Community Engagement Improves STD Testing and Treatment in Asia
October 27, 2017
Allison Mathews is a postdoctoral research fellow at the University of North Carolina at Chapel Hill. She leads 2BeatHIV, a research project examining the social and ethical aspects of research on curing HIV. She recently attended two symposiums in China about sexually transmitted disease prevention and control. In this blog post, she shares her thoughts and photos from this visit.
Researchers, policy-makers, physicians and students convened for the 2017 UNC-South China International Summit for STD Prevention and Control and Expert Consultation on Advancing Implementation Research on Syphilis, HIV and Hepatitis in Asia in Guangzhou, China, and the 2017 International Symposium on STD Clinical Services Improvement for High-Risk Populations in Shenzhen, China, from Sept. 21 to 28, 2017. Researchers presented on the state of the HIV/STD epidemic in Asia and consulted on ways to improve approaches for prevention, testing, and treatment. One main priority for the meeting was to to identify and evaluate new ways to combat the epidemic.
To be sure, the need to find new ways to combat the HIV/STI epidemic is not new. We have been dealing with the same problems for decades: the lack of systematic screening for STIs in pregnant women has been a longstanding problem in several Asian countries and worldwide. There are few sexual health promotion clinics that are openly gay-friendly or focus on serving men who have sex with men (MSM). Additionally, there are limited resources to monitor and evaluate outreach, especially among key populations from marginalized communities. However, the summits in Guangzhou and Shenzhen offered opportunities for a multi-sectoral examination of new mechanisms to improve prevention, testing, and treatment of HIV/STIs in key populations.
Ground-up approaches using community engagement were shown to be effective at improving testing and treatment of key populations in Asian countries. Crowdsourcing contests were one method used to identify innovative solutions to transform the way we conduct testing and treatment of key populations. Crowdsourcing is a bottom-up approach where people work collaboratively to develop effective solutions. Contests are a subset of crowdsourcing approaches that elicit submissions to solve a specific problem, where entries are judged by an expert panel and finalists are celebrated.
Weiming Tang of UNC Project-China and colleagues recently completed a study using crowdsourcing contests to improve HIV testing among MSM in China. The findings suggest that using crowdsourced messages designed by community members for community members may be more effective at promoting HIV testing among MSM in China than campaign messages developed from the top-down.
Similarly, Jason Ong of the London School of Hygiene and Tropical Medicine examined the effect of a crowdsourcing contest to design the logo for the International AIDS Society 2014 meeting in Australia. Interviews with conference organizers, attendees and participants revealed that the crowdsourced logo captured the local Australian “flavor” and conveyed a simple, multilayered meaning.
Lastly, I presented findings from the 2BeatHIV project, which examined the use of a crowdsourcing contest to design a campaign to raise awareness about HIV cure research in Durham, N.C. The contest provided an opportunity for community members to create campaign messaging around HIV cure research that reflected their lived experiences, cultural values and local context. Importantly, each study examining crowdsourcing contests showed how community members felt empowered to contribute to the fight against the HIV/AIDS epidemic without being scientists.
MSM face a number of barriers to receiving high-quality HIV services across the care continuum. Online engagement and telemedicine may help engage key populations and decentralize current testing and treatment systems.
For example, Weibin Cheng of the Guanzhou Center for Disease Control and Prevention discussed the use of GZTZ.org as an online mechanism for community-based organizations (CBOs) and the Chinese government to partner in engaging Chinese MSM. GZTZ.org is a website that provides a list of influential gay websites in China. It is sponsored by the Chinese Centers for Disease Control, but is run by local CBOs, who are proficient in reaching community members, delivering behavioral health interventions, and eliciting community feedback. The website features a dynamic scenario story designed by community members to simulate real-world decisions people would encounter and provides a diagnostic prescription based on their personalized HIV risk profiles. The goal is to turn the demonstration project into a routine government activity to promote HIV prevention, testing and treatment among Chinese MSM.
Telemedicine is increasingly becoming a mechanism for healthcare delivery in China and across the world. Specifically, 72 percent of hospitals and 52 percent of physician groups have telemedicine programs in China and there were 12 million telemedicine visits in China in 2016. Zhi Hong, senior vice president at GSK, stressed the importance of leveraging big data and analytics to capture real-time data on decision-making to improve health delivery. There have been efforts to use big data to inform the creation of new mechanisms for service delivery.
For example, the Dean Street Express is a clinic being pilot tested in London that allows people to receive sexual health screenings six days a week by using a touch screen to check-in, self-test, and receive blood results within six weeks. Similarly, Rosanna Peeling of the World Health Organization’s Social Innovation in Health Initiative argued that it was important to identify and develop new and unconventional solutions developed by various actors to address healthcare delivery challenges with positive effects beyond health. The WHO Social Innovation in Health Initiative seeks to partner with universities and countries to enable innovation with communities.
Social media and apps also play a big role in healthcare innovation. Two gay social networking apps, BlueD and Hornet, provide HIV and PrEP education to their users and enable their users to publicly declare HIV, testing and medication status as part of their profiles. Partnerships between social networking apps, researchers and service providers may be useful in reaching MSM and other key populations for study recruitment, data collection, service provision and HIV/STI education.
These innovative tools show promise for engaging key populations in various aspects of research and service delivery. Still, more work needs to be done to assess the effectiveness of these mechanisms for improving various HIV/STI-related health outcomes among key populations. It is important to note that these tools seem to encourage a sense of empowerment and ongoing involvement in the fight to curb HIV/STIs in Asia.
View more photos from Allison Matthews at the Institute for Global Health and Infectious Diseases blog.