Defining Elimination of Genital Warts - A Delphi Study Dr Laila Khawar

Background – Elimination of an infectious disease A public health problem Intervention World Health Organization (WHO) Intervention coverage target or Process Target Measurement Surveillance targets 1. Elimination definition 2. Elimination threshold Or Impact target The ultimate goal of any public health program is for elimination of an infection or disease. When an infection is identified as a public health problem, an intervention is introduced in the endemic population. This intervention ultimately reduces the disease’s prevalence to a level where it no longer remains a public health problem; this point is sometimes referred to as elimination of that disease. The elimination targets are primarily formulated by the World Health Organization (WHO). The WHO formulates a threshold for elimination, such as 1 case per 10,000 population, this is also called the impact target; the intervention coverage target, also known as process target, and eventually some pre-requisites for the surveillance systems to capture the burden of infection and measure elimination.

Trends of genital warts in young Australians HPV vaccination for girls launched HPV vaccination for boys launched No elimination targets have been defined for genital warts When? What? How? The two boxes here represent the timeline of human papillomavirus or HPV vaccination program that was introduced in Australia for school-going girls and boys. High and widespread HPV vaccination coverage has resulted in dramatic declines in genital warts among young people. There is real potential for elimination of GW in the foreseeable future. However, there are no agreed targets to define elimination of GW; it is unknown when elimination will occur, or even how it should be measured.

19 Australian and international experts invited A Delphi study Delphi is a well-known research method where a team of experts is consulted for achieving convergence of opinion concerning real-world knowledge. feedback 2nd round - Analysis of results - 1st round - Analysis of results - 3rd round - Analysis of results feedback Consensus Delphi workshop To answer these questions, we are in a process of conducting a Delphi study, and I will be presenting some preliminary results today. Delphi is a well-known research method where a team of experts is brought together to achieve a consensus on a real-world problem by going through a number of rounds with feedback of responses into the successive round, this process continues until consensus is reached. After using modelling and epidemiological data, we developed an 8-item questionnaire containing preliminary genital warts elimination definition and targets. This questionnaire was administered in a one-day face-to-face Delphi workshop where we invited 19 Australian and international experts. Two quantitative rounds were conducted. 8-item questionnaire containing elimination targets and definitions 19 Australian and international experts invited 2 Quantitative Rounds

Exclusion/inclusion criteria Items excluded if: Items modified as per the feedback if: Consensus met. Item finalised: ≥70% of participants scored item ≤4 No consensus is reached, item failed to meet either of the other 2 criteria ≥70% of participants scored item ≥7 Experts were asked to show their level of agreement with each item on a 9-point Likert scale. Items were excluded for the next round if ≥70% of participants scored item ≤4; Items were finalised if a consensus was met by ≥70% of participants scored item ≥7; if an item failed to meet either of the 2 criteria, then it was modified per the feedback for the next round

Results 95% response rate (18/19) Consensus reached: 3/8 items (Process & Measurement targets) No consensus reached: 5/8 items (Elimination definitions & Impact targets) Experts’ feedback on these 5 items is being incorporated for an online as opposed to a face-to-face iteration (Round 3) 18/19 experts participated 3/8 items reached consensus including process and measurement targets 5 items could not meet consensus including elimination definition and impact targets, which is expected given that these would be the hardest targets to reach consensus on. We are now in a process of incorporating experts’ feedback on these items for the next phase, which is an online versus face-to-face iteration

Acknowledgement Prof Rebecca Guy Dr Skye McGregor Prof Basil Donovan