Promotion of HBV vaccination among people who inject drugs in Georgia


Health Research Union, Georgia

Project start

April 2023

Main applicant and principal investigator

Maia Kajaia, MD, Assoc Prof; Project Coordinator, Health Research Union

Deputy applicant and principal investigator

George Kamkamidze, MD, Prof; Head of Research, Health Research Union


An estimated 296 million people were living with chronic Hepatitis B virus (HBV) in 2019 and an estimated 280 000 people died from HBV related liver cirrhosis or hepatocellular carcinoma. A recent systematic review and meta-analysis reported 6-9% prevalence of hepatitis B surface antigen (HBsAg) among people who inject drugs globally, with substantial geographic variation. In Georgia is a country with intermediate to high burden of hepatitis B: hepatitis B surface antigen (HBsAg) prevalence of 2.9% and hepatitis B core antibody (anti-HBc) prevalence of 25.9% in the general adult population. Among people who inject drugs, HBsAg and anti-HBc prevalence was 7.2% and 51.3%, respectively, in 2015. The estimated number of people who inject drugs in Georgia is high at 52.500 (50.000 – 56.000) and the estimated adult (18-64 years) national prevalence of injection drug use is 2.2% (2.1% - 2.4%). HBV vaccination has been included in Georgia’s national immunization programme since 2002. The estimated HBV immunization coverage among 1-year-olds has been >90% during 2012–2019 but declined to 85% in 2021. Vaccination coverage among people who inject drugs is very low at 7.5% and only 20% are willing to be vaccinated.


The overall goal of the project is to promote universal HBV vaccination among people who inject drugs in Georgia. The specific objectives are to assess and improve knowledge and attitudes toward HBV vaccination among people who inject drugs and improve offering of and referral to universal HBV vaccination for people who inject drugs.


A knowledge, attitude and practice (KAP) survey related to hepatitis B and HBV vaccination will be conducted among 120 people who inject drugs, recruited through snowball sampling initiated at harm reduction centers in different parts of the country. Around 200 staff from the Georgian Harm Reduction Network (covering 26 non-governmental organizations/harm reduction centres) will receive training about HBV (covering epidemiology, clinical course and management, prevention and vaccination strategies), with specific focus on improving awareness and skills for promoting, offering and ensuring referral to HBV vaccination services. Printed information and education materials for people who inject drugs will be developed and distributed among the training participants at the end of each training session. Lastly, two-hour informational-educational sessions, guided by the KAP survey findings, will be offered to 50 volunteer people who inject drugs to enhance their knowledge, understanding, skills and motivation to receive HBV vaccination and promote it among their peers.

Output / impact

The study is expected to improve HBV vaccination coverage among people who inject drugs and thereby contribute to reducing the burden of HBV infection in this high-risk population. The KAP survey will provide valuable information about current gaps in awareness, knowledge, attitudes and practices about hepatitis B and HBV vaccination among people who inject drugs in Georgia and guide the development and implementation of targeted interventions to scale-up vaccination coverage. Increased awareness and knowledge about HBV vaccination among harm reduction staff will help fuel promotion and encouragement of vaccination services. In addition, education of voluntary users will help improve knowledge, attitudes and acceptability of HBV vaccination in their peer networks. The study coincides with current preparations for widescale national hepatitis B treatment and prevention activities and will generate information that can be used by policy makers for planning of the hepatitis B elimination program among key populations in Georgia.