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Background People who inject drugs (PWID) are more likely to engage in unsafe sexual behavior placing them at high risk of acquiring HIV and other STIs. This study aims to assess the prevalence and predictors of inconsistent condom use with casual and/or paid sexual partners among PWID in Georgia. Methods Integrated Bio-Behavioral Surveillance Survey was conducted among PWID in seven major cities of Georgia. Study design was cross-sectional with respondent-driven sampling (RDS) methodology. Data collection was carried out through individual face-to-face interviews. Of the 2005 PWID who participated in the study, we analyzed a subsample of 619 (30.9%) who reported having casual and/or paid sexual partners during the last 12 months and described prevalence and predictors of consistent condom use. Results Consistent condom use during casual and/or paid sex in past 12 months was reported by 49.4% of respondents. The likelihood of consistent use with casual and/or paid sexual partners was statistically significantly associated with residence, family income, drug use frequency, drug dependence and HIV risk self-perceptions. In multivariable analysis independent predictors of always using condom at casual/paid sex during the last 12 months were place of residence (aOR = 6.4; 95% CI: 3.2–12.7), family income (aOR = 2.1; 95% CI:1.3–3.5) and drug use frequency (aOR = 0.6; 95% CI: 0.4–0.9). Conclusion The study revealed low prevalence of consistent condom use with casual and/or paid sexual partners among PWID in Georgia. Integration of safe sex educational interventions in harm reduction services may improve the rates of condom use among PWID and should focus PWID with lower socio-economic status and residing outside capital city.

ObjectiveTo provide the first national estimate of syphilis prevalence among people who inject drugs (PWID) in Georgia, alongside updated HIV prevalence and associated risk behaviours, and to identify factors associated with infection.DesignCross-sectional Integrated Bio-Behavioural Surveillance Survey conducted in 2022. Respondent-driven sampling was used to recruit PWID. Data were collected through standardised face-to-face interviews using structured questionnaires, and venous blood samples were collected for laboratory testing. HIV was diagnosed by serology, and syphilis was assessed using a two-step algorithm (Rapid Plasma Reagin screening with Treponema pallidum haemagglutination assay confirmation). Logistic regression models were applied to identify correlates of infection.SettingThe study was conducted in community settings across seven major cities of Georgia that represent the main urban centres with large PWID populations. Survey implementation was supported by local peer-led and community-based harm reduction organisations with established trust and access to PWID networks, facilitating participant recruitment and ensuring feasibility.ResultsHIV prevalence was 0.9% and syphilis prevalence 2.1%. Coinfection with HIV and syphilis was observed in 0.2% of participants. HIV infection was significantly associated with longer duration of injection drug use (adjusted OR (aOR) 0.2; 95% CI 0.5 to 0.9) and lack of access to HIV prevention services (aOR 2.8; 95% CI 1.1 to 7.8). Syphilis prevalence was significantly lower among PWID who had not had casual or paid sex in the past year (OR 0.06; 95% CI 0.02 to 0.2). Unsafe sexual behaviours were common: 25.8% reported sex with a casual partner in the past year, 12.3% reported a paid partner, and only around half used condoms consistently with these partners.ConclusionsDespite a relatively low HIV prevalence, syphilis prevalence among PWID in Georgia highlights ongoing sexual risk behaviours. Current harm reduction programmes primarily address injection-related risks, with limited sexually transmitted infection (STI) prevention efforts. Expanding sexual health interventions within harm reduction services, including STI screening, structured counselling and safe sex education, is essential to reduce STI transmission and improve health outcomes among PWID.

