Barriers of Linkage to Hepatitis C Care and Treatment Among People Who Inject Drugs in Georgia

Background: People who inject drugs (PWID) in Georgia have a high prevalence of hepatitis C virus antibody (anti-HCV). Access to care among PWID could be prioritized to meet the country’s hepatitis C elimination goals. This study assesses barriers of linkage to hepatitis C care among PWID in Georgia.Methods: Study participants were enrolled from 13 harm reduction centers throughout Georgia. Anti-HCV positive PWID who were tested for viremia (linked to care [LC]), were compared to those not tested for viremia within 90 days of screening anti-HCV positive (not linked to care [NLC]). Participants were interviewed about potential barriers to seeking care.Results: A total of 500 PWID were enrolled, 245 LC and 255 NLC. LC and NLC were similar with respect to gender, age, employment status, education, knowledge of anti-HCV status, and confidence/trust in the elimination program (p>0.05). More NLC (13.0%) than LC (7.4%) stated they were not sufficiently informed what to do after screening anti-HCV positive (p<0.05). In multivariate analysis, linkage to care was associated with perceived affordability of the elimination program (adjusted prevalence ratio=8.53; 95% confidence interval: 4.14-17.62). Conclusions: Post testing counselling and making hepatitis C services affordable could help increase linkage to care among PWID in Georgia.

A study based on four immunoassays: Hepatitis C virus antibody against different antigens may have unequal contributions to detection

Background All commercial Hepatitis C virus antibody (anti-HCV) assays use a combination of recombinant antigens to detect antibody response. Antibody responses to individual antigenic regions (core, NS3/4 and NS5) used in assays have not been investigated. Methods In this study, we quantified HCV viral load, tested anti-HCV with four commercial assays (Ortho-ELISA, Murex-ELISA, Architect-CMIA and Elecsys-ECLIA) in 682 plasma specimens. In antigenic region ELISA platform, microwells were coated with three antigens: core (c22-3), NS3/4 (c200) and NS5 individually. The signal-to-cutoff (S/Co) values of different assays, and antibody responses to individual antigens were compared. The specimens were divided into HCV RNA positive group, anti-HCV consistent group, and anti-HCV discrepant group. Results Anti-core and anti-NS3/4 were simultaneously detected in 99.2% of HCV RNA positive specimens and showed great consistency with total anti-HCV signals. Responses to the core region were more robust than those to the NS3/4 region in anti-HCV consistent group (p < 0.001). Anti-NS5 only occurred in companying with responses to the core and NS3/4 antigens, and failed to affect the final anti-HCV positive signals. In anti-HCV discrepant group, 39.0% of positive signals could not be traced back to any single antigenic region. Conclusion Antibody responses to the core and NS3/4 antigens were stronger, whereas responses to the NS5 antigen were the weakest, indicating that individual antigenic regions played different roles in total anti-HCV signals. This study provides an impetus for optimizing commercial anti-HCV assays.

Occupational Sharp Injury and Splash Exposure among Healthcare Workers in a Tertiary Hospital

Background Occupational hazards like sharp injury and splash exposure (SISE) are frequently encountered in health-care settings. The adoption of standard precautions by healthcare workers (HCWs) has led to significant reduction in the incidence of such injuries, still SISE continues to pose a serious threat to certain groups of HCWs. Materials and Methods This was a retrospective study which examined the available records of all patients from January 2015 to August 2019 who self-reported to our emergency department with history of sharp injury and/or splash exposure. Details of the patients, mechanism of injury, the circumstances leading to the injury, status of the source (hepatitis B surface antigen, human immunodeficiency virus, and hepatitis C virus antibody status), and the postexposure prophylaxis given were recorded and analyzed. Data were represented in frequency and percentages. Results During the defined period, a total of 834 HCWs reported with SISE, out of which 44.6% were doctors. Majority of the patients have SISE while performing medical procedures on patients (49.5%), while 19.2% were exposed during segregation of waste. The frequency of needle stick injury during cannulation, sampling, and recapping of needle were higher in emergency department than in wards. More than 80% of HCWs received hepatitis B vaccine and immunoglobulin postexposure. Conclusion There is need for periodical briefings on practices of sharp handling as well as re-emphasizing the use of personal protective equipment while performing procedures.

