Evidence to support crowdsourcing challenges Weiming Tang University of North Carolina Project-China University of North Carolina at Chapel Hill SESH (Social Entrepreneurship to Spur Health) Global

OUTLINE 1 2 Evidence from systematic reviews and scoping reviews Evidence from randomized controlled trials 2 “Testing saves lives” Crowdsourcing to improve condom use Eight city community trial “HepTest Contest”

OUTLINE 1 2 Evidence from systematic reviews and scoping reviews Evidence from randomized controlled trials 2 “Testing saves lives” Crowdsourcing to improve condom use Eight city community trial “HepTest Contest”

Searching We found 84 reviews on PubMed (Since 2013) Included 3 reviews in this report (Two reviews from the SESH Study Team) These reviews summarized the areas that crowdsourcing had been used Image source: PubMed

1. Mapping of Crowdsourcing in Health: Systematic Review 202 relevant studies used crowdsourcing, including 9 RCTs Crowdsourcing was used in Health promotion (I.e. Sexual+Health) Research (RCTs on evaluating) Care 4 most frequent areas: public health psychiatry surgery oncology Crowdsourcing was used in health promotion (91, 45.0%), research (73, 36.1%), and care (38, 18.8%) The 4 most frequent areas were: public health (67, 33.2%), psychiatry (32, 15.8%), surgery (22, 10.9%), and oncology (14, 6.9%) Half of the reports (49.0%) referred to data processing, 34.6% referred to surveying, 10.4% referred to surveillance or monitoring, and 5.9% referred to problem-solving. Figures: SESH team; Crequit P et al, 2018, JMIR

2. Crowdsourcing in Health and Medical Research: A Systematic Review 86 studies identified: effectiveness feasibility cost Most common purposes were: to evaluate surgical skills to create sexual health messages to provide layperson CPR out-of-hospital 4 studies used a challenge contest to solicit HIV testing promotion materials and increase HIV testing rates 2 studies found this approach saved money Figure: SESH; Han et al, LSHTM, 2018

3. Ethical Concerns of Crowdsourcing Contests and Innovation Challenges: Scoping Review Crowdsourcing poses several ethical concerns along the steps Lessons learned will help us to avoid the failure of future contests Organizing: excluding community voices Soliciting: overly narrow participation Promoting: divulging confidential information Judging: biased evaluation Recognizing: insufficient recognition of the finalist Sharing: Not implemented/ Not widely disseminated Crowdsourcing contests can be effective and engaging public health tools but also introduce potential ethical problems Organizing: potential for excluding community voices; Soliciting: potential for overly narrow participation; Promoting: potential for divulging confidential information; Judging: potential for biased evaluation; Recognizing: potential for insufficient recognition of the finalist; Sharing: potential for the solution to not be implemented or widely disseminated Tucker JD et al, 2018, JMIR

OUTLINE 1 2 Evidence from systematic reviews and scoping reviews Evidence from randomized controlled trials 2 “Testing saves lives” Crowdsourcing to improve condom use Eight city community trial “HepTest Contest”

1. Crowdsourcing HIV Test Promotion Videos: A Noninferiority RCT in China Intervention arm: an one-minute crowdsourced video Control arm: an one-minute health-marketing video 721 never tested MSM were recruited online and randomized Key findings HIV test uptake was similar between the crowdsourced arm (37%, 114/307) and the health marketing arm (35%, 111/317) 35% HIV+ Cost saving Above figure: Distribution of the participants; Left figure: crowdsourcing contest poster Tang et al, 2016, CID

2. Reimagining Health Communication: A Non-Inferiority RCT of Crowdsourcing in China Intervention arm: an one-minute crowdsourced video Intervention arm: an one-minute crowdsourced video Non-inferiority in three weeks: difference: +1.3%, 95%CI: -4.8 to 7.4% In three months: difference: +2.5%, 95%CI: -4.5 to 9.5%) Similar HIV testing rates and other secondary outcomes Cost saving Participants: MSM who engaged in condomless sex in 3 months Key findings Left figure: contest promotion; Tang et al, 2017, Lancet, abstract

3. Crowdsourcing to Expand HIV Testing Services: A Closed Cohort Stepped Wedge RCT in China Final intervention: multi-media HIV testing campaign an online HIV testing service local participatory activities tailored for MSM Evaluated using a closed cohort stepped wedge RCT in 8 Chinese cities Recruitment: Blued, 8 cities The proportion differences of HIV test: 8.9% (95% CI 2.2 to 15.5) the intention-to-treat analysis: RR= 1.43, 95% CI 1.19-1.73 Left figure: Intervention VS control periods; Right figure: Intervention strategy SESH study team, 2017, Trial

Intervention improved self-reported testing rates of: 4. Crowdsourcing to Expand Hepatitis B/C testing: an online RCT in China Intervention improved self-reported testing rates of: 556 men recruited, Online RCT Solicit short descriptions of hepatitis B and C testing (Video and images) *HBV *HCV *HIV *Chlamydia *Gonorrhoea Fitzpatrick T , 2018, Unpublished

SESH website: www.seshglobal.org Acknowledgements We thank the audience for their time and patience, and thank the people who contributed to this workshop. Funding Support: NIH (NIAID 1R01AI114310; FIC 1D43TW009532)and UNC CFAR (NIAID 5P30AI050410) SESH website: www.seshglobal.org