Ukraine faced significant fluctuations in COVID-19 morbidity and mortality, alongside an escalating HIV epidemic. This mixed-methods study, conducted between February and August 2022, employed a sequential explanatory design combining a quantitative analysis of national data and qualitative interviews to investigate the pandemic's effects on HIV services in Ukraine. The observed trends confirmed that the pandemic significantly disrupted facility-based HIV testing due to logistical challenges, an increased burden on healthcare workers, and supply shortages. Meanwhile, community-based testing showed resilience, largely attributed to programmatic adjustments rather than the pandemic itself. The initiation of antiretroviral therapy declined, especially during initial lockdowns, reflecting diminished treatment capacities. Despite these challenges, telemedicine and home medication delivery innovations supported antiretroviral therapy adherence. Furthermore, improvements in viral load testing and suppression rates showed healthcare resilience. The study highlights the critical need for adaptable, sustainable healthcare strategies in crises, emphasized during the war with Russia. Plain Language Summary How COVID-19 Changed HIV Care in Ukraine: Challenges, Adaptations, and Innovations In recent times, Ukraine, like many other countries, has been dealing with two big health problems: the COVID-19 pandemic and the ongoing HIV epidemic. With over 104 million cases of COVID-19 reported in Europe by early 2022, Ukraine faced the coronavirus as well as an increasing HIV crisis, especially among older adults and through various ways of spreading. This study, done between February and August 2022, aimed to understand how the COVID-19 pandemic affected the HIV services in Ukraine. By using numbers and in-depth interviews with health officials, service providers, and community members, we looked into the state of HIV care during this challenging period. Our findings show that the effects of the pandemic on HIV services were mixed. While HIV testing done in the community managed to adjust and keep going despite the changes, services in healthcare facilities ran into many problems. Lockdowns and restrictions made it hard for people to get to these places, leading to a big drop in HIV testing and the start of antiretroviral therapy, a key treatment for managing HIV. Despite these challenges, there were important changes and new ideas. Services such as telemedicine and delivering medication were started to make sure patients could continue their antiretroviral therapy without any breaks. The testing for viral load, which is important for checking how well HIV treatment is working, slowly went up, showing a system that could adapt to the pressures of the pandemic. The ability to adjust and keep going shown by some HIV services in Ukraine during the COVID-19 pandemic highlights the need for healthcare delivery methods that can change as needed and last over time. This study points out the importance of ongoing efforts to support people living with HIV, especially when facing big challenges, and gives valuable lessons for managing healthcare services during difficult times like the conflict with Russia.

The goal of this study was to examine specific factors placing young (aged <30) women who inject drugs at higher risk for HIV, and to establish the need for targeted interventions within this population. A national cross-sectional sero-survey was conducted in 2004-2005 in six regions in Poland. A snowball sample of ever-injectors was recruited from drug treatment facilities and the surrounding community. Log-binomial regression was used to estimate adjusted prevalence ratios (PRs). A total of 491 injection drug users younger than 30 were recruited, of whom 159 were women and 332 were men. The prevalence of HIV was 16.4% and 9.6% among women and men, respectively. In multivariate analysis, young female injectors whose education terminated at the primary level were more likely to be HIV-positive compared to males with a similar level of education (PR = 3.34, 95% CI = 1.86-6.00) and more highly educated women (PR = 4.16, 95% CI = 2.21-7.82). This study confirms an elevated risk of HIV among under-educated young women. Suggestions for specific interventions to reduce HIV transmission are presented. Additional research is needed to quantify the differential distribution of risk behaviors which amplify their likelihood of transmission.

Introduction There is little information on adherence to antiretroviral therapy (ART) in the Eastern European region. This prospective study evaluated multiple measures of adherence and their association with viral suppression among HIV patients in Georgia. Methods A prospective cohort study enrolled 100 consecutive antiretroviral‐naïve adult (age ≥18 years) patients, who were followed for three months. Adherence was assessed by medication refill and three self‐report measures (an AIDS Clinical Trial Group [ACTG] tool for four‐day adherence, a visual analogue scale [VAS] and a rating task for 30‐day adherence). The VAS represented a line anchored by 0 and 100% corresponding to the percentage of prescribed doses taken. The rating task asked patients to rate their ability to take all medications as prescribed, with responses categorized into six levels of adherence: very poor (0%), poor (20%), fair (40%), good (60%), very good (80%) and excellent (100%). Patients with adherence of ≥95% by medication refill, ACTG and VAS, and ≥80% by rating task, were defined as adherent. Results Of 100 patients enrolled, eight had missing data and were excluded from analysis. Among the remaining 92 patients, the median age was 39 years, and 70% were men. Major modes of HIV acquisition were injection drug use (IDU; 47.3%) and heterosexual contact (44.1%). The proportions of adherent patients were as follows: 68% by medication refill, 90% by ACTG questionnaire, 38% by VAS and 42% by rating task. On average, four months after commencing ART, 52 (56.5%) patients had a viral load <400 copies/ml and 26 (28.3%) patients had a viral load <50 copies/ml. Of 43 persons with a history of IDU, 22 (51.2%) reached a viral load of <400 copies/ml. In multivariate analysis, only refill adherence was a statistically significant predictor of viral suppression of <400 copies/ml: the risk ratio was 1.7 (95% CI: 1.1–2.8). Refill adherence, VAS and rating task were associated with viral suppression of <50 copies/ml. Non‐IDUs were twice as likely to achieve viral load <50 copies/ml compared to IDUs. Refill adherence had the largest area under the receiver‐operating characteristic curve for predicting viral suppression. Conclusions Medication refill adherence was the strongest predictor of viral suppression. IDUs can achieve optimal virologic outcomes, but may require additional adherence support.

