Finding the Missing Millions in Mexico

By Lucía Brown, Lorena Stoopen, Lucía Méndez Carreón, Dana Lau

As part of the World Hepatitis Alliance’s (WHA) “Find the Missing Millions” programme, InTec Products, an infectious diagnostic manufacturer and WHA partnered on a pilot project to provide hepatitis C tests to WHA members in an effort to increase the scope of their screening campaigns and so help to find the “missing millions”.

FundHepa is non-profit organisation created in 1998 by a group of people concerned about the dramatic advance of liver problems and the intention to reverse it. FundHepa is split into 4 sections focusing on eliminating Viral Hepatitis through; Vaccination, Transplants, Research and Guiding.

The campaign

FundHepa, which is based in Mexico is one of the organisations that participated in the InTec programme. Data estimated from the Mexican National Survey of Health in 2000, reported that the seroprevalence in the general population was 1.4% with the percentage of individuals with viremia (the presence of viruses in the blood) being 0.5%.

To mark World Hepatitis Day, FundHepa focused on providing testing and raising awareness of hepatitis. In order to reach as many people as possible we decided to host the event in Paseo de la Reforma, an iconic and popular area, where people of diverse backgrounds would be able to take part in the testing.

To reach a wide range of people the testing was open to the public. It was held on a Sunday on both the walk and bike way at Paseo de la Reforma during the cities half marathon. To achieve this, permission was gained from the cities Institute for Sports (InDeporte). There was a delay in permission being granted due to the Institute being reluctant to offer a space for an event offering blood testing. MVS Radio Foundation created a radio advert that invited people to come and get tested on the given date, time and place. The advert was played 75 times from July 14th to July 28th on their radio stations across the metropolitan area.

Additionally, personnel from The National Institute of Medical Sciences and Nutrition Salvador Zubirán (INCMNSZ) agreed to help with awareness raising and spaces for testing.  As the event progressed, we began to receive more attention from media outlets and gained more volunteers and more organisations supported the initiative, which helped provide more assistance with both the testing and awareness raising.

We felt that the success of the event was due to it being in the open and our interactions with people on the street, informing them about hepatitis. The cascade effect of this visibility in terms of people informing their friends and family has the potential to have a significant impact on awareness of viral hepatitis and any future campaigns.

We also found that how we approached people about the testing impacted the likelihood of them agreeing to be tested. Approaching people with “Do you want to be tested for hepatitis C?” resulted in people more likely to decline, so we decided to frame the question differently using a broader discussion on World Hepatitis Day. This proved to be successful as we found that people were more open to this and it gave us the opportunity to explain the risk factors and the importance of being tested.

We received this feedback from a participant “The information was very helpful. I couldn’t believe that such simple things could be risk factors.”

 

 

 

Universidad Autónoma de México plantel Xochimilco (UAM-X)

We decided to conduct testing at UAM-X and invite the Mexican Institute for Social Security (IMSS) through their “PrevenIMSS” programme, a prevention-orientated care model, to conduct both hepatitis B and influenza vaccinations. This project was implemented with the support of personnel from UAM Iztapalapa who in the past conducted similar testing. The event was opened to the UAM-X community, students and employees, in order to provide tests and vaccines to a large population. In the case of a positive result, patients were referred to a physician from FundHepa.

We conducted the tests over the course of three days and were situated behind the University cafeteria. The activity was promoted through the University web page, on posters and social media. 12 nursing interns conducted the tests, with nurses from PrevenIMSS doing the vaccinations. Making both testing and vaccination available in one setting proved to be very effective in attracting more people.

Universidad Autónoma Metropolitana Iztapalapa (UAMI)

We organised an open campaign at Universidad Autónoma Metropolitana Iztapalapa (UAMI). The awareness raising was carried out through different social media platforms at the UAMI and information was distributed through email.  Advertisements were placed strategically around the campus within academic offices, libraries and student communal facilities. Additionally, information stands were placed around the campus.

We successfully utilised social media as the majority of participants learned of the event through this, additionally, word of mouth proved to be very useful in engaging passersby with the information stands. We also provided on-campus counseling to share information about hepatitis C, as well as the means of contracting and preventing the disease.

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) 

Lastly, hepatitis C screening was held in two of the largest health institutes in Mexico City to screen as many hospital employees and patients as possible. In order to create awareness among healthcare workers and the general population (hospital patients and their relatives), information pamphlets were provided for those who needed further information as well as to take home to educate others around them.

The gastroenterology department and the epidemiology department of the institute were involved in the planning and execution of this screening campaign. The screening was open to all employees of the INCMNSZ. Alongside the hepatitis C screening influenza vaccinations were also offered. The campaign was advertised on the institute website and printed materials were placed around the hospital. Over the course of 10 days, we sampled 2,118 employees at the INCMNSZ. The campaign was then extended to a nearby hospital (GEA) where they sampled 382 employees in four days.

Key learnings

  • Health education to empower populations is needed.
  • Screening for hepatitis C should be universal.
  • Partnerships with other organisations to support testing initiatives such as these are a good way to ensure greater impact.
  • People who test positive for hepatitis C must be linked up to health systems for treatment and follow up.
  • Sharing information through external partners can increase participation.
  • In order to reach the greatest number of people you need to take the testing to them and work at times that are convenient for the group you are targeting.

Top tips for success

We found that the following factors have made our activity a success:

  • The cooperation from different stakeholder such as; the hospital authorities, hospital staff and University staff.
  • Integrating hepatitis C testing along with other health services, such as the influenza vaccination, resulted in more individuals wanting to be tested and greater awareness of the campaign.
  • Utilising social media, email and adverts on University campuses to highlight the risk factors of hepatitis C.
  • Staggering testing to allow different participants with varying timetables to attend.

 

Challenges

  • It took some time to get participants to undertake the tests as they did not want to give blood.
  • Due to the different work shifts it was difficult to capture health care workers so we had to adjust the opening times of our tent to accommodate the nurses working the night shift, we also talked to the chiefs of each of the departments (especially, nursing, surgery, transplant, lab) to make sure that their personnel were aware of the campaign.