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      The HepTestContest: a global innovation contest to identify approaches to hepatitis B and C testing

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          Abstract

          Background

          Innovation contests are a novel approach to elicit good 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 2017 World Health Organization hepatitis B and C testing guidelines.

          Methods

          This contest involved four steps: 1) establishment of a multisectoral steering committee to coordinate a call for contest entries; 2) dissemination of the call for entries through diverse media (Facebook, Twitter, YouTube, email listservs, academic journals); 3) independent ranking of submissions by a panel of judges according to pre-specified criteria (clarity of testing model, innovation, effectiveness, next steps) using a 1-10 scale; 4) recognition of highly ranked entries through presentation at international conferences, commendation certificate, and inclusion as a case study in the WHO 2017 testing guidelines.

          Results

          The innovation contest received 64 entries from 27 countries and took a total of 4 months to complete. Sixteen entries were directly included in the WHO testing guidelines. The entries covered testing in different populations, including primary care patients ( n = 5), people who inject drugs (PWID) ( n = 4), pregnant women ( n = 4), general populations ( n = 4), high-risk groups ( n = 3), relatives of people living with hepatitis B and C ( n = 2), migrants ( n = 2), incarcerated individuals ( n = 2), workers ( n = 2), and emergency department patients ( n = 2). A variety of different testing delivery approaches were employed, including integrated HIV-hepatitis testing ( n = 12); integrated testing with harm reduction and addiction services ( n = 9); use of electronic medical records to support targeted testing ( n = 8); decentralization ( n = 8); and task shifting ( n = 7).

          Conclusion

          The global innovation 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.

          Electronic supplementary material

          The online version of this article (10.1186/s12879-017-2771-4) contains supplementary material, which is available to authorized users.

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          Most cited references38

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          Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001-2008.

          Many persons infected with hepatitis C virus (HCV) are unknown to the healthcare system because they may be asymptomatic for years, have not been tested for HCV infection, and only seek medical care when they develop liver-related complications. We analyzed data from persons who tested positive for past or current HCV infection during participation in the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2008. A follow-up survey was conducted 6 months after examination to determine (1) how many participants testing positive for HCV infection were aware of their HCV status before being notified by NHANES, (2) what actions participants took after becoming aware of their first positive test, and (3) participants' knowledge about hepatitis C. Of 30,140 participants tested, 393 (1.3%) had evidence of past or current HCV infection and 170 (43%) could be contacted during the follow-up survey and interviewed. Only 49.7% were aware of their positive HCV infection status before being notified by NHANES, and only 3.7% of these respondents reported that they had first been tested for HCV because they or their doctor thought they were at risk for infection. Overall, 85.4% had heard of hepatitis C; correct responses to questions about hepatitis C were higher among persons 40-59 years of age, white non-Hispanics, and respondents who saw a physician after their first positive HCV test. Eighty percent of respondents indicated they had seen a doctor about their first positive HCV test result. These data indicate that fewer than half of those infected with HCV may be aware of their infection. The findings suggest that more intensive efforts are needed to identify and test persons at risk for HCV infection. Copyright © 2012 American Association for the Study of Liver Diseases.
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            Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control.

            Sexually transmitted infections (STIs) remain a major global public health issue, with more than 448 million incident bacterial infections each year. We review recent advances in STI point-of-care (POC) testing and implications for STI prevention and control. Accurate immunochromatographic assays to detect HIV, hepatitis C virus (HCV) and syphilis antibodies have made home or supervised self-testing possible. Several studies have demonstrated feasibility and excellent test characteristics for HIV, HCV and syphilis POC tests. Rapid oral HIV tests are now available for purchase at retail sites across the United States. Combined HIV and syphilis tests using a single finger prick blood sample are under evaluation. Oral POC STI tests with comparable performance to blood-based POC tests are available for self-testing. POC tests can expand screening, improve syndromic management and reduce loss to follow up. POC STI tests have the potential to facilitate prompt treatment and partner services. POC STI tests create opportunities for new social and financial models of community-based testing services. Increasing equity and access to testing will create challenges in linkage to care, quality assurance, partner services and surveillance. These important developments warrant research to understand appropriate contexts for implementation.
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              Viral hepatitis in resource-limited countries and access to antiviral therapies: current and future challenges.

