A small Eastern European country with limited resources and a high prevalence of hepatitis C, Georgia had factors in its favor in 2015, when it launched a historic effort to eliminate the virus. It had demonstrated both political will and technical capacities with an approach to universal access to health services that had led to steep drops in TB incidence and HIV-related deaths in the preceding year. And because of those strengths, it was selected to receive support from the U.S. Centers for Disease Control and Prevention and from Gilead, the company producing the stratospherically priced drug that was the first among those demonstrated to cure the virus, would be donated in sufficient supplies to treat those who needed it. With success, Georgia would have led the first The treatment, it was hoped could lead to the first successful effort to eliminate a chronic infection with medicines but no vaccine.
Four years later, according to a report in Clinical Infectious Diseases, the effort has yielded impressive results with a 21% drop in prevalence of the virus and a 19% drop in infections. But the progress needed to rid the country of the virus has stalled due to standing challenges that include geographical access to screening, high co-payments for diagnostic and monitoring tests, as well as barriers to services for those, including people who inject drugs, facing the greatest risks of infection.
Along with rising numbers of cases in the United States in recent years, the Georgia experience highlights, a commentary in the same issue notes, that while the direct acting antiviral medicines approved in the last decade have opened the opportunity to stop the spread of the virus, the drugs remain just part of the answer. Also needed are innovative technologies that allow rapid point of care diagnostics and structural solutions to service barriers, including through integration of screening, testing and care in harm reduction programs.