Abstract BackgroundEffective therapies to combat coronavirus 2019 (COVID-19) are urgently needed. Hydroxychloroquine (HCQ) has in vitro antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the clinical benefit of HCQ in treating COVID-19 is unclear. Randomized controlled trials are needed to determine the safety and efficacy of HCQ for the treatment of hospitalized patients with COVID-19. MethodsWe conducted a multicenter, double-blind randomized clinical trial of HCQ among patients hospitalized with laboratory-confirmed COVID-19. Subjects were randomized in a 1:1 ratio to HCQ or placebo for 5 days and followed for 30 days. The primary efficacy outcome was a severe disease progression composite end point (death, intensive care unit admission, mechanical ventilation, extracorporeal membrane oxygenation, and/or vasopressor use) at day 14. ResultsA total of 128 patients were included in the intention-to-treat analysis. Baseline demographic, clinical, and laboratory characteristics were similar between the HCQ (n = 67) and placebo (n = 61) arms. At day 14, 11 (16.4%) subjects assigned to HCQ and 6 (9.8%) subjects assigned to placebo met the severe disease progression end point, but this did not achieve statistical significance (P = .350). There were no significant differences in COVID-19 clinical scores, number of oxygen-free days, SARS-CoV-2 clearance, or adverse events between HCQ and placebo. HCQ was associated with a slight increase in mean corrected QT interval, an increased D-dimer, and a trend toward an increased length of stay. ConclusionsIn hospitalized patients with COVID-19, our data suggest that HCQ does not prevent severe outcomes or improve clinical scores. However, our conclusions are limited by a relatively small sample size, and larger randomized controlled trials or pooled analyses are needed. Treatments for patients hospitalized with COVID-19 are urgently needed. In this multicenter, double-blind, randomized trial, five days of hydroxychloroquine (N=67) did not suggest benefit compared to placebo (N=61). Hydroxychloroquine increased qT interval, D-dimer, and trended towards an increased length of stay. Larger trials are needed.

Background. Efavirenz exhibits marked interindividual variability in plasma levels and toxicities. Prior pharmacogenetic studies usually measure exposure via single plasma levels, examine limited numbers of polymorphisms, and rarely model multiple contributors. We analyzed numerous genetic and nongenetic factors impacting short-term and long-term exposure in a large heterogeneous population of human immunodeficiency virus (HIV)-infected women. Methods. We performed 24-hour intensive pharmacokinetic studies in 111 women receiving efavirenz under actual-use conditions and calculated the area-under-the-concentration-time curve (AUC) to assess short-term exposure; the efavirenz concentration in hair was measured to estimate long-term exposure. A total of 182 single-nucleotide polymorphisms (SNPs) and 45 haplotypes in 9 genes were analyzed in relationship to exposure by use of multivariate models that included a number of nongenetic factors. Results. Efavirenz AUCs increased 1.26-fold per doubling of the alanine aminotransferase level and 1.23-fold with orange and/or orange juice consumption. Individuals with the CYP2B6 516TT genotype displayed 3.5-fold increases in AUCs and 3.2-fold increases in hair concentrations, compared with individuals with the TG/GG genotype. Another SNP in CYP2B6 (983TT) and a p-glycoprotein haplotype affected AUCs without substantially altering longterm exposure. Conclusions. This comprehensive pharmacogenomics study showed that individuals with the CYP2B6 516TT genotype displayed >3-fold increases in both short-term and long-term efavirenz exposure, signifying durable effects. Pharmacogenetic testing combined with monitoring of hair levels may improve efavirenz outcomes and reduce toxicities.