              Chronic viral hepatitis is a major public health issue worldwide and mostly affects resource-limited countries. These regions combine a considerable set of barriers to containing the epidemic, including shortage of healthcare workers, poor medical infrastructures, insufficient screening and poor access to care and treatment. At a time when morbidity and mortality of chronic liver disease has been widely improved in wealthy countries by new innovative strategies and potent antiviral drugs, it is now urgent to face the challenges of better management of chronic hepatitis in resource-poor countries from the perspectives of global health and social justice.
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                Author and article information

                Contributors
                +86 13560294997 , jdtucker@med.unc.edu
                kmeyers@adarc.org
                yigeguimo@gmail.com
                Karyn.kaplan@gmail.com
                pendsera@who.int
                kevin.fenton@phe.gov.uk
                Isabelle.Andrieux-Meyer@geneva.msf.org
                figueroac@who.int
                pgoicochea@hivforum.org
                charles.gore@hepctrust.org.uk
                ishizakia@who.int
                giten.khwairakpam@treatasia.org
                veronicam@berkeley.edu
                mozalevskisa@who.int
                mhninburg@hepeducation.org
                ponsiano.ocama@gmail.com
                Rosanna.Peeling@lshtm.ac.uk
                walshn@who.int
                massimo.colombo@polimi.it
                easterbrookp@who.int
                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central (London )
                1471-2334
                1 November 2017
                1 November 2017
                2017
                : 17
                Issue : Suppl 1 Issue sponsor : Publication of this supplement was funded by the WHO. Information about the source of funding for specific projects can be found in the individual articles. The articles have undergone the journal's standard peer review process for supplements. PE is a WHO staff member and has no financial conflicts of interest. RC has received funding from the U.S. Agency for Healthcare Research and Quality to conduct systematic reviews on hepatitis C screening. MH receives funding from the NHMRC in Australia for a Principal Research Fellowship. The Burnet Institute receives funding from Gilead Science, Abbvie and BMS for investigator initiated research, for which MH is the lead investigator, and receives support from the Victorian Government through the Victorian Operational Infrastructure Support Program. PH is an employee of BioMed Central. The Supplement Editors declare that they were not involved in the peer review process for any paper on which they are an author.
                : 701
                Affiliations
                [1 ]University of North Carolina Chapel Hill Project-China, Number 2 Lujing Road, Guangzhou, 510095 China
                [2 ]ISNI 0000000122483208, GRID grid.10698.36, Institute of Global Health and Infectious Diseases, , University of North Carolina Chapel Hill, ; 130 Mason Farm Rd, CB# 7030, Chapel Hill, NC 27599-7030 USA
                [3 ]SESH Global, Number 2 Lujing Road, Guangzhou, 510095 China
                [4 ]ISNI 0000 0004 0421 0304, GRID grid.280587.0, Aaron Diamond AIDS Research Center, ; 455 1st Avenue # 7, New York, NY 10016 USA
                [5 ]ISNI 0000 0004 1936 8972, GRID grid.25879.31, University of Pennsylvania Neurology Department, ; 3400 Spruce Street, Philadelphia, PA 1914 USA
                [6 ]Asia Catalyst, 1109, 1270 Broadway, New York, NY 1001 USA
                [7 ]ISNI 0000 0001 0685 5219, GRID grid.417256.3, WHO Regional Office for South East Asia, World Health House, ; Indraprastha Estate, Mahatma Gandhi Marg, New Delhi, Delhi 110002 India
                [8 ]Southwark Council, 160 Tooley Street, London, SE1 2QH UK
                [9 ]ISNI 0000 0001 1012 9674, GRID grid.452586.8, Médecins Sans Frontières, ; Rue de Lausanne 78, 1202 Genève, Switzerland
                [10 ]ISNI 0000000121633745, GRID grid.3575.4, World Health Organization HIV Department, ; 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
                [11 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Forum for Collaborative HIV Research and the University of California Berkeley School of Public Health, ; 1608 Rhode Island Avenue NW, Suite 212, Washington, DC 20036 USA
                [12 ]World Hepatitis Alliance, 1 Baden Place, London, SE1 1YW UK
                [13 ]Hepatitis C Trust, 27 Crosby Road, London, SE1 3YD UK
                [14 ]TREAT Asia, Exchange Tower, 388 Sukhumvit Road, Suite 2104, Klongtoey, Bangkok 10110 Thailand
                [15 ]ISNI 0000 0001 1939 8248, GRID grid.420226.0, WHO Regional Office for Europe, ; UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark
                [16 ]Hepatitis Education Project, 1621 S. Jackson Street, 2t 201, Seattle, WA 98144 USA
                [17 ]Department of Medicine, Makere College of Health Sciences, PO Box 7072, Kampala, Uganda
                [18 ]ISNI 0000 0004 0425 469X, GRID grid.8991.9, London School of Hygiene and Tropical Medicine, ; Keppel Street, London, WC1E 7HT UK
                [19 ]ISNI 0000 0004 0639 4522, GRID grid.417260.6, The WHO Regional Office for the Western Pacific, ; P.O. Box 2932, 1000 Manila, Philippines
                [20 ]ISNI 0000 0004 1756 8807, GRID grid.417728.f, IRCCS Humanitas Hospital, ; Rozzano, Italy
                [21 ]EASL International Liver Foundation, Geneva, Switzerland
                Article
                2771
                10.1186/s12879-017-2771-4
                5688427
                29143673
                1b4336f2-413f-4bd1-a3d4-d6f761d663bf
                © World Health Organization. 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution IGO License ( http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

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                Infectious disease & Microbiology
                Infectious disease & Microbiology

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