On-site testing for hepatitis C at a government agency in Tbilisi. Thousands of Georgians have been cured of hepatitis C as a result of a giant experiment, in which the ex-Soviet nation tests the effectiveness of an aggressive public-health strategy. (Photo: Georgia’s Ministry of Labor, Health and Social Affairs)

Thousands of Georgians have been cured of hepatitis C as a result of a giant experiment, in which the ex-Soviet nation tests the effectiveness of an aggressive public-health strategy.

In the unprecedented project, all Georgians suffering from hepatitis C – an estimated 130,000 individuals – are being treated with expensive American medications free of charge. The program has entered its third year this May, and by 2020, Georgia hopes to be the first country in the world virtually free of the infectious liver disease.

The project is being undertaken by the US Centers for Disease Controls, the Georgian Ministry of Health and Gilead Sciences Inc., the American pharmaceuticals giant that developed the medications. Starting in 2015, Gilead’s medication, dubbed Sovaldi, was administered to 5,800 Georgian hepatitis patients with severe complications like advanced liver fibrosis and cirrhosis. The following year, a newer drug developed by Gilead, called Havroni, was given to anyone with an active infection.

Georgian officials and epidemiologists reported a full recovery rate of over 90 percent among a total of 30,000 citizens who have been treated during the first two years of the program.

“We naturally had better results last year because most patients involved did not have significant liver damage, and we had a new, combined drug to give,” said Dr. Maia Butsashvili, an infectious disease specialist at Neolab, a clinic participating in the program.

The success rate was 80 percent in patients with severe liver damage, and 97 percent for those with a less-advanced stage of the disease, said Butsashvili, who is also a director of Health Research Union, a non-profit working on prevention and treatment of viral infections.

In the United States, Gilead Sciences charges $1,000 for a single Sovaldi pill. A 12-week Havroni protocol costs about $84,000. Gilead’s largesse in the Georgian experiment is an investment: if the project succeeds, it could help the company make a case for internationally and nationally funded programs to eliminate hepatitis C worldwide by making the cure available to everyone who needs it. Gilead representatives did not respond to emailed questions by the time this story was published.

Georgia was chosen as a proving ground due to its manageable population size and its high prevalence of hepatitis C. Georgia has the third highest rate of infection in the world after Egypt and Mongolia. Surveys from the early 2000s estimated that 6.7 percent (almost 200,000 people) of Georgia’s total population was infected with hepatitis C.

The disease spread in Georgia as the country regained independence following the Soviet collapse in 1991 and was plunged into a prolonged period of civil war and economic instability. Sterilization practices were substandard and intravenous drug use was rampant at that time. “The big contamination of the 1990s is catching up with us now. We have lots of men in their 40s who now face life-threatening liver conditions,” Butsashvili said.

Georgia still has a significant problem of injected drug use – the main source of hepatitis C infections – with almost 50,000 estimated active users, according to a study by Curatio International Foundation and Bemoni Public Union.

With hardly any state aid available at home until recently, many Georgians with the disease migrated to Europe, in particular France, to seek government-funded treatment programs there, said Ina Inaridze, of Médicines du Monde, a French humanitarian group, involved in a campaign for hepatitis C prevention and affordable treatment in Georgia. “Over the years, there has been a high incidence of hepatitis C among Georgian asylum seekers in France, which is known for its policy of offering social protection even to undocumented migrants,” Inaridze said.

For years addressing the public health challenge connected with hepatitis C was not a priority for the Georgian government, and the association of the disease with drugs and sexual promiscuity discouraged public empathy, said Marina Chokheli, coordinator of harm reduction programs at the Open Society Georgia Foundation. “To change this, we have focused on helping organize patients as a community, so they could demand government attention and push to change public attitudes.”

Those advocacy efforts led authorities to place a greater priority on tackling the disease. The turning point occurred in 2013, when the government began offering free treatment in prisons. Before that, the Georgian state had lost several cases in the European Court for Human Rights for failing to extend medical services to inmates sick with hepatitis C.

With the launch of the prison program, officials realized the scale of the problem and the cost of its treatment, Butsashvili said. “Since every untreated individual is a potential cause of a new infection, it is more efficient to tackle the problem in a comprehensive manner,” she said.

Now that the free treatment is being extended to everyone, activists are pushing for the government to fully cover the cost of tests that determine if an infection is active, as well as post-treatment tests. The tests cost about $200 and are partly underwritten by the government, but there is no consistent nationwide formula of sharing costs and the price remains a hurdle for poor Georgians, said Chokheli.

Inaridze and Chokheli say the Georgian government’s harsh anti-drug policies are hampering eradication efforts because drug users tend to shun detoxification and harm reduction programs. “As long as we have people who don’t take these tests because of the costs… and the government’s policy is focused on persecution, rather than engagement of drugs users, the program will not advance as quickly as it should,” Chokheli said.

Even so, there is a broad excitement in Georgia that the program was even made possible.

“History knows only one successful case of the global elimination of an infectious disease, which was smallpox,” said Butsashvili. “If the effort in Georgia is a success, it will create a real hope for a second case.”