Originally published by our sister publication Pharmacy Practice News
By Ethan Covey
The country of Georgia has made substantial progress toward the elimination of hepatitis B and C viruses, and may serve as a model for other public health officials as they work toward achieving WHO goals to eliminate viral hepatitis as a public health threat by 2030.
A recent report summarizes the progress made in Georgia toward the WHO’s indicators nearly a decade after the country launched a hepatitis elimination effort (MMWR Morb Mortal Wkly Rep 2024;73[30]:660-666).
“In 2022, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were the main causes of liver disease and liver cancer worldwide, causing 1.3 million deaths,” said Rania Tohme, MD, MPH, the associate director for Global Health in the CDC’s Division of Viral Hepatitis. “Yet, hepatitis B can be prevented with a vaccine, and hepatitis C can be cured with treatment.”
In 2015, approximately 5% of adults in the country of Georgia had HCV—more than five times the global average. To address the outsized impact HCV was having in the country, Georgia launched the world’s first HCV elimination program, working with the CDC and other partners.
By 2021, the adult prevalence of HCV decreased by nearly 67%, and the estimated number of new chronic HCV infections dropped by approximately 61%. By April 2024, nearly 90% of adults in Georgia had been screened for HCV. An estimated 83% of people with chronic HCV were diagnosed, and 86% of them started treatment.
“These findings indicate that the country of Georgia has made significant progress in diagnosing and treating persons with hepatitis C and preventing new infections,” Dr. Tohme told Pharmacy Practice News.
The program was so successful, they decided to also focus on HBV. For HBV, the report highlighted the positive impact of high vaccination coverage among infants, which has surpassed the WHO target to eliminate mother-to-child transmission. However, the prevalence of HBV in adults remained stable in 2021 compared with 2015, indicating the need to scale up vaccination, testing and treatment for HBV.
In April 2024, the government of Georgia endorsed an HBV elimination program. This includes providing free screening and treatment to all citizens starting in September 2024. A national hepatitis B screening and treatment registry also is being developed.
Dr. Tohme noted that while implementing similar programs in other countries is feasible, it requires collaboration across multiple sectors and buy-in from policymakers and key decision makers.
However, “if a country is committed to hepatitis B and hepatitis C elimination, there are ways to make it happen,” she said.
She added that future research could focus on identifying the different barriers that prevent people from continuing their care and treatment.
“The report found that among people who initially tested positive for ever having had hepatitis C, 12% did not receive the necessary test to confirm that they have a current chronic infection,” she said. “Additionally, among people with a confirmed chronic hepatitis C infection, 14% did not initiate treatment. This information might help inform development of interventions that might decrease loss to follow-up in the hepatitis care cascade.”
Risha Irvin, MD, MPH, the Health Equity Program director with Johns Hopkins Health System, an associate professor in the Division of Infectious Diseases, and the director of Sharing the Cure, Maryland Community-Based Programs to Test and Cure Hepatitis C, at the Johns Hopkins University School of Medicine, in Baltimore said, “The country of Georgia has done a phenomenal job implementing their hepatitis C elimination program to reduce the prevalence of chronic hepatitis C and incorporating hepatitis B prevention into their plan.”
HBV vaccination is mandatory for healthcare workers and some other occupational groups, according to another study (Eurosurveillance 2023;28[30]:2200837). Hepatitis B vaccination is also offered to people diagnosed with HCV.
Dr. Irvin said infectious disease pharmacists could play a key role in HCV treatment, particularly focusing on supporting patient treatment adherence. They can also support hepatitis B eradication by vaccinating adults, screening and treating people with HBV.
“Additionally, to reach hepatitis C elimination metrics, hepatitis C care and treatment must be shifted from specialty care to primary care providers, pharmacists, etc. with the goal of making treatment more accessible,” she said. “In the U.S., for example, the VA [Veterans Affairs] has done amazing work on hepatitis C elimination, and it has primarily been led by pharmacists.”
“This work is really public health implementation,” she added. “It highlights the need for a public health strategy which incorporates harm reduction and preventative services. It also highlights the importance of surveillance data and Georgia using their surveillance data to focus on PWID [people who inject drugs] and incarcerated persons.”
In the United States, the CDC recommends a birth dose of HepB vaccination for all infants, as well as vaccination for all unvaccinated children younger than 19 years of age, adults ages 19 to 59 years, and adults, 60 years and older with risk factors for HBV or without identified risk factors but seeking protection against the disease.