Abstract MOAB0301 Hepatitis C Care Cascade for People Living With HIV in the Country of Georgia Nikoloz Chkhartishvili1, A. Abutidze1, N. Bolokadze1, O. Chokoshvili1, N. Dvali1, L. Sharvadze1,2, T. Tsertsvadze1,2 1Infectious Diseases, AIDS and Clinical Immunology Research Center 2Ivane Javakhishvili Tbilisi State University

Disclosure No conflicts of interest to declare

Georgia GEORGIA Area: 69,700 km2 Population: 3.7 million Armenia Turkey Russia Azerbaijan Black Sea Area: 69,700 km2 Population: 3.7 million GNI per capita: $4,160 Upper-middle income economy

HIV and HCV Epidemiology in Georgia HIV Epidemiology 2015 Population Survey Estimated adult HIV prevalence: 0.4% % Estimated number anti-HCV+ 7.7% 208 800 HCV RNA+ 5.4% 150 300 New HIV Cases by Transmission Mode HCV prevalence among PLHIV: 34% End-stage liver disease due to HCV is second leading cause of death in PLHIV Baliashvili D et al. Abstract THU-203; EASL 2017. AIDS Health Information System, Infectious Diseases, AIDS and Clinical Immunology Research Center

Access HCV Treatment in Georgia 2011 2012 2013 2014 2015 Free PEG/RBV for HIV/HCV co-infected Free PEG/RBV for prisoners 60% price reduction on PEG/RBV for general public National Hepatitis C Elimination Program TREAT ALL

Objective Evaluate engagement across the HCV care continuum among people living with HIV in Georgia

Methods Population: Data source: Stages of cascade: Estimated numbers Adult (age ≥18 years) HIV-infected individuals known to be alive by September 1, 2016. Data source: National AIDS Health Information System (AIDS HIS) Stages of cascade: HIV/HCV co-infected (estimated) Diagnosed both for HIV and HCV Treated for HCV infection Achieved sustained virologic response (SVR) Estimated numbers Spectrum/EPP software was used to estimate PLHIV Estimated HIV/HCV co-infection was calculated using observed HCV prevalence and Spectrum derived estimate of PLHIV

Standard of HCV Care anti-HCV screening at the entry into HIV care HCV RNA testing for anti-HCV+ HCV genotyping and liver fibrosis assessment for HCV RNA+ HCV Treatment 12.2011-05.2015: PEG/RBV for 24 or 48 wks 06.2015-03.2016: SOF/PEG/RBV for 12 wks SOF/RBV for 12-24 weeks 03.2016-present: LDV/SOF ± RBV for 12 or 24 wks ART regardless of CD4 cell count for HIV/HCV since 2013

HCV Care Cascade n=3300 n=1099

HCV Care Cascade n=3300 58% n=1921 not aware of HIV status n=1099 9% n=280 diagnosed for HIV but not for HCV n=1099 diagnosed both for HIV and HCV

HCV Care Cascade n=3300 n=1099 n=697

HCV Care Cascade n=3300 366 PEG/RBV 277 DAAs 54 PEG/RBV retreated with DAAs n=1099 n=697

HCV Care Cascade n=3300 n=1099 n=697 n=480

HCV Care Cascade n=3300 n=1231 (38%) n=857 (26%) n=642 n=1099 (19%)

Treatment Outcomes of PEG/RBV (Dec 2011 – May 2015) 420 HIV/HCV Co-infected Patients Started on PEG/RBV EOT: 217 Patients 33 relapsed 203 patients discontinued 108 non-responders 53 severe side effects 42 self-discontinued 184 SVR Overall SVR rate = 44%

Treatment Outcomes of DAA Regimens (Jun 2015 – Sep 2016) 296 88 110 98 109 30 13 66 82 20 50 12 101 37 45 19 331 134 99 125 36 23 95 60 107 38 49 Data for 4 genotype 4 patients not shown

Strength and Limitations National AIDS Health Information System captures information on all PLHIV diagnosed in Georgia Limitations: HIV/HCV positive persons might be diagnosed and treated for HCV within national elimination program without identifying HIV status Estimation of HIV/HCV co-infected persons was based on assumption that HCV prevalence in the same is HIV diagnosed and undiagnosed

Conclusions The major gap in the HCV care cascade is at the stage of diagnosis resulting from deficiencies in HIV diagnosis Reducing the number of people living with undiagnosed HIV/HCV co-infection will be critical for achieving population level impact of free HCV treatment program

Acknowledgement Regional AIDS Centers in Kutaisi, Batumi, Zugdidi and Sokhumi Infectious Diseases, AIDS and Clinical Immunology Research Center