Promotion of HBV vaccination among people who inject drugs in Georgia

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 hepato-cellular carcinoma. A recent systematic review and meta-analysis reported 6-9% prevalence of Hepatitis B surface antigen (HBsAg) among people who inject drugs (PWID) globally, with substantial geographic variation. Georgia is a country with intermediate to high burden of Hepatitis B: HbsAg prevalence of 2.9% and Hepatitis B core antibody (anti-HBc) prevalence of 25.9% in the general adult population. Among PWID, HBsAg and anti-HBc prevalence was 7.2% and 51.3%, respectively, in 2015. The estimated number of PWID in Georgia is high (estimated adult national prevalence of injection drug use is 2.2%). HBV vaccination coverage among PWID is very low at 7.5% and only 20% are willing to be vaccinated.

Objective

The goal of the project was to promote universal HBV vaccination among PWID in Georgia. The specific objectives were to assess and improve knowledge and attitudes toward HBV vaccination among PWID and improve offering of and referral to universal HBV vaccination for PWID.

Methods

Knowledge, attitude, and practice (KAP) survey related to Hepatitis B and HBV vaccination was conducted among 120 PWID, 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) received 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. Two-hour informational-educational sessions, guided by the KAP survey findings, were offered to 50 volunteer PWID to enhance their knowledge, understanding, skills and motivation to receive HBV vaccination and promote it among their peers. Printed information and education materials for PWID were developed and distributed among the training participants.

Results

The KAP survey helped to find existing gaps in the knowledge related to Hepatitis B and HBV vaccination, barriers and favorable factors that might influence on the attitude of PWID to get vaccinated against Hepatitis B. According to the survey results, knowledge gaps existed regarding symptoms, transmission routes, contagiousness, and long-term effects of the disease. Awareness of HBV vaccine was also limited, with misconceptions about its effectiveness, dosage, and duration of protection. PWID had high perceived risk of Hepatitis B, with most acknowledgement of the importance of testing. The survey revealed mixed attitudes toward HBV vaccination, with a significant portion who were uncertain of its necessity despite acknowledging the increased risk. A large proportion of PWID had already been tested for HBV, but gaps still exist in recent testing. Low vaccination rates were found among PWID, attributed to the lack of awareness, perceived necessity, barriers regarding access, and concerns about side effects. The survey also revealed a limited participation in informational-educational activities related to Hepatitis B and HBV vaccine among PWID and high interest in receiving more information, with informational-educational sessions as preferred a method of delivery.

The comprehensive training initiative for Harm reduction centers showed to enhance the capacity of staff members to promote HBV vaccination effectively among PWID, contributing to Hepatitis B prevention efforts. Informational-educational sessions equipped volunteer PWID with knowledge, skills, and motivation to promote HBV vaccination among their peers. Participants learned effective messaging techniques to encourage HBV vaccination uptake within their community.

Conclusions / impact

The findings of KAP survey revealed knowledge gaps, poor attitudes, and practices about Hepatitis B vaccination. The training program for Harm reduction centers aimed to address these gaps, equipping staff members with the knowledge and skills to promote HBV vaccination effectively. Informational-educational sessions for volunteer PWID empowered participants to advocate for HBV vaccination within their communities.

Overall, the study underscores the importance of targeted education and intervention strategies in addressing knowledge gaps, improving attitudes toward HBV vaccination, and ultimately increasing HBV vaccine uptake among PWID. By reducing the burden of HBV within this vulnerable population, the project contributes to broader public health goals of disease prevention and control. In addition, the study coincides with current preparations for widescale national Hepatitis B treatment and prevention activities and generated information that can be used by policy makers for planning of the Hepatitis B elimination program among key populations in Georgia.