NUR09400 Management of Chronic Disease: Infectious Disease

ion to promote safe health in hospitals. Required guidelines were developed in 2003 and were launched in 450 facilities. After the implementation with adequate training, monitoring and supervision there was an increase in compliance of the healthcare workers to precautions such as hand hygiene and personal protective equipment.  There was a decrease in the annual incidence of HCV infection from 28% to 3% among previously uninfected recipients of renal dialysis (2,4).  The result was obtained in 60 facilities with dialysis units. These guidelines were found to be useful by World Health Organization and were revised and adopted in 2008 (2,4). After the international Health Regulation assessment, it was found that the National Infection Control Program was successful in decreasing the iatrogenic transmission of HCV (4). Also, the Egyptian's "viral hepatitis care and treatment program" has successfully provided the subsidized care and treatment services to 190,000 people in Egypt having the chronic hepatitis-C infection (4). It is considered the most significant national programs in the world. It has been successful in a small number of facilities, but the high cost of treatment and the increasing population with the chronic infection is causing the challenges (4). There is still a need for establishing the viral hepatitis surveillance system for implementing the preventive interventions.

NCCVH has set the national control strategy that outlines the best practices for delivering the patient care after 2006 (2, 5). It highlights the set of service principles. In addition one of the most effective and successful programs in the Egypt, national viral hepatitis treatment programmes (5). Using this programme more than 850 000 received treatment, and more than one million were evaluated since 2006 (5). The nationwide network of “digitally connected viral hepatitis-specialized” treatment programme was established. Before 2011, prevention of infection was limited to the awareness and education campaigns for undergraduates and postgraduates in universities along with vaccination campaigns (5). This was helpful in serving people up to 6 million. It helped create access to the all HCV-infected individuals (5).

 For national eradication of viral hepatitis,   “Plan of Action for the Prevention, Care & Treatment of Viral Hepatitis, Egypt” has been finalized for 2014-2018. After 2011, this plan focuses on seven components including “surveillance, infection control, blood safety, hepatitis B virus (HBV) vaccination, care & treatment, communication, and research.”  This plan includes robust and dynamic steps to prevent viral hepatitis. Policy-related support and the system changes are critical to success. However, the main limitations are the reduced focus on funding and reduction of indirect costs (6). A similar plan is proposed for controlling the hepatitis C (3) in Egypt.

Task 2

The preventions and control strategies that are used in Egypt are proper hand hygiene, safe infection, effective sterilization of medical equipment, screening donated blood, education of health professionals and population about preventive methods and lastly, early treatment, education, counseling of infected patients (1).  The Hepatitis C infection is likely to persist in Egypt for several decades. Thus there is a need for changes in the existing strategies. Two of the main current strategy that needs modifications are awareness of both health professionals and infected patients through campaigns and, Prevention, Care & Treatment plan (blood safety, early treatment based on surveillance, screening, and monitoring).

Campaigns were although done but failed to include the allied healthcare professionals.   The campaigns shall be able to increase public access to all hepatitis vaccine as well as advocate for vaccine access. Egypt should be able to support the evaluation of new hepatitis vaccines and vaccinations approaches which is also one of the WHO strategies for Hepatitis infection 2016-2021 (2, 7).   The campaigns on safe blood, hand hygiene or use of protective equipment, for healthcare workers, must be modified to contain the social media awareness elements. This element must also be used to promote public awareness of hepatitis vaccination. In different countries like Australia and US, health care is involved to participate in the social media campaign to promote awareness of various chronic health conditions like childhood obesity or diabetes (8). Social media is the way to reach a massive number of population in less span of time. The strategy of DAAs has been found useful due to 90% efficacy against HCV genotype 4 (8). It has been able to provide excellent SVR results in the Egyptian context. To make this strategy more successful, there is need to eliminate the poor awareness about the use of sterilized equipment and medical instruments (8).

