers and contributing factors that might influence timely diagnosis and treatment of HIV infection. Cross sectional study design was used. Target population included HIV-infected persons. Study subjects were selected by simple random sampling. Study participants were sampled from the registry of HIV infected patients. Quantitative data were collected through individual, face-to-face interviews, using specially designed questionnaire for this study. In total 182 HIV-infected individuals participated in survey, of whom 74 (40.6%) were females and 108 (59.6) were males. The level of awareness and knowledge on HIV/AIDS was similar in both male and female HIV positive individuals, although a higher proportion of men than women have heard of HIV/AIDS before their diagnosis. HIV infection is more stigmatizing for women than men. Fear of being abandoned by both community and family due to HIV/AIDS diagnosis was higher among female respondents. Higher proportion of male respondents than women reported an illness-related unemployment. Women were more likely to hide their diagnosis from other people compared to men. Higher proportion of female compared to male respondents reported notifying family members about their HIV status. Significantly higher proportion of female HIV-infected individuals have been accompanied by a family member on visit to physician due to HIV/AIDS compared to male HIV-infected respondents. A higher proportion of men than women reported an interruption/discontinuation of treatment regimen. Georgia has ensured free and unrestricted access to HIV service for all HIV infected individuals in the country. However, the stigma related to HIV still creates barriers to service utilization. Therefore, HIV national program should continue implementation of focused and concerted interventions to improve HIV awareness among gender populations.

CLINICAL PHASES OF CHRONIC HEPATITIS B AMONG GEORGIAN PATIENTS.

Hepatitis B virus infection remains one of the major healthcare problems in Georgia with an exposure prevalence of 25.9% (Positive Anti-HBc) and chronic HBV infection (Positive HBsAg) 2.9%. Determination of clinical phase of chronic HBV infection is crucial for evaluation prognosis and accordingly, initiation of antiviral treatment, which might be lifelong. The specific aim of our study was to collect data on clinical characteristics of HBV-infected patients and determine the clinical phases of chronic HBV infection in the Georgian population. We randomly selected 111 chronic HBV-infected patients from the database of the medical center Mrcheveli. Liver fibrosis was assessed by Fibroscan, and viral load data were computed by the Real Time polymerase chain reaction (PCR) methodology. Liver fibrosis results were available for 74 of the patients (67%), and a majority of patients (72 of the 74, 97%) had no signs of advanced liver fibrosis. Viral load data were available for 94 patients, of whom 70 (74.5%) had an HBV-DNA level less than 2000 IU/ml, while 18 (19.1%) had an HBV-DNA level between 2000 and 20000 IU/ml and 6 (6.4%) were higher than 20000 IU/ml. Data for the assessment of the clinical phase of chronic HBV infection were available for 54% of patients (60 of the 111). Only 3.3% (2/60) of patients had undetectable HBV-DNA and 75% (45/60) had a viral load <2000 IU/ml. Two patients were HBeAg-positive, one of them with hepatitis and another with normal ALT. A few patients classified as HBeAg-negative with chronic hepatitis given normal ALT criteria: 3/60 (5%) by EASL and 6/50 (10%) patients by AASLD. In summary, 11/60 (18.5%) and 8/60 (13.5%) patients had HBV-DNA >2000 IU/ml but a normal ALT. Given the small number of patients, we cautiously conclude that most patients (75%) had HBeAg-positive or -negative chronic HBV infection without hepatitis. However, up to 19% of patients were not possible to classify in any of the internationally recognized phases of HBV infection. Patients within this indeterminate grey area, should be evaluated cautiously and management needs to be individualized. It will be interesting to evaluate the reason high viral load in HBeAg negative patients with normal ALT and long-term outcome among these patients (liver fibroses and/or HCC development).

ASSOCIATION OF QUALITY OF LIFE WITH LIVER FIBROSIS AMONG PATIENTS TREATED FOR HEPATITIS C IN GEORGIA.

A seroprevalence survey was conducted in 2015 in Georgia among adults aged ≥18 years. This survey data was used to estimate anti-HCV seroprevalence in Georgia at 7.7% and HCV RNA prevalence at 5.4%. Treatment adherence, recovery and quality of life are interrelated, however, there are limited data on the role of successful antiviral treatments in changing the quality of life (QOL) of patients in Georgia. A questionnaire assessed the QOL for patients involved in the hepatitis C elimination program. Patient responses were analyzed to estimate the magnitude of any association between quality of life with the degree of liver fibrosis and various laboratory parameters. Liver fibrosis status was measured by the FIB4 score and liver elastography. We recruited 378 eligible adult participants who were beneficiaries of the hepatitis C elimination program (HCV RNA-positive) before the start of antiviral treatment. Of the surveyed individuals, 283 (77.5%) were males; the median age was 47 years (range 20 to 83). Almost 30% of participants had advanced liver fibrosis. The following factors were associated with advanced liver fibrosis: older age (PR=7.05; 95% CI:3.93-12.65), general weakness (PR=5.88; CI:2.23-15.45) and insomnia (PR=3.5, CI:1.37-9.19). Muscle pain (PR=2.75, CI:1.91-3.96) and abdominal pain (PR=3.23, CI:2.19-4.77) were more common among participants with a high FIB4 score; these patients were also more likely to report that liver disease affects family life (PR=4.23, CI:2.94-6.09). This study suggests that advanced liver fibrosis is associated with poorer QOL, an association that has been noted by research elsewhere in Europe. Given that the Georgian experience appears to be similar to other European countries, public health interventions to improve QOL may be expedited by collaboration with regional neighbors.

