Bouscaillou Julie, Champagnat Julie, Luhmann Niklas, Avril Elisabeth, Inaridze Ina, Miollany Véronique, Labartkava Koka, Kirtadze Irma, Butsashvili Maia, Kamkamidze George, Pataut Dominique
Médecins du Monde, France.
Médecins du Monde, France.
Int J Drug Policy. 2014 Sep;25(5):871-8. doi: 10.1016/j.drugpo.2014.01.007. Epub 2014 Jan 23.
Drug use and hepatitis C virus (HCV) are both major public health issues in Georgia. However, the access to HCV prevention and care is still very limited in the country. This study was conducted to examine the HCV epidemic among people who inject drugs (PWID) in Tbilisi and to assess the treatment needs of this most-at-risk population.
Respondent-driven-sampling was used to obtain a sample of PWID in Tbilisi. Each participant was interviewed face-to-face and underwent an HCV antibody-based rapid diagnostic test. If a test was positive, a further evaluation was performed, including direct detection of HCV by PCR, genotyping and liver fibrosis assessment by transient elastography. People needing urgent treatment were defined as those who were currently infected and had severe liver fibrosis (liver stiffness above 10kPa). Prevalences were calculated crude and then weighted to adjust for the sampling method. Risk factors for liver fibrosis were studied using generalized linear models.
A total of 216 PWID were recruited in October 2012. The mean age was 39.6 and 7.9% were female. HCV antibodies were found in 91.9% of the participants and 82.0% had a chronic infection. Among the chronically infected participants, genotype 3 was predominant (66.9%) and 10.4% had viruses from two different genotypes. Severe liver fibrosis was found in 24.2% of the infected participants (only in men) and was significantly associated with the duration of drug use and coinfection with hepatitis B.
Georgian PWID are very exposed to HCV and have high levels of severe liver fibrosis. Hence, harm reduction services should be scaled-up in Georgia and HCV treatment programmes should be implemented straight away and should include active drug users. Other risk factors for liver fibrosis, such as hepatitis B, should be specifically addressed in this population.
药物使用和丙型肝炎病毒（HCV）都是格鲁吉亚的主要公共卫生问题。然而，该国丙型肝炎的预防和治疗服务获取渠道仍然非常有限。本研究旨在调查第比利斯注射吸毒者中的丙型肝炎病毒流行情况，并评估这一高危人群的治疗需求。
采用应答者驱动抽样法在第比利斯获取注射吸毒者样本。对每位参与者进行面对面访谈，并进行基于丙型肝炎病毒抗体的快速诊断检测。如果检测呈阳性，则进一步评估，包括通过聚合酶链反应直接检测丙型肝炎病毒、基因分型以及通过瞬时弹性成像评估肝纤维化。急需治疗的人群定义为当前感染且患有严重肝纤维化（肝脏硬度高于10千帕）的人。计算患病率的粗值，然后加权以调整抽样方法。使用广义线性模型研究肝纤维化的危险因素。
2012年10月共招募了216名注射吸毒者。平均年龄为39.6岁，女性占7.9%。91.9%的参与者检测出丙型肝炎病毒抗体，82.0%患有慢性感染。在慢性感染参与者中，3型基因型占主导（66.9%），10.4%感染了两种不同基因型的病毒。24.2%的感染参与者（仅男性）存在严重肝纤维化，且与吸毒持续时间和乙型肝炎合并感染显著相关。
格鲁吉亚的注射吸毒者极易感染丙型肝炎病毒，且严重肝纤维化水平较高。因此，格鲁吉亚应扩大减少伤害服务，立即实施丙型肝炎治疗项目，且项目应涵盖现有的吸毒者。该人群中其他肝纤维化危险因素，如乙型肝炎，应得到特别关注。