Lack of funds is the major barrier to the digitally connected “viral hepatitis-specialized" treatment programme and Plan of Action for the Prevention, Care & Treatment of Viral Hepatitis, Egypt” (9,10). There is a need for ring-fenced governmental funding to enforce the policies and national treatment plan. Egypt must implement the ring-fenced governmental funding to enhance the treatment facility. The specific treatment programme can finance for sustainability like the strategic direction 4 of WHO. Egypt should establish the equitable mechanisms for pooling funds across the health systems for ensuring adequate coverage for continuum of hepatitis services.  The country must offer financial risk protection by reducing financial barriers. Thus, the prevention and control plan for curtailing the hepatitis C infection must be modified by aiming for financial sustainability. It will allow people to receive the hepatitis services without any financial hardships. By raising the revenue, and financial risk protection, Egypt can increase access to high quality screening, medication, and diagnostics for hepatitis C infection.  It will help manage the indirect costs by modifying the national control and treatment plan 2014-2018 by improving the financial services (6,7, and9).  Indirect costs can be managed by offering transfer vouchers or decentralizing services. It will allow better service uptake, improve early treatment adherence of infected patients and decrease the financial burden on households. The surveillance, vaccination care and treatment and blood safety control strategies must be aligned with the financial risk protection. It means there is a need for focus on affordable vaccines and health commodities (6, 7, and 9).  Appropriate funding is also required to address the complication of hepatocellular carcinoma and decompensated cirrhosis.  This is the major burden of Egypt and can be addressed by adequate health care resource allocation (9, 10).

Task 3

One of the strategies chosen for development of action plan is the education of health professionals and infected people about the infection prevention method. The health professionals lack the skills required for risk reduction in at-risk people and awareness of medical equipment sterilization, hand hygiene, safe blood transfusion. On the other hand, the infected patients lack the awareness of preventive actions to prevent infection and reduce the comorbidities.

The action plan aims to develop a social media campaign for improving awareness of both health professionals and the public in Egypt.  The goal will be to increase awareness among the target population by 30% regarding vaccination within the two years. The goal is to reduce the transmission of infection by health professionals (by 30%) and increase the public access to early diagnosis and preventive strategies (up to 40%). A further goal is to ensure 50% safe injections and 95% blood safety screened in the quality assured manner within five years.

 For first year the plan is as follows-

Activities	Duration
Partnership engagements   recruitment staff	June- July 2018
Planning project media content meeting security requirements,	August- September 2018
Development of surveys, training of volunteers protocols,	Oct- Nov 2018
Baseline data analysis  reporting and documenting	Nov- Dec 2018
Implementation	Jan onwards
Evaluation	June- July 2019

(Table 1-Rough plan)

The rationale for the social media campaign is because it is the evidence-based option for health promotion (11). There is literature evidence of many health care professionals using the social media for preventing chronic health conditions like Breast cancer awareness campaign on Facebook (11). The literature review also provided the efficacy of the social media campaign. On one study, online anti-smoking campaign on Youtube was conducted  followed by quantitative and qualitative analysis of  audience response (12). There was greater prevalence of the positive response from the audience. There was more number of positive messages and ratings than negative ones (12). In another study the social media campaign was used to increase the physical activity. It was 13-week social media-based –exercise (13).  The positive outcome of the campaign was greater number of people enrolling in the exercise classes due to promotional media content (13).

The platforms of social media that will be used are Facebook and Twitter. The rationale includes more than one billions users of Facebook across world and 35,000,000 in Egypt(14). Every day more than one million people tweet at Twitter (14). Therefore, it will be the best platform to create HCV awareness among the patients and knowledge of sterilization/blood safety/hand hygiene among health workers, most needed in Egypt.   

 Appropriate staffing will be recruited to post awareness creating content on social media. It will improve communications between healthcare professionals and patients.  The videos and posts will emphasize the importance of hand hygiene and educate the patient on early treatment.   There will be constant online training and supervision of the healthcare workers. It will help even those living in remote areas lacking training facilities (11).  Similarly, the patients will be aware of the risk factors and protective factors to fight the infection. The target population will receive the updated information on evidenced-based options (15).  Best practices mandated by CDC (center for disease control and prevention) government on social media campaigns will be used such as scale word of mouth, removal of controversial topics (16).

The benefits of the campaign include, awareness among all sections of society has infected people. Health care professionals would be able to prevent hospital-based transmission by adhering to hand hygiene policy and sterilization of equipment. There may be greater participation in screening services by patients and at-risk people. On the other hand, there may be greater participation in screening of donating blood and safety precautions by care providers. The social media campaign will be successful as it will be implemented in alignment with the ongoing campaigns in different cities. It will also be easy for the policymakers to make decisions (15).

