Issue 1, 2017. February-March



Georgia, the United States' Center for Disease Control and Prevention (CDC) and pharmaceutical company Gilead have teamed up to create a pioneering program that could become an international example of how to eliminate Hepatitis C, one country at a time.

Inge Snip
Photos by George Surguladze

Every morning he woke up tired. Not just tired, but exhausted. "I used to love going out to meet with friends," says Levan Ekseulidze, 51, while sitting at a colorful dining table surrounded by exotic plants and Georgian paintings. "I was quite active, but I did not like anything anymore. I did not want to go anywhere," the former dentist says, as he explains to about the years he had Hepatitis C, a liver disease affecting an estimated 6.7% of Georgia's population, one of the highest rates in the world. Fatigue and depression are some of the few symptoms in the later stages of the viral infection.

Hepatitis C is a major contributor to the global disease burden, as it causes "chronic, life-long infections, resulting in progressive liver damage that leads to cirrhosis and hepatocellular carcinoma," a report by the World Health Organization states. With a high level of hepatitis-related mortality worldwide, the easily preventable infection is very costly to cure; one treatment round costs about $85,000 per person.

But a new revolutionary program in Georgia, which negotiated free medication from pharmaceutical company Gilead, is trying to tackle the infection rate in the country. The five-year strategic plan, which started in 2015, aims to eliminate Hepatitis C countrywide and serve as a worldwide example by doing so.

Ekseulidze took part in the program and was cured after just three months of treatment. "The change in my life has been major," Ekseulidze explains, whom was diagnosed in the early 2000s, but could not afford the medication to treat it.

Gregg Alton, Executive Vice President of Corporate and Medical Affairs at Gilead Sciences, tells that providing Georgia with free medication was an easy decision: it seemed the perfect place to do a test case to show other countries that Hepatitis C could be cured countrywide with their new medication.

"You have a manageable population in terms of a study size, and you have a high prevalence of the disease. It really struck me as a great opportunity for us to do a demonstration project of how you can actually, in a poor country, eliminate Hepatitis C if you bring in all the elements of screening, treatment, of building the clinics, of reducing stigma, and on working on prevention. And that seemed to be something [government leaders] were very committed to do," Alton says.

Currently, over 8,500 people (of those approximately 285,000 Georgians with Hepatitis C) have been treated, of which 90% have been cured. The aim of the program is to have 90% of the patients infected with Hepatitis C virus screened and 95% of the patients treated and cured after four years.

If the program is successful, it could have major implications for the elimination of the disease worldwide.

"I am hopeful that in five to ten years the infection will no longer be a significant healthcare burden for Georgia," Alton tells, and who says Gilead will not give the medication for free in other countries, but sees it as an example to show other countries that the investment in the medication is worth it. "And we are talking with possible donors who could support governments in eliminating Hepatitis C as well."

But there are some concerns from experts when it comes to the sustainability of the project.

Maia Butsashvili, infectious disease specialist and HRU director at Neolab, one of the first participating medical laboratories, says "the reinfection rate might be quite high if the government does not take enough measures in the health sector to prevent Hepatitis C infections." About 50% of Neolab's participants in the program were infected through unsafe procedures in the healthcare system. Butsashvili is also worried about harsh laws on drug abuse: the other 50% of the participants at their lab were infected through unsafe and shared needles.

This concern is widely held. Paata Sabelashvili, who has been advocating for the decriminalization of drug use for several years, says the program is falling short on recognizing the effects of law enforcement aiming to imprison anyone using drugs. "We want to have patients to be able to get medication at the harm reduction centers, or mobile ambulances. But patients have been harassed by the police; they searched the bus twice, expecting to find drugs, scaring away the people who need the Hepatitis C program the most."

But both Butsashvili and Sabelashvili believe the Ministry of Health is slowly recognizing it needs to have a stronger position in the drug decriminalization discussion to ensure the success of the program. Alton notes that Gilead is working closely with the government to advise them how to deal with this situation. "At the advisory board that meets several times a year in Georgia, we have experts from all over the world, and we also have representatives from the drug-using population," he says. For Ekseulidze, who got infected in the 1990s while injecting himself with "all kinds of drugs," says two of his friends who were in the program tested positive a few months after they were cured. He, however, blames it on the large amounts of alcohol they consumed afterwards. "You need a healthy diet after you are cured, but we Georgians don't always believe wine and fatty foods are bad for us."

It is obvious there are a lot of hurdles to overcome to achieve the goal of eliminating Hepatitis C, but the program is making some important and crucial steps necessary to defeat the disease, with a potential global impact.