Barriers of Linkage to Hepatitis C Care and Treatment among People who Inject Drugs in Georgia

Background People who inject drugs (PWID) in Georgia have a high prevalence of hepatitis C virus antibody (anti-HCV). Access to care among PWID could be prioritized to meet the country’s hepatitis C elimination goals. This study assesses barriers of linkage to hepatitis C care among PWID in Georgia. Methods Study participants were enrolled from 13 harm reduction centers throughout Georgia. Anti-HCV positive PWID who were tested for viremia (linked to care [LC]), were compared to those not tested for viremia within 90 days of screening anti-HCV positive (not linked to care [NLC]). Participants were interviewed about potential barriers to seeking care. Results A total of 500 PWID were enrolled, 245 LC and 255 NLC. LC and NLC were similar with respect to gender, age, employment status, education, knowledge of anti-HCV status, and confidence/trust in the elimination program (p>0.05). More NLC (13.0%) than LC (7.4%) stated they were not sufficiently informed what to do after screening anti-HCV positive (p<0.05). In multivariate analysis, linkage to care was associated with perceived affordability of the elimination program (adjusted prevalence ratio=8.53; 95% confidence interval: 4.14-17.62).ConclusionPost testing counselling and making hepatitis C services affordable could help increase linkage to care among PWID in Georgia.

Multicenter evaluation of EIAs and CLIAs in the detection of hepatitis C virus antibody among blood donors in China

Background: Recent data on anti-HCV screening assays among large population of blood donors is limited. The present study aimed to perform a multicenter evaluation of EIAs and CLIAs for detection of anti-HCV among blood donors in 16 different Chinese blood establishments.Methods: A total of 1,309 samples including 582 anti-HCV screening negatives and 727 positives collected from 15 blood establishments all over China. Ten different anti-HCV assays (eight EIAs and two CLIAs) were evaluated in 16 different blood centers/banks. Confirmatory testing was performed using recombinant immunoblot assay and HCV RNA tests.Results: The plasma panel contained 963 negative samples, 261 positives, and 85 indeterminate samples, based on the results of confirmatory test. False positive rate of screening tests was 39.67% (382/963) and the positive prediction value was only 35.76% (260/727). Among ten anti-HCV assays, Roche and InTec had the highest sensitivity (98.47%), while KHB and Wantai (indirect) had the highest specificity (99.23%). Then we analyzed the combined performance of these assays with two assays’ strategy widely used in China: Ortho or Abbott together with InTec could find all the true positives and Wantai (indirect) with Livzon (sandwich) got a highest specificity of 97.80%. Indeterminate samples showed quite different signal to cutoff (S/CO) ratios tested by Roche compared with confirmed positives (4.84 vs 19.36, p<0.0001), and higher S/CO ratios than confirmed negatives (4.84 vs 2.94, p=0.020). Conclusion: False reactivity in anti-HCV screening should be treated as urgent issue. RIBA indeterminate donations may be a special group, while it still worth to be further studied.

Multicenter evaluation of EIAs and CLIAs in the detection of hepatitis C virus antibody among blood donors in China

Background: Recent data on the evaluation of screening serological assays on anti-HCV among a large sample of blood donors is lacking. The present study aimed to perform a multicenter evaluation of EIAs and CLIAs for detection of anti-HCV among blood donors in 16 different Chinese blood establishments.Methods: A total of 1,309 samples containing 582 anti-HCV screening negatives and 727 positives collected from 15 blood establishments all over China. A total of 10 different anti-HCV assays (8 EIAs and 2 CLIAs) were evaluated in 16 different blood centers/banks. Confirmatory testing was performed using recombinant immunoblot assay and HCV RNA tests.Results: There were 963 true negatives, 261 positives, and 85 indeterminate samples. False positive rate of screening testing was 39.67% (382/963) and the positive prediction value was only 35.76% (260/727). Roche and InTec had the highest sensitivity (98.47%) and KHB and Wantai (indirect EIA) had the highest specificity (99.23%). Ortho/Abbott together with InTec could detect all the true positives. Among samples with discrepant results by different assays, indeterminate samples showed quite different S/CO ratios detected by Roche compared with confirmed positives (4.84 vs 19.36, P<0.0001), and higher signal to cutoff (S/CO) ratios than confirmed negatives (4.84 vs 2.94, P=0.020). However, there was no difference among the three groups when detected by Abbott. When S/CO ratio went to 8.2 on Roche and 4.2 on Abbott, the PPV could achieve more than 95%.Conclusion: False reactive problem of anti-HCV screening should be solved urgently. RIBA indeterminate donations may be a special group, should be further studied.