hiv and hepatitis prevention programmes in eastern europe ... · –decriminalization of a)...

HIV and Hepatitis Prevention

Programmes in Eastern Europe

Case Example: Georgia

Nikoloz Chkhartishvili, MD, MS, PhD Deputy Executive Director for Research

Infectious Diseases, AIDS and Clinical Immunology Research Center

30-31 January 2019, Bucharest

• No conflicts of interest


HIV in Georgia

% Estimated Number

Anti-HIV+ 0.4% 10 500

0%

20%

40%

60%

80%

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

20

17

20

18

Distribution of New Diagnoses by Transmission Categories

IDU Hetero MSM


344 351 385

455 424

526 490

564

717 719

631 672

0

100

200

300

400

500

600

700

800

20

07

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

20

17

20

18

Number of New Diagnoses

HCV in Georgia

2015 Population Survey

% Estimated number

anti-HCV+ 7.7% 208 000

HCV RNA+ 5.4% 150 000

Risk Factors for HCV Infection

IDU only; 33,6%

IDU + Blood

transfus.; 4,6%

Blood transfus.

only; 15,1%

Undetermined; 46,7%

30-31 January 2019, Bucharest Baliashvili D et al. Abstract THU-203; EASL 2017.

HCV/HIV Ratio: 19.8

Timeline of HIV Response in Georgia


1984 1994 1997 2001 2002 2004 2005 2015 2017 2019

HIV Lab

National programs on

AIDS prevention and treatment

Triple ART NSP

Arrival of Global Fund: ART and PMTCT scale-up

Prevention roll-out

OST

Treat All

PrEP

Transition from GF to domestic funding by 2022:

OST and ART already transitioned

PMTCT

Needles and Syringes Distributed, 2011-2017

30-31 January 2019, Bucharest GAM Country Reports 2011-2017 https://aidsreportingtool.unaids.org/

0.9 mln 1.0 mln 2.0 mln 3.6 mln 3.6 mln 4.5 mln 3.8 mln 0

20

40

60

80

100

0

1

2

3

4

5

2011 2012 2013 2014 2015 2016 2017

Mill

ion

s

Total needles/syrunges distributed Needles/syringes distributed per PWID

https://aidsreportingtool.unaids.org/



Needles/Syringes Distributed Per PWID Per Year

in Eastern Europe and Central Asia (EECA)

0 50 100 150 200 250 300

Lithuania

Belarus

Georgia

Armenia

Republic of Moldova

Ukraine

Azerbaijan

Latvia

Uzbekistan

Kazakhstan

Estonia

Kyrgyzstan

Tajikistan

30-31 January 2019, Bucharest UNAIDS AIDSInfo http://aidsinfo.unaids.org/

http://aidsinfo.unaids.org/


OST Program in Georgia

• OST introduced in 2005

through the Global Fund

Support

• Since 2017 the service is

fully funded by the

Government

• The service is free to all in

need

OST Coverage

1 008 4 736 7 905 0%

5%

10%

15%

20%

25%

30%

35%

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

2015 2016 2017

OST

Co

vera

ge (

%)

No

of

pe

rso

ns

on

OST





OST Coverage in Eastern Europe and Central Asia

32%

22%

14% 10%

5% 5% 4% 4% 3% 3% 1% 1%

0%

5%

10%

15%

20%

25%

30%

35%

Geo

rgia

Lith

uan

ia

Esto

nia

Latv

ia

Arm

enia

Kyr

gyzs

tan

Be

laru

s

Ukr

ain

e

Mo

ldo

va

Tajik

ista

n

Aze

rbai

jan

Kaz

akh

stan

30-31 January 2019, Bucharest Source: UNAIDS AIDSInfo http://aidsinfo.unaids.org/



Drug Policy


Barrier

• Harsh drug policy based on punishment rather than care

Progress

• Constitutional court decisions on:

– Decriminalization of a) possession of dried marijuana <70 g (October

2015), b) cultivation of cannabis <151 g (Jul 2017), c) possession of

desomporphine 0.00009 g (Jul 2017), d) recreational use of marijuana

(Nov 2017); Legalization of recreational use of marijuana (Jul 2018)

• Repressive law enforcement practices has been changing

and imprisonment for drug related offences is decreasing Beselia A et al. The Drug Situation in Georgia 2016-2017. Tbilisi, Georgia. Human Rights Education and Monitoring Center (EMC): https://emc.org.ge

0%

5%

10%

15%

20%

25%

2002 2003 2004 2005 2006 2007 2008 2009 2010 2012 2015 2017

PWID MSM


BioBehvaioral Surveys:

