Community engagement and chronic viral hepatitis public health interventions: a systematic review, meta-analysis, and complementary crowdsourcing open call.

BACKGROUND

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.

METHODS

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.

FINDINGS

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.

INTERPRETATION

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.

FUNDING

National Natural Science Foundation of China.