Maia Butsashvili, MD, PhD, Director of Health Research Union
Lasha Gulbiani, MPH, project coordinator at Health Research Union.
Hepatitis B virus (HBV) infection is a leading cause of chronic liver disease, including cirrhosis and hepatocellular carcinoma, with an estimated 254 million people chronically infected worldwide and over 800,000 annual deaths. In Georgia, HBV remains a significant challenge, with 21.7% prevalence of HBV core antibody and 2.7% prevalence of HBsAg among adults in 2021 with a disproportionately high burdens among people who inject drugs (PWID) and men who have sex with men (MSM). Furthermore, Georgia has one of the highest rates of injection drug use globally, with an estimated 52,500 PWID and national prevalence of 1.41% in the general population. Despite the 2024 launch of the State HBV Program, focusing on screening, vaccination, diagnostics, and treatment, enrollment of key populations remains low. Barriers include stigma, lack of awareness, and limited access to services. This study is designed to fill critical gaps in understanding these barriers and facilitators specific to the Georgian context.
The overall aim of the project is understanding the barriers of state HBV program enrollment among key populations and improvement of program uptake. Specific objectives include assessing the barriers and facilitators for HBV screening, vaccination, and linkage to care for key populations, specifically MSM and PWID. In addition, the project aims to identify gaps in service delivery and areas for improvement. Furthermore, the project aims to strengthen linkage to care within the HBV program by enhancing outreach strategies and community engagement targeting vulnerable groups. Finally, the project will advocate for the integration of HBV prevention and care within harm reduction centers and community-based organizations for PWID and MSM. Through these objectives, the project will help increase vaccination coverage, improve access to healthcare, and ensure better integration of high-risk populations into HBV prevention and care services.
A cross-sectional study will be conducted to identify barriers and facilitators related to HBV screening, vaccination uptake, and linkage to care among PWID, MSM, stakeholders, and the general population. A modified version of the Stage 1 questionnaire will be used, with PWID recruited through harm reduction centers and MSM through community-based organizations. All participants will complete anonymous, self-administered surveys to ensure privacy and minimize stigma. A patient satisfaction survey will be conducted among HBV program beneficiaries of the State HBV Program. To enhance linkage to care, outreach and education activities will be implemented, including social media campaigns, promotional videos, and capacity building for HR centers and CBOs. Forums will bring together stakeholders, healthcare providers, and communities to share findings and co-develop solutions. Furthermore, community outreach activities will focus on engaging with high-risk populations and the general public to raise awareness. Finally, advocacy efforts such as policy briefs, stakeholder workshops, and partnerships will promote the integration of HBV services into harm reduction centers and inform sustainable national strategies.
The project is expected to have a significant impact on scaling up HBV program coverage among PWID and MSM in Georgia by directly increasing their enrollment in the State HBV Program. Through strong advocacy, the initiative will also raise program visibility, not only within these high-risk groups but also across the wider population. By assessing barriers and facilitators for HBV screening, vaccination, and linkage to care, the project will generate critical insights for the development of targeted interventions tailored to community needs. Increased uptake of HBV vaccination among PWID and MSM will substantially reduce the burden of infection in these populations. Moreover, the data collected will directly inform improvements in the State HBV Program, supporting strategies to enhance service delivery and strengthen outcomes for key populations.