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

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.

Towards elimination of hepatitis B and C in European Union and European Economic Area countries: monitoring the World Health Organization's global health sector strategy core indicators and scaling up key interventions.

The World Health Organization 'Global Health Sector Strategy on Viral Hepatitis 2016-2021' aimed at the elimination of viral hepatitis as a public health threat provides a significant opportunity to increase efforts for tackling the epidemics of hepatitis B and hepatitis C virus infections across Europe. To support the implementation and monitoring of this strategy, core epidemiological and programmatic indicators have been proposed necessitating specific surveys, the systematic collection of programmatic data and the establishment of monitoring across the care pathway. European Union and European Economic Area countries already made progress in recent years implementing primary and secondary prevention measures. Indeed, harm reduction measures among people who inject drugs reach many of those who need them and most countries have a universal hepatitis B vaccination programme with high coverage above 95%. However, while a further scaling up of prevention interventions will impact on incidence of new infections, treating those already infected is necessary to achieve reductions in mortality. The epidemiological, demographic and socio-political situation in Europe is complex, and considerable diversity in the programmatic responses to the hepatitis epidemic exists. Comprehension of such issues alongside collaboration between key organisations and countries will underpin any chance of successfully eliminating hepatitis.

Assessment of the viral hepatitis response in Kyrgyzstan: 11–15 July 2016: mission report

The WHO Regional Office for Europe conducted an assessment mission in Kyrgyzstan over a period of four days, with the aim to make a short review of hepatitis related surveillance, national policies and services. The result of this short review would inform the Ministry of Health and WHO identify specific areas for further technical cooperation. The report does not claim to be a comprehensive assessment of all aspects related to viral hepatitis prevention and control but it could best be used to start a dialogue between WHO and the MOH for further technical support in the priority areas identified.

Hepatitis E virus: Assessment of the epidemiological situation in humans in Europe, 2014/15.

BACKGROUND: Hepatitis E virus (HEV) is endemic in EU/EEA countries, but the understanding of the burden of the infection in humans is inconsistent as the disease is not under EU surveillance but subject to national policies. STUDY: Countries were asked to nominate experts and to complete a standardised questionnaire about the epidemiological situation and surveillance of HEV in their respective EU/EEA country. This study reviewed surveillance systems for human cases of HEV in EU/EEA countries and nominated experts assessed the epidemiology in particular examining the recent increase in the number of autochthonous cases. RESULTS: Surveillance systems and case definitions across EU/EEA countries were shown to be highly variable and testing algorithms were unreliable. Large increases of autochthonous cases were reported from Western EU/EEA countries with lower case numbers seen in Northern and Southern European countries. Lack of clinical awareness and variability in testing strategies might account for the observed differences in hepatitis E incidence across EU/EEA countries. Infections were predominantly caused by HEV genotype 3, the most prevalent virus type in the animal reservoirs. CONCLUSION: Discussions from the expert group supported joint working across countries to better monitor the epidemiology and possible changes in risk of virus acquisition at a European level. There was agreement to share surveillance strategies and algorithms but also importantly the collation of HEV data from human and animal populations. These data collected at a European level would serve the 'One Health' approach to better informing on human exposure to HEV.