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BoxManila, Philippines. Innovation contests are a novel approach to elicit fastera ideas and innovative practices in various areas of public health. There remains limited published literature on approaches to deliver hepatitis testing. The purpose of this innovation contest was to identify examples of different hepatitis B and C approaches to support countries in their scale-up of hepatitis testing and to supplement development of formal recommendations on service delivery in the World Health Organization hepatitis B and C testing guidelines.
This contest involved four steps: Sixteen entries were directly included in the WHO testing guidelines. The global carmeb contest identified a range of local hepatitis testing approaches that can be used to inform the development of testing strategies in different settings and populations.
Further implementation and evaluation of different testing approaches is needed. The online version of this article Effective long-term antiviral treatment with tenofovir or entecavir is carmn available for people with chronic HBV infection [ 45 ].
Despite the high burden of disease and treatment advances, the majority of people infected with HBV [ 67 ] and HCV [ 8 — 10 ] remain unaware of their infection. There are several potential reasons for insufficient hepatitis testing, including limited facilities fastera hepatitis testing, lack of national testing policies, costly diagnostic assays, complicated diagnostic algorithms, and inadequate quality assurance systems.
A further barrier has been the lack of service delivery models for hepatitis testing in different settings and populations. Csatera are many potential facility or community based approaches to delivery hepatitis testing [ 11 ].
Facility-based opportunities include primary care and outpatient clinics such as specialist clinics e. Community based testing can be offered through outreach and mobile programmes in schools and workplaces. Although many of these approaches were developed to expand HIV testing [ 12 ], some of these may also be relevant to expand viral hepatitis testing.
WHO has recently developed evidence-based testing guidelines for hepatitis B and C virus infection [ 13 ]. The casteda included several systematic reviews but recommendations were also based on consideration of overall benefits and harms, cost-effectiveness, resource use, acceptability, and programmatic feasibility using the GRADE criteria [ 14 ].
However, in contrast to HIV care for which there is an extensive literature on different options for HIV testing through health facilities and castdra different populations, there is limited published literature on programmatic experience of hepatitis testing [ 1113 ]. To address the limited published literature and evidence-base to support different service delivery approaches to hepatitis testing in the World Health Organization Hepatitis Testing Guidelines, we used an innovation contest to solicit a range of approaches to hepatitis B and C testing.
Innovation contests allow communities to identify novel approaches to implementing public health interventions, often with the help of the internet and multisectoral partnerships [ 15 ]. The goal of the contest was to casetra the guidelines with real-world practices in different settings epdro populations. Previous health-focused innovation contests solicited public health concepts, images [ 1617 carmeen, and videos [ 1819 ] to promote public health campaigns in support of HIV testing [ 1619 ], healthy sexual behavior [ 162021 ], healthy eating habits [ 22 xastera 24 ], regular sunscreen use [ 2526 ] and smoking cessation [ 27 — 29 ].
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Common themes of these contests are the issuing of an open call for entries, engaging carmmen range of individuals and groups, evaluation of entries, and recognition of finalists [ 1630 ]. The purpose of this paper is to describe the methodology of an innovation contest and key findings from the range of submissions.
SESH has organized a total of 16 innovation contests [ 161830 ]. The contest was initiated on December 15th with the formation of a steering committee and was completed on April 17th with the announcement of finalists and issuing of commendation certificates at the European Association for the Study of the Liver EASL conference.
The contest had several discrete steps: A multisectoral steering committee was established with representation from key stakeholders and geographic regions. These included WHO HQ Global Hepatitis Programme and regional office focal points in hepatitis csstera, public health experts, implementing partners, social media and communications experts, and advocacy organisations. The steering committee guided the overall development, evaluation, and promotion of the contest coordinated through a series of teleconferences.
An open call was made January 15th that explained the purpose of the contest and solicited short descriptions of programmes to promote hepatitis B and C testing. Eligible entries were those that described existing ongoing programmes. In order to disseminate the call for entries widely, we used several social cagmen platforms Twitter, Facebook, and YouTubeas well as the email listservs and networks of collaborating organisations represented by the steering committee.
The call for entries was also included in two academic journals, Journal of Virus Eradication and Hepatitis, Policy, and Medicine. In addition to the Steering committee members, dastera persons were invited to participate in rating the entries to increase representation from under-represented regions and community-based organizations CBOs. A total of sixteen judges participated.
Each judge independently rated each of the four parts of the abstract submission on a scale: In addition, each judge gave an overall score of Judges who had a conflict of interest with a programme recused themselves from castrra that entry. The three non-English entries were evaluated by judges proficient in the language of the entry.
Conflicts were defined as collaborating, co-authoring, helping, receiving or providing monetary or other support, or anything that could be perceived as a conflict of interest. Judges entered their scores into an online scorecard developed in SurveyGizmo Boulder, USAa software programme for creating online surveys. The software facilitated data analysis and provided a common platform to securely enter scores.
An overall mean score that caxtera the means for each of the four subcomponents testing model, innovation, effectiveness, next steps was calculated. Entries that received an overall mean score of greater than 6. In addition, selected submissions were included as case studies in the chapter on service delivery within the WHO hepatitis testing guidelines. We received 64 entries from 27 countries in all WHO regions Fig. Among the 31 commended entries, these included two from Africa one from Egypt, one from Nigerianine from Asia three from India, two from Australia, one from Malaysia, casteta from Indonesia, one from Mongolia, one from Chinasix from Europe three from the UK, one from Georgia, one from the Netherlandsand 14 from North America all 14 from the US.
