Trends in tuberculosis notification and treatment in Georgia

Background: Georgia, a former Member of 26 countries with the high MDR-TB burden in the world, has taken significant measures in achieving the WHO goals. Aim: To assess interventions undertaken in the management of the National TB Program (NTP) of Georgia. Method: NTP has provided universal access to TB diagnosis and treatment countrywide; introduced WHO-approved modern diagnostic methods; FAST strategy was successfully implemented for early TB-detection in general healthcare facilities; NTP participate in the pilot project for integrated TB, HIV and HCV screening, which will be expended countrywide; Georgia became one of the pioneers in programmatic use of the new TB-drugs in line with active drug safety monitoring; was strengthened primary healthcare provider engagement in TB control; NTP increased research capacity through collaboration with international partners in conducting clinical/observational studies; increased involvement of civil society and implemented novel technologies for the improvement of TB care and adherence. Results: In the last decade the incidence of all TB cases in Georgia fall by 53% (in children by 72%, in prison by 96%), while the number of DR-TB patients - by 49%. Successful treatment outcomes in sensitive TB reached 82% (2018 cohort) and 65% in DR-TB (2017 cohort). Lost to follow-up in sensitive TB was 6% and in DR-TB - 20%. The prevalence of DR-TB in new cases in 2019 was 11.7% and in re-treatment cases–31%. Conclusion: Despite remarkable advances, TB, and especially DR-TB, remains one of the main challenges for the Georgian healthcare system. Additional actions needed to achieve End-TB strategic milestones in further reducing TB incidence and improving treatment outcomes.