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.

HEPATITIS B VACCINATION: KNOWLEDGE AND ATTITUDE AMONG WOMEN OF REPRODUCTIVE AGE IN GEORGIA.

Georgia is a country with high prevalence of hepatitis B. Based on a 2015 population serosurvey, the prevalence of hepatitis B surface antigen (HBsAg) is 2.9% and prevalence of anti-HBc is 25.5% in general population. Hepatitis B vaccine has been included in the national immunization schedule of Georgia only since 2002. Thus, most reproductive aged women were not vaccinated during young childhood. Cross-sectional study was conducted in the capital of Georgia, Tbilisi. Reproductive aged women were randomly selected and then recruited from three maternity care centers during prenatal care. The self-administered questionnaire included questions on socio-demographic information, hepatitis B vaccination status and awareness of HBV infection status. A total of 2185 reproductive aged women were enrolled in the study. The mean age was 28.5 (age range 17-46) years. Most (76.4%) had a bachelor and/or master's degree. 20.0% of respondents never heard about HBV. Very few (3.3%) knew they were infected with HBV. We could not determine if women were chronically infected or were exposed and developed antibodies. HBV knowledge was limited: 57.5% were not aware of available HBV treatment; 51.6% didn't know HBV infection could be prevented (35.8% named HBV vaccination, 29.3% named condom use). Only 10% of study participants reported being vaccinated for HBV. Awareness of HBV infection was higher among women over age 25 (72.1%) compared to women aged 25 years or less (27.9%) (P<0.0001). Among women who reported having an HBV infection, 40.6% did not name vaccine as a prevention method and 38.2% did not have information about availability of HBV treatment (P<0.05). Based on our study results, knowledge about HBV infection and vaccination is very low among reproductive aged women in Georgia. Women's health centers can be a good place to reach reproductive aged women for counseling on HBV infection and promote vaccination against hepatitis B.

[Chronic bacterial-and-viral vasculitis as a possible risk factor of disordered stability of the coronary atherosclerosis course].

In order to assess the real significance of some plasma and vascular indices in disorders of the stable course of coronary heart disease (CHD) in chronic bacterial- and viral infection-invasion, we determined the blood plasma lipid hydrogen peroxide (LHP) activity, a direct index of the lipid peroxidation degree, and measured the concentration of specific antibodies to Chlamydia pneumoniae (C. pneunoniae), herpes simplex virus type 1 (HSV-1), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) by means of the enzyme-linked immunosorbent assay (ELISA). We examined a total of 70 patients presenting with CHD combined with a concomitant infection both with a stable course of the disease (Group One) and acute coronary syndrome (Group Two), as well as 50 infected people without verified signs of coronary atherosclerosis (Group Three). The comparison group consisted of patients with CHD, being seronegative for the causative agents referred to above. The condition of the major vessels was appropriately assessed by means of duplex ultrasonography (DU). Resulting from the findings of the carried out investigation, we singled out a triad of symptoms characteristic of the transformation of the chronic infectious process into the recurrent phase, which for the CHD patients with the presence of the conventional risk factors of atherosclerosis might become a cause of the disordered stable course of the disease and development of acute ischaemic attacks. The revealed alterations seemed to have been based upon an infectious-origin inflammatory lesion of the vessels, which was duly confirmed by duplex ultrasonography.

16S rDNA characterisation of bacterial and archaeal communities during start-up of anaerobic thermophilic digestion of cattle manure.

A laboratory-scale continuously stirred anaerobic thermophilic batch digester was inoculated with cattle manure. Bacterial and archaeal communities, as well as digester performances, were analysed during reactor start-up for about 20 days. Polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) was used for overall detection and for study of the dynamics of microbial populations. Dominant bacteria and archaea 16S rDNAs were sequenced from the sample on day 12. Ten bacteria and 3 archaea OTUs (operational taxonomic units) were identified from the 52 clones sequenced. Sequences corresponding to the dominant bacterial SSCP peak were phylogenetically close to the 16S rDNA sequence of Bacillus thermoterrestris, whereas sequences corresponding to the two dominant archaeal SSCP peaks were phylogenetically close to the 16S rDNA sequence of Methanoculleus thermophilicus and Methanosarcina thermophila.