1. Combining mass media and the internet to screen individuals at risk for hepatitis C Freke Zuure Online Research and Prevention unit Public Health Service of Amsterdam

2. GOR 2009 Hepatitis C virus (HCV) infection  Transmission mainly through blood-blood contact  No vaccine available  ± 180 million infections worldwide  Low prevalence in many Western countries  Asymptomatic at first  In 20-30 years HCV can lead to severe liver problems  Improved treatment options available  Problem: multi-faceted risk groups, hidden in the general population

3. GOR 2009 Hepatitis C Internet Project (HIP) Overall aim: To evaluate whether a hidden population of HCV-infected individuals can be identified through a public media campaign alongside an internet risk assessment and low-threshold blood screening procedure

4. GOR 2009 HIP details  Pilot project in the Netherlands  Amsterdam and South Limburg  Aim: to test ~6,000 individuals at risk for HCV infection between April 2007 and December 2008

5. GOR 2009 1.Public, regional media campaign HIP strategy

6. GOR 2009 1.Public, regional media campaign 2.Tailored HCV risk assessment questionnaire at WWW.HEPTEST.NLWWW.HEPTEST.NL HIP strategy Questionnaire was evaluated before its online use in a study among liver patients with known HCV status (before HIP): Sensitivity: 84.6% Specificity: 63.8%

7. GOR 2009 1.Public, regional media campaign 2.Tailored HCV risk assessment questionnaire at WWW.HEPTEST.NLWWW.HEPTEST.NL 3.Free and anonymous blood test HIP strategy

8. GOR 2009 1.Open media campaign 2.Tailored HCV risk assessment questionnaire at WWW.HEPTEST.NLWWW.HEPTEST.NL 3.Free and anonymous blood test 4.Free and anonymous confirmation test at the Public Health Service 5.Direct referral to a specialist at the hospital HIP strategy

9. GOR 2009 Additional online services 1.Free email and/or SMS reminder for blood testing 2.Free email and/or SMS alert when the test’s result could be obtained online Additional data collection Online questionnaire on usability and acceptability of the screening procedure

10. GOR 2009 Results

11. GOR 2009

12. Evaluation study on perceived usability and acceptability  How do participants experience the risk screening tool in terms of usability and acceptability?

13. GOR 2009 Method Online questionnaire, offered to all participants after receiving the result of the risk assessment questionnaire

14. GOR 2009 Measures (1) Usability: ‘ease of use’ (n=4, α=.81) and ‘usefulness’ (n=5, α=.89) “How comprehensible are the risk test questions to you?” Acceptability of online risk test (n=4, α=.87) and virtual paper&pencil risk test (n=4, α=.92) “What did you think of determining your risk on the Internet? unpleasant ***** pleasant”

15. GOR 2009 Measures (2) Internet skills (n=4, α=.83) “How familiar are you with using Internet questionnaires?“ Outcome efficacy (n=3, α=.71) “How important do you think it is for you to know whether you are infected with hepatitis C?”

16. GOR 2009 U&A study population

17. GOR 2009 U&A study population  N= 2,154  Median age: 44 years (IQR 31 – 55 years)  42.7% male  Education –Low11.5% –Low medium32.9% –Medium high46.3% –High9.3%

18. GOR 2009 Results (n=2,154) Mean score 5 point scale Std. deviation Internet skills4.30.8 Usability: online risk questionnaire4.80.4 Usability: online risk questionnaire result4.40.7 Acceptability: online risk assessment4.60.6 Acceptability: paper risk assessment2.91.1 Outcome efficacy4.80.4

19. GOR 2009 Results How would you prefer to complete the hepatitis C risk test? (n=2,154) on paper2.5% on the internet82.5% no preference15.1% Do you intend to follow the risk test advice? (n=259) IntentionN (%) Testing advice compliance 1 Certainly not2 (0.8%)1 / 2 (50%) 21 (0.4%)0 (0%) 310 (3.9%)2 / 10 (20%) 426 (10.0%)7 / 26 (26.9%) 5 Certainly220 (84.9%)130 / 220 (59.1%) Mean score 4,8

20. GOR 2009 U&A study limitation  Females, older aged, and testing-advice-adherent participants were significantly more willing to participate in the usability & acceptability study

21. GOR 2009 Conclusions  Testing procedure using the internet works well  Blood test advice uptake (28%) is much higher compared to similar projects  Usability and acceptability as perceived by participants is high  Risk assessment questionnaire selects high risk groups as the HCV prevalence among testers (3.5%) is 9-35 times the estimated prevalence among the Dutch population  Website attracted less persons at risk of HCV than expected, and therefore the number of identified HCV infected individuals is low

22. GOR 2009 Acknowledgements  Public Health Service of Amsterdam:Maria Prins, PhD Udi Davidovich, PhD Anneke van den Hoek, MD, PhD  South Limburg Public Health Service:Christian Hoebe, MD, PhD Hans Frantzen Natacha Gelissen  National Hepatitis Center:Paula van Leeuwen, MSc  Academic Medical Center, Amsterdam:Christine Weegink, MD, PhD prof. Peter Jansen, MD  Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven:prof. Roel Coutinho, MD  School of Psychology, University of Maastricht:prof. Gerjo Kok  And all other participants and co-workers of the departments This project is funded by Roche Netherlands provided an unrestricted grant for broadcasting of the television commercial Schering-Plough provided an unrestricted grant for the translation of www.heptest.nlwww.heptest.nl