Know your hepatitis status – increasing access to testing for a hidden infection.

Do you know if you could be infected with hepatitis B or C? What that could mean for your health?

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A man places covers on bike seats to raise awareness of hepatitis in the Netherlands. WHO

A staggering 95% of people infected with hepatitis B or C around the world do not know they are infected. One reason for this is that people can live without symptoms for many years. When they find out they havehepatitis, it is often too late for treatment to be fully effective. As a result, liver damage becomes cirrhosis or liver cancer.

To help countries build up national hepatitis testing and treatment programmes and to encourage more people globally to get tested, WHO will shortly release new testing guidelines for hepatitis B and C.

To show how the testing guidelines could translate into real action on the ground, WHO and its partner, Social Entrepreneurship for Sexual Health (SeSH) recently launched a contest to find real-world examples of innovative ways to reach different populations across various countries and settings and test for hepatitis.

The #HepTestContest Innovation Contest received 64 contributions from 27 countries. The project selected around 20 of the best approaches to testing for hepatitis, and then whittled down the list to 5 finalists.

A multi-faceted approach

As well as national testing campaigns, approaches include testing in prisons, testing in the workplace and hospital emergency rooms, integrated HIV-hepatitis testing, as well as the use of internet, social media, and electronic medical records to flag higher risk patients for testing in primary care.

“We needed examples of innovations and best practices to help guide and inspire others,” said Philippa Easterbrook from the WHO Global Hepatitis Programme, who co-led the project. “From prisons in Australia, use of an internet-based risk self-assessment tool in the Netherlands, community testing camps for drug users in India, to testing in primary care in Mongolia we learned some great lessons about how to build awareness of this hidden disease, improve testing rates and link those infected to treatment and care.“

In Manipur, a small state in North East India, an estimated 92% to 98% of drug users are estimated to havehepatitis C. Although HIV testing is free here, testing for hepatitis is not. Awareness about the virus is low and treatment expensive.

A community network organization, the Community Network for Empowerment (CoNE) led the campaign: “We organized awareness-raising sessions, and encouraged free voluntary testing for over a month. Of the 1011 people tested, just under half were positive for hepatitis C. We provided post-test counselling and were also able to offer treatment,” described Rajkumar Nalinikanta, the organization’s president.

Community involvement and strategic partnerships

A critical feature of this approach was the strong community involvement and support as well as strategic partnerships to leverage reductions in the price of treatments. “Bringing together pharmaceutical companies, government, research organizations and communities helped negotiate price reductions make hepatitistreatments more affordable,” concluded Dr Easterbrook.”

A close-up of a red cover for a bike seat that raises awareness of the need for hepatitis testing in the Netherlands. A close-up of a red cover for a bike seat that raises awareness of the need for hepatitis testing in the Netherlands. WHO
A close-up of a red cover for a bike seat that raises awareness of the need for hepatitis testing in the Netherlands.
A close-up of a red cover for a bike seat that raises awareness of the need for hepatitis testing in the Netherlands.
WHO

Thousands of miles away in the Netherlands, another campaign used an internet-based risk assessment to target populations of people infected with hepatitis C who were difficult to identify and hard to reach.

“We used social media and the web to draw in people who might be at risk to undertake a self-assessment in a choice of 7 languages. The anonymity of the internet helped enormously,” said Janke Schinkel of the Public Health Service of Amsterdam. “This was balanced with highly visible and creative public communication campaigns – that reached a cross-section of Dutch society.”

“The contest demonstrated a range of possibilities. It showed that if we can develop acceptable testing approaches to suit different contexts and cultures, then we can increase effective hepatitis testing in more countries and communities,” concluded Dr Easterbrook.

These 2 approaches were among the 5 finalists selected by a panel of experts including representatives from WHO, World Hepatitis Alliance, and Médecins sans Frontières, who reviewed the testing models for innovation, effectiveness, and plans for sustainability.

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