HIV Prevalence Key Populations




Prevention Services for MSM

• Education and counseling

• Condoms and lubricants

• STI management

• HIV testing

• Popular leader program

• Community mobilization

• Outreach

• Peer-driven intervention

• Internet-based intervention

3018

3826 3846

5774

1739 2038 2291

3317

0

1000

2000

3000

4000

5000

6000

7000

2015 2016 2017 2018

Prevention services Tested for HIV


Number of MSM Reached by Prevention

Services and HIV Testing

Tsereteli N, et al. 2018

PrEP

• Started in September 2017 under the Global Fund Support, to be

transitioned in July 2019

• High risk MSM and transgender people

• Sep 2017 – Oct 2018: capital city of Tbilisi; expanded to three

regional sites in Nov 2018

• Services provided:

– Daily TDF/FTC; Laboratory and clinical monitoring; Awareness rising; Risk reduction counseling; Adherence support

• Implemented in partnership with local CBO


PrEP Program Results

4 13 15 15 18

30

47 55

65

84 94

107 113

120 124

0

20

40

60

80

100

120

140


Cu

mu

lati

ve #

per

son

s o

n P

rEP

Total enrolled 124

Median time on PrEP (IQR) 2.9 (1.0-6.3)

New HIV while on PrEP 0

New syphilis while on PrEP 4

ART criteria: CD4<200 CD4<350 CD4<500 TREAT ALL

Antiretroviral Therapy

970 1025 1047 1014 992 962 921 872

39%

81%

29%

71%

0%

20%

40%

60%

80%

100%

0

200

400

600

800

1000

2010 2011 2012 2013 2014 2015 2016 2017

% D

iagn

ose

d p

erso

ns

Nu

mb

er o

f n

ew in

fect

ion

s

Estimated number of new infections % Diagnosed on ART % Diagnosed suppressed

30-31 January 2019, Bucharest AIDS Health Information System; Spectrum Estimates 2018

ART Coverage and Viral Suppression

in EECA Countries


0 20 40 60 80 100

Lithuania

Russian Federation

Kyrgyzstan

Kazakhstan

Belarus

Republic of Moldova

Tajikistan

Armenia

Uzbekistan

Ukraine

0 20 40 60 80 100

Azerbaijan

Kazakhstan

Ukraine

Belarus

Tajikistan

Kyrgyzstan

Russian Federation

Lithuania

Republic of Moldova

Armenia

Georgia Georgia

UNAIDS AIDSInfo http://aidsinfo.unaids.org/

ART Coverage Viral Suppression



Treatment Cascade in EECA and Georgia

30-31 January 2019, Bucharest UNAIDS Data 2018

73%

36% 26%

48% 39% 35%

0%

20%

40%

60%

80%

Diagnosed On ART Suppressed

EECA Georgia

Undiagnosed HIV

10500

5090

0

2000

4000

6000

8000

10000

12000

HIV Infected Diagnosed

• 52% of PLHIV undiagnosed

• Low HIV testing coverage of KAPs

• Missed opportunities to test and

diagnose in healthcare settings

• Self-testing for KAPs

• HIV testing in primary healthcare

• Integration of HCV and HIV testing 30-31 January 2019, Bucharest

100% 48%

National Hepatitis C Elimination Program Launched in April 2015

Strategy:

• Test and Treat

• Prevent HCV transmission – Blood safety

– Infection control

– Harm reduction

• Increase awareness

• Improve HCV surveillance 30-31 January 2019, Bucharest

Georgia

150,000

64,232 51,072

34,048 33,452

0

20000

40000

60000

80000

100000

120000

140000

160000

HCV infected(estimated)

Diagnosed Initiatedtreatment

Assessed forSVR

Cured

HCV Cascade: October 31, 2018

100% 43% 34% 23% 22% 80% 67% 98% 43%


>1 million adults screened for HCV

National Hepatitis C Elimination Treatment Database

Decentralization of HCV Service Delivery

• Integration of HCV testing and care in primary care

– 8 primary care centers engaged as of Jan 2019

increase to up to 70 sites

• Integration of HCV testing and care in harm reduction

– 1 OST and 3 NSP sites engaged as of Jan 2019

increase to 15 sites



Harm reduction

Blood safety

Infection control

Integrated services

Combination HIV and HCV Prevention

Acknowledgements

• Akaki Abutidze, George Korkotashvili, Nino Tsereterli, Maka Gogia, Mzia Tabatadze, Irma Kirtadze, Koka Labartkava


Infectious Diseases, AIDS and Clinical

Immunology Research Center

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