Following the collapse of the Soviet Union, there was a pronounced change in the availability of modern contraceptive methods and an accompanying shift in the knowledge and attitudes of Georgian women related to sexual behaviors. This study describes differences in sexual behaviors, condom use and family planning practices among several generations of reproductive-aged Georgian women. Study participants were recruited from three large cities in Georgia. Women >25 years were recruited from the Cervical Cancer Screening National Program by consecutive sampling; those <25 years were recruited from universities using random sampling. Data collection included self-administered, anonymous surveys. Bivariate analyses were conducted and adjusted prevalence ratios (PR) with 95% confidence intervals were computed. Among the 350 participants, independent predictors of age at first sexual intercourse were age (aPR 0.27; 95% CI 0.12-0.57), level of education (aPR 0.23; 95% CI: 0.11-0.44), marital status (aPR 2.8;95% CI:1.3-6.0) and religion (aPR 4.01; 95% CI:1.17-13.68). Younger women were more likely to have a premarital sexual relationship compared to older women (RR=0.85; 95% CI: 0.80-0.89); older women were also significantly more likely to use family planning methods with a current partner (RR=2.15; 95% CI: 1.48-3.13). Similarly, advanced education was associated with family planning (RR=1.66; CI: 1.13-2.45). This study describes clear generational differences in current sexual behavior among Georgian women of reproductive age and these differences, especially in age at first sexual intercourse, premarital sexual relationship and use of contraceptive methods, are influenced by age, level of education, marital status and religion. This information is vital to designing contextually appropriate strategies to prevent sexually transmitted infections.

The relationship between the pattern of virus load response to highly active antiretroviral therapy (HAART) and CD4 lymphocyte response was assessed in a cohort of 249 human immunodeficiency virus (HIV) type 1—infected women at 3 times: 1 before and 2 after initiation of therapy, with follow-up of 6–12 months. Patients with a durable response to HAART (i.e., >1 log decrease in HIV-1 RNA sustained for the study periods) had a continuous and significant increase in CD4 cell counts over time, whereas those with no response (<0.5 log decrease in HIV-1 RNA) had a slight decline. Patients with a mixed response (initial decrease >1 log, followed by a subsequent decrease <0.5 log) had an increase in CD4 cell count, followed by a plateau. The trend in CD4 cell count differed significantly by response to HAART, with those patients who experienced a durable response having significantly higher CD4 cell counts than others.

Introduction: In Georgia limited data exists about awareness of blood borne-diseases among dental health care workers (DHCW). Methodology: To assess DHCW knowledge, attitudes and practices related to infection control practice guidelines designed to limit transmission of blood-borne diseases, a cross-sectional study was conducted. All respondents were asked to voluntarily complete a self-administered questionnaire. Doctors of Dental Medicine, nurses, and dental residents were recruited from 13 private and governmental dental units in three large Georgian cities: Tbilisi (the capital city), Batumi (Western Georgia) and Rustavi (Eastern Georgia). Results: Of 244 DHCWs recruited, 196 (80%) agreed to participate. Nearly 42% DHCWs did not know the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Georgia. Knowledge about risk factors for transmission of human immunodeficiency virus (HIV), HCV and HBV was low; correct response proportions among all DHCWs were 45.3%, 37.9% and 34.2% for these pathogens, respectively. The 59.7% of DHCWs were uninformed about post-exposure prophylaxis for HIV. Only 37.3% reported being well informed on infection control guidelines. Nearly all (95.6%) DHCWs expressed interest in receiving additional education on occupational transmission of blood-borne pathogens. Conclusions: Overall, the study suggests DHCWs are aware they have insufficient knowledge of universal precautions. There is a need for developing a continuous education program that is accessible to practicing DHCWs.