Li Yifan, Kpokiri Eneyi, Elasi Dalia, Sheng Rongrong, Wang Keying, Conyers Hayley, Zhang Ye, Adda Danjuma K, Matthews Philippa C, Fitzpatrick Thomas, Tucker Joseph D, Wu Dan
Department of Social Medicine and Health Education, School of Public Health & Laboratory for Digital Intelligence and Health Governance, Nanjing Medical University, Nanjing, China.
Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
EClinicalMedicine. 2025 May 2;83:103234. doi: 10.1016/j.eclinm.2025.103234. eCollection 2025 May.
Chronic viral hepatitis causes a high burden of morbidity and mortality, especially in low- and middle-income countries (LMICs). While community engagement, which involves stakeholders in addressing health-related issues, has shown promise to enhance hepatitis outcomes, evidence on its impact remains limited. To summarize the current state of knowledge on this topic we performed a systematic review and a crowdsourcing open call.
A parallel mixed-methods approach was used in this study. The systematic review included publications that evaluated a community-engaged intervention, reported chronic viral hepatitis outcomes, included a comparator group, and were published in English up to 12 March 2025. A random-effects model was used to pool the overall effect of the community-engaged interventions on hepatitis outcomes. To ensure innovative ideas from LMICs were included, we organized a complementary crowdsourcing open call using the WHO/TDR practical guide. Thematic analysis identified key themes in the crowdsourced submissions.
35 studies were included in the systematic review, and 28 crowdsourced submissions were analyzed. In both the systematic review and open call, community-engaged interventions included peer-based interventions, community health workers, interactive educational programs, and patient advocacy. The meta-analysis, predominantly of studies from high-income countries, found community-engaged interventions significantly improved HBV vaccine completion (RR 1.59, 95% CI 1.15-2.19; = 88.10%), HBV/HCV test uptake (RR 2.33, 95% CI 1.78-3.06; = 99.10%), HBV and HCV linkage to chronic viral hepatitis care (RR 1.96, 95% CI 1.46-2.64; = 96.20%), HBV/HCV treatment adherence (RR 1.14, 95% CI 1.03-1.27; = 0%), and HCV sustained virologic response (RR 1.50, 95% CI 1.23-1.83; = 93.90%). Open call submissions, largely from LMICs, highlighted community-led interventions where patients led community-based organizations to advocate for improved access to hepatitis care.
Findings underscored the importance of community engagement in chronic viral hepatitis service delivery across the care continuum. Implementing community-engaged interventions can enhance chronic viral hepatitis elimination efforts.
National Natural Science Foundation of China.
慢性病毒性肝炎造成了很高的发病和死亡负担，尤其是在低收入和中等收入国家（LMICs）。社区参与，即让利益相关者参与解决健康相关问题，已显示出有望改善肝炎治疗效果，但其影响的证据仍然有限。为总结关于该主题的当前知识状况，我们进行了一项系统评价和一次众包公开征集。
本研究采用了平行混合方法。系统评价纳入了评估社区参与干预措施、报告慢性病毒性肝炎治疗效果、设有对照组且截至2025年3月12日以英文发表的出版物。采用随机效应模型汇总社区参与干预措施对肝炎治疗效果的总体影响。为确保纳入来自低收入和中等收入国家的创新想法，我们使用世界卫生组织/热带病研究和培训特别规划（WHO/TDR）实用指南组织了一次补充性众包公开征集。主题分析确定了众包提交内容中的关键主题。
系统评价纳入了35项研究，分析了28份众包提交内容。在系统评价和公开征集中，社区参与干预措施包括同伴干预、社区卫生工作者、互动教育项目和患者宣传。荟萃分析主要基于来自高收入国家的研究，发现社区参与干预措施显著提高了乙肝疫苗接种完成率（风险比1.59，95%置信区间1.15 - 2.19；I² = 88.10%）、乙肝/丙肝检测接受率（风险比2.33，95%置信区间1.78 - 3.06；I² = 99.10%）、乙肝和丙肝与慢性病毒性肝炎治疗的衔接率（风险比1.96，95%置信区间1.46 - 2.64；I² = 96.20%）、乙肝/丙肝治疗依从性（风险比1.14，95%置信区间1.03 - 1.27；I² = 0%）以及丙肝持续病毒学应答率（风险比1.50，95%置信区间1.23 - 1.83；I² = 93.90%）。公开征集提交内容主要来自低收入和中等收入国家，强调了社区主导的干预措施，即患者领导社区组织倡导改善肝炎治疗的可及性。
研究结果强调了社区参与在慢性病毒性肝炎整个治疗过程服务提供中的重要性。实施社区参与干预措施可加强慢性病毒性肝炎消除工作。
中国国家自然科学基金。