 The potential partnerships include Non- Governmental and governmental Organizations for completing the campaign within one year. It will be a cost-effective campaign as there will be less number of resources required when compared to real campaign on streets.  Approximately $300 would be invested for advertisements, use of analytics graphics, photos, and videos as well as social media management.

Particulars	Cost allocated in $
Advertisement	50
Graphics, Photos, and Videos	50
Analytics	100
Social media management	100

(Table- 2- Sample budget- approximate )

 The success of the campaign can be evaluated through internal statistics of the programs, a number of followers, visitors in hospitals for screening, and community feedback surveys. It will help ensure that the target people are educated and have received proper counseling. Adobe SiteCatalyst will help count number of clicks on the Facebook page (17).  Future implications may include nurses acting as better advocate and educators of patients.   Nurses may help educate people on using social media and help create user accounts.

Task 4

It is recommended to implement this strategy of social media campaign while simultaneously focusing on the safe and affordable care.  It is recommended to develop the strong strategic information system that will help people understand the epidemics of viral hepatitis.  It will better help focus on the response when the information is shared in the social media (1, 2, 3).  There must be a development of effective indicators to gauge the response of the health care providers, the impact of the campaign and new strategies to monitor the implementations.  There is need to measure the progress in legal measures and policy implementation for improving the hepatitis response (6, 7).  In order to ensure the success of the robust campaign measures, the governing bodies shall ensure transparency and accountability mechanisms. Both the government and nongovernment bodies must coordinate for strong civil society participation. It is essential as there is a need for a range of partners and stakeholders for implementing campaign at broad scale.  Through the social media campaign, it will be possible to make strong leadership and governance, which is needed for setting clear targets while engaging with all relevant stakeholders. There is a need for inclusive and transparent assessment and reporting processes.

There is a need for greater collaboration between the researchers and the policymakers to ensure that the evidence-based option is translated into practice to provide the desired impact. It will help health care providers to understand better. The government of Egypt is recommended to convene partners and promote and shape glob; research agenda. It must collaborate with the WHO on the development of new vaccines, service delivery approaches and other commodities (18). It must regularly, document the priorities for innovation and accelerating care (6, 9). To ensure the success of the social media campaign, Egypt must devise the injection safety policy aligning with the WHO guidelines. There is a need of innovating safety-engineered injection to prevent reuse. The epidemics of the hepatitis C can be controlled by increasing access to the sterile injecting equipment. Health care providers can be made aware using the comprehensive package of    There is a need for the development of effective hepatitis C vaccine. There is also the need to collaborate with WHO for country health systems surveillance platform (7, 19).

 To improve the rate of access to health care the government must work on the social media campaign and target the health equity, engage communities, and leverage public and private sectors. The social media campaign should share effective interventions that are tailored to specific population and sections of society. The surveillance, vaccination care and treatment and blood safety control strategies must be aligned with the financial risk protection. It is because lack of funds has been found to be a measure barrier. It is suggested to develop equitable mechanisms for pooling funds across the health systems. It will allow for adequate coverage for continuum of hepatitis services. It needed because the coverage of prevention programmes is limited. The same can be disseminated through the social media campaign. It is also suggested to address the stigma and discrimination through the campaign to protect people with high risk of infection (7, 19).

References

1. Kouyoumjian, S. P., Chemaitelly, H., & Abu-Raddad, L. J. (2018). Characterizing hepatitis C virus epidemiology in Egypt: systematic reviews, meta-analyses, and meta-regression. Scientific reports, 8(1), 1661.
2. El Kassas, M., Elbaz, T., Elsharkawy, A., Omar, H., & Esmat, G. (2018). HCV in Egypt, prevention, treatment and key barriers to elimination. Expert review of anti-infective therapy, 16(4), 345-350.
3. org. (2015). Access to Innovation: Hepatitis C and the Egyptian National Experience. Retrieved from https://www.wto.org/english/tratop_e/trips_e/trilat_symp15_e/Manal_trilatsymp_e.pdf
4. Centers for Disease Control and Prevention (CDC. (2012). Progress toward prevention and control of hepatitis C virus infection--Egypt, 2001-2012.  Morbidity and mortality weekly report, 61(29), 545.
5. El?Akel, W., El?Sayed, M. H., El Kassas, M., El?Serafy, M., Khairy, M., Elsaeed, K., ... & Shaker, M. K. (2017). National treatment programme of hepatitis C in Egypt: Hepatitis C virus model of care. Journal of viral hepatitis, 