A Population-based survey for the prevalence of Hepatitis C Virus Infection in Georgia

1. A Population-based survey for the prevalence of Hepatitis C Virus Infection in Georgia Ana Kasradze National Center for Disease Control and Public Health September 6, 2014

2. Rationale for Survey • Georgia may be among countries with highest HCV burden worldwide • Limited data on national HCV prevalence, risk factors and population at risk (Tbilisi survey > 10 years prior) • Need for high quality serporevalence data (Disease burden) • Need to describe genotypes (treatment and response) • Georgia Ministry of Health priority

3. HCV Genotypes in Georgia *Source: Stvilia, et al: J Urban Health; 83(2):2006:289-298;. †Bouscaillou, J., et al. (2014). : Int J Drug Policy ¶Karchava, et al: Georgia Medical News: 2009 Dec; (177): 51-55

4. Objectives • Primary Objective: Estimate the prevalence of HCV infection in the general population by age groups, regions, and urban/rural residence • Secondary Objectives • Assess risk factors for HCV infection in Georgia • Describe HCV circulating genotypes • Identify knowledge and perceptions towards hepatitis and its prevention and treatment

5. Survey • Design:multistage, cluster, random sampling • Population: males and females > 18 years of age, residing in randomly selected households in Georgia. • Sample size: total approximately 7,000 (based on 95% confidence interval +/- 1%, design effect of 2, 30% non-response rate) • Stratification: 16 Strata (10 regions + 6 cities) • Tbilisi (sample of 1000, including 200 IDU) • Telavi, Kutaisi, Batumi, Zugdidi , Rustavi (sample of 400*5=2000, including 500 IDU)

6. IDU Subsample • Additional sample of the IDU population within the 6 sampled cities of Georgia • Design - Snowball sampling any self-reporting IDU respondents other IDUs with whom they have contact • Will be analyzed independently of the main seroprevalence sample • Will give stronger prevalence estimates for this high-risk group

7. Data Collection Team • Survey Instrument – Questionnaire • Household information • Socio-demographic data • Medical History • Lifestyle information • Knowledge, Attitudes, Perceptions • Specimen - venous blood

8. HCV Testing Algorithm Anti-HCV Anti-HCV Positive Anti-HCV Negative HCV RNA HCV RNA Positive HCV RNA Negative HCV Genotyping

9. Analysis • HCV prevalence in Georgia (+/- 1%) and • Cities (6) • Regions (10) • Bivariate analysis assessing association between factors (demographic/risk) and HCV infection • Multivariate logistic regression • models examining association between independent variables and HCV infection • HCV Genotype distribution

10. Benefits • National/Regional by Urban/Rural Data • HCV infection prevalence (burden) • Risk factors for transmission (prevention) • Genotype distribution (care and treatment) • Laboratory capacity building • Epidemiology capacity building • Additional research/studies (stored sera)

11. Next Steps (Serosurvey) • Protocol (finalize and submit to IRB) • Recruitment of Teams • Training and Validation of Survey Tool • Fieldwork • Laboratory Analysis and Capacity Building • Data Analysis/Modeling • Publication of Results

12. Acknowledgments • US Centers for Disease Control and Prevention (CDC) • Emory University SPH and SOM • University of Bristol • Division of Viral Hepatitis/NCHHSTP/CDC

13. Thank you!