Hepatitis C virus reinfection among people who inject drugs in the country of Georgia and injection-related risk factors: Implications for HCV elimination in the EECA region

Hepatitis C (HCV) infection is a major global health challenge, with particularly high prevalence among people who inject drugs (PWID) in the Eastern European and Central Asian region (EECA). While the country of Georgia has made major progress in reducing overall HCV prevalence, less is known about HCV reinfection rates and risk factors for reinfection among PWID. In this study, we aimed to: (1) estimate HCV reinfection rates and (2) identify risk factors associated with HCV reinfection among PWID. Data were from the 2022 Integrated Bio-Behavioral Surveillance Study (IBBS) of PWID in Georgia. For the present analysis, the sample was restricted to the 462 PWID who had previously received HCV treatment through the national elimination program. The survey included a behavioral component (face-to-face interviews using a standardized questionnaire covering injection-related risk behaviors), and a laboratory component (blood samples for HCV RNA testing). We conducted regression models based on bivariate analyses to identify risk factors associated with laboratory-confirmed HCV reinfection. Overall, the reinfection rate was 13% among PWID in our sample. We found that younger PWID had higher odds of HCV reinfection compared to older PWID. The highest reinfection rate was among participants aged 18–24, (33.3%), although this group comprised a small portion of the sample (n = 3). Those reporting public injecting, had an adjusted odds ratio AOR of 8.08 [95% CI: 2.13,30.98] of HCV reinfection. At the time of the study, continuous opioid injection every day during the last 12 months was also associated with reinfection with an AOR of 2.26 [95% CI: 1.06,5.01]. Reinfection presents a challenge to HCV elimination. We identified several key factors that may influence reinfection including age, injection environment, and duration of drug injection. These findings emphasize the necessity for an integrative approach to harm reduction that addresses both behavioral and environmental risk factors.