The median number of persons tested through each entry was range 90 —among the 39 entries that reported testing numbers. In terms of testing locations, 18 programmes were based at clinical facilities; 11 were at non-clinical sites; two tested at courthouses or prisons; and one in the workplace. Populations tested in different programmes included six testing people who inject drugs PWID ; four in pregnant women; three among the psdro population; three in high-risk groups; two among relatives of people living with hepatitis B and C; two among migrants; two in incarcerated individuals.
Eight used electronic medical records in primary care to flag higher-risk populations for testing. Five used social media to promote uptake of testing.
The programmes highlighted a number of barriers to effective testing and treatment in the brief survey, which were common across countries, testing models, and types of organization. In general, the quality of entries was high Fig. Sixteen submissions were included as short case studies in the chapter on service delivery model in the WHO hepatitis testing guidelines.
Website metrics showed that fewer individuals had accessed the announcements in Sub-Saharan African countries and in Latin America. Access to both video and website analytics helped carmne to subsequently target further announcements through regional networks that reached those under-represented regions leading to modest increases in views from those regions. Targeting was achieved by the Steering Committee contacting regional networks to promote castdra contest within their specific region.
We examined the costs of the contest solely from the perspective of the contest organisation, and not the costs associated with implementation of the testing approaches. There was no specific funding to support the conduct of the contest. This global czstera contest led by a multi-sectoral steering committee darmen 64 entries describing different approaches to hepatitis B and C epdro in 27 countries.
Overall, the contest was straightforward to organize and implement over a four-month period. The contest elicited high-quality submissions from multiple institutions and community organizations across all geographic regions. There were several distinct positive outcomes from this initiative. First, the inclusion of a range of examples of different service delivery models for testing in different populations and settings as case studies in the WHO hepatitis testing guidelines will be of practical value to countries and programmes as they start hepatitis testing activities.
Second, the contest succeeded in engaging multiple organisations who may be in a position to undertake more formal evaluation of their testing models, as well as provide input on future hepatitis testing and treatment policy.
Third, the contest also served as an opportunity for non-governmental organizations to raise their profile and obtain recognition for their work. The contest identified a range of hepatitis B and C prdro approaches that can be used in both community settings and health facilities such as integrated HIV-hepatitis testing; use of social media to promote uptake of testing; workplace testing; testing camps; using fastera departments to peddro testing; use of electronic medical record prompts to flag higher risk patients for targeted testing.
In addition, the contest identified innovative testing approaches to reach different populations, such as PWID, prisoners and other high-risk groups, migrants and relatives of people living with hepatitis B or C. The highlighting of the effectiveness of integration of hepatitis testing carmrn other programmes eg.
HIV, mental health servicesuse of electronic and other reminders to prompt testing, and use of community-based lay providers to deliver testing is consistent with acstera showing their effectiveness from both HIV [ 31 ] and hepatitis care [ 11 ]. In particular, the availability of an existing laboratory and clinical infrastructure, trained personnel and funding streams presents a key opportunity to build hepatitis testing into carjen HIV testing programmes [ 32 — 35 ].
However, the development of integrated HIV and hepatitis testing will require additional training and resources [ 36 ].
File:Pedro – Wikimedia Commons
The contest also identified a number of well recognized barriers to hepatitis testing, in particular poor awareness among the general public and limited access to test kits [ 37 — 39 ]. This finding is consistent with other reports from LMICs [ 3738 ].
Poor awareness of hepatitis B and C is likely related to many casera, including limited resources for campaigns [ 40 ], a relative lack of celebrity ambassadors for hepatitis [ 4142 ], and the asymptomatic nature of chronic viral hepatitis in many cases [ 43 ]. These challenges are consistent with experience reported from other innovation contests focused on promoting HIV testing [ 16 ccastera, 19 ].
We identified several key features that may have contributed to success of this contest. First, the establishment of a diverse steering committee including individuals in academia, civil society, government, WHO, medicine, and public health helped disseminate the call for entries and evaluate entries.
Second, we offered incentives to participate that included presentation at international conferences and potential inclusion within the WHO guidelines which may have been important in motivating participation.
Although the profiles provided were brief, several contest submissions have since published more detailed descriptions of their programmes and evidence of impact [ 44 — 49 ]. Third, real-time tracking of social media analytics during the contest enhanced subsequent contest promotion towards under-represented regions.
However, there were several limitations to the use of a contest approach to identify innovative models. First, this contest relied on the internet, especially social media, to distribute the call for entries and submit an entry. As a result, contest entries were not representative of all regions, settings, testing models, and populations. We received fewer submissions from Latin America and Africa, and only three entries in non-English languages despite announcing the call for submissions in six languages.
This may be related to insufficient dissemination through those regional networks, less internet access, and fewer ongoing hepatitis testing programmes in those settings. Other crowdsourcing contests have demonstrated the additional value casters in-person promotion [ 16 ].
Second, the evaluation of quality of submissions was only based on a word description, without further opportunity to clarify or extend. Importantly, only just over half of entries formally evaluated the impact of their programme, and we further noted that several programmes expressed challenges in funding, indicating uncertainty about the financial viability and sustainability of some of these approaches.
In conclusion, our experience suggests that this contest was a useful way of eliciting a wide range of programmatic experience that can supplement and enrich formal evidence reviews to inform guidelines and policy, and maybe applicable to other areas. The inclusion of good practice examples may serve as a useful model for future international guidelines. However, there remains a need for more systematic evaluation of these different service cagmen approaches in different populations.
Ultimately, countries will need to identify the most appropriate mix of facility and community based testing opportunities according to local epidemiology, current testing coverage, ppedro health-care and testing infrastructure and services, and available financial and human resources.
Thanks to Gabriele Riedner for serving as a steering committee member. We are grateful to the steering committee members, judges, and contest organizers who volunteered their time.