Hepatitis C Risk and Protective Factors Associated With Drug Policies in the Republic of Georgia

The hepatitis C (HCV) epidemic in the Republic of Georgia has been fueled by injection drug use (IDU) and compounded by punitive drug policies. This cross-sectional study examined HCV risk and protective factors among two high-risk populations in Georgia: people enrolled in opioid substitution therapy (OST) (n = 967) and people entering the prison system (n = 500). Results revealed that because of the universal HCV screening and treatment protocols within the prison system, incarcerated individuals were more likely to be tested and aware of their HCV status (85 percent) compared to people in OST (73 percent). The percentage of people with HCV was higher among OST patients (84 percent) than incarcerated individuals (60 percent); the percentage of people in OST with HCV awaiting treatment was higher (25 percent) than incarcerated individuals (0 percent). Logistical regression analysis revealed that NGO funding significantly predicted the likelihood of being tested for HCV, knowing one's HCV status, and being HCV negative. In conclusion, the study found that the universal HCV testing and treatment of incarcerated individuals provide a seemingly paradoxical opportunity for risk reduction and public health protection by interrupting the chain of HCV transmission among these high-risk populations whose vulnerability increases within the very system that also treats them.