HepC: Hopeful Forecast for “Project of the Century”

35-year-old Alexandre got infected by Hepatitis C as a result of injective drug abuse, but he has been fortunate to be involved in the Hepatitis C Elimination Program, in which the government fully funds his expensive treatment. The results of the National Survey about the spread of Hepatitis C in Georgia will be published soon and specialists predict that approximately 200 thousand people are affected. The Ministry of Health promises to fund treatment of all Hepatitis positive patients and the project is expected to last for 5 years.

A lot has been said about the elimination project this year – the program started with the initiative of the government and the global campaign has been successful so far. Deputy Health Minister Valeri Kvaratskhelia says the program is “near to ideal”. However, a number of problems within the implementation need timely solutions. If, during the first two years, the results of the program are not noticeably positive, the pharmacy-company Gilead will reconsider continuing the supply of medications for free.        

According to Kvaratskhelia, “No one is insured from shortcomings. Today the number of doctors should be increased as, according to the plan, 5,000 patients should finish their treatment by this November. The screening component also needs to be increased in order to diagnose those who are not yet aware of being infected.”

Infectionist Maia Butsashvili, from the NeoLab Clinic involved in the elimination project, says that the earlier a person is diagnosed with a level of liver damage, the higher their chances of recovery. Therefore, prevention is important and any Georgian citizen should be able to be examined on Hepatitis C. “This disease develops without symptoms and if the patient is diagnosed with acute Hepatitis, the treatment starts a long 3 months later. We wait for their immune system to cope, but if this does not happen, we start prescribing medication. Unfortunately, patients perceive this procedure as a refusal for treatment.” The two week free Hepatitis screening program of the Ministry of Health started on July 27th in Tbilisi and at local laboratories of the National Center of Public Health in 9 regions of Georgia.

The World Hepatitis Day, on 28th of July, was also celebrated in Georgia. This year’s key messages were: “Prevent Hepatitis – know the risks, demand safe injections, vaccinate children, get tested, seek treatment.” A number of events took place in Tbilisi in support of the patients. One of the global event-processions was organized by the Harm Reduction Network of Georgia (GHRN), Community Advisory Board of patients (GeCAB) and the member organizations of the Network of People Using Drugs (GeNPUD), as well as the initiative groups of patients and drug users. The campaign framework included a series of events held on July 28th in Tbilisi, Rustavi, Telavi, Gori, Kutaisi, Samtredia, Ozurgeti and Batumi.

NGO New Vector, together with the organization Hepa Plus, was one of the first to voice the problem of Hepatitis C in Georgia and demand a price reduction on medication by mobilizing the community of patients.  “We thank everyone for the accessibility of Hepatitis C treatment with Sofosbuvir medications, yet we want to highlight the problems that exist in the current governmental program,” – says Konstantine Labartkava, the Head of New Vector. According to Labartkava, society should discuss problems that exist in the intersecting spheres, such as decriminalization of drug abuse and the importance of State Harm Reduction Programs, as the majority of infected patients belong to the group of drug abusers.

Hepatitis C positive 35-year-old Alexandre has recently faced another problem: the prescribed medication Ribavirin caused a severe allergic reaction and his treatment has been temporarily terminated. “I try not to worry. My biggest concern is that our infectionists lack experience in Hepatitis C management. The disease emerged in the 80s and despite a large number of variations in its treatment formula, it needs high professional experience. Our doctors, however, are gaining this knowledge only now.”

According to Tengiz Tsertsvadze, the Head of Georgian-French Hepatological Clinic Hepa, the forecast for the elimination program is hopeful. 291 patients involved in the program are undergoing treatment in his clinic. 98 of them have finished the first stage, 66 patients have fully recovered. “This is a wonderful data. Although when the virus is zeroed after a month, it means that the virus is vulnerable against the medication, therefore it has a bigger perspective of full recovery. The patient should have adequate expectations. A strict regime of treatment is crucial for full recovery; the patient should not skip any of the doses.”

Hepatitis C positive Alexandre says that a lot of people close to him don't go through with the treatment as they are waiting for the introduction of the new generation medication Harvoni to Georgia. It has already registered and will become accessible from autumn to patients within the elimination program.

According to George, a lot of patients fear treatment with Interferon medication, ‘During the Elimination Program campaign the government mainly accented medications like Sofosbuvir and Harvoni, therefore the infected patients believe in treatment only with these medications.”

“Interferon is a medically-tested, effective medication. We, doctors, often need to consult with our patients about it. Unfortunately, a lot of them stick to their opinion and refuse other treatment. This carries a life threatening risk,” concludes the infectionist Butsashvili.

 “There are a number of optimal combinations of treatments in the world, but Georgian citizens should make use of what they have at this stage, as a lot of countries dream of having accessibility to these expensive medications. The implementation of a similar elimination program will be possible in the USA only by the year 2045. As for the Sofosbuvir, depending on the genotype, it cures 70-85 % of patients with biliary cirrhosis and 81-95 % of patients without it. However, Harvoni is only used for the treatment of the first genotype,” says Tsertsvadze.

City Hall and the Ministry of Health provide funding for the diagnosis of infected citizens from Tbilisi, including those below the poverty line. According to the Head of Tbilisi City Hall’s Social Assistance Administration Department Gela Chiviashvili, funding for patients will continue in the following year as well, therefore, the only thing the patients need to do is visit a clinic.

As for the free screening, Tbilisi Screening Centers offer free testing for Hepatitis C as it has been added as a component to the National Cancer Prevention Program. 2600 patients have already been tested and 10 % have been diagnosed with the Hepatitis virus so far. 

Photo: Raising awareness of testing and treatment opportunities in the streets of Tbilisi.

Irma Kakhurashvili

01 August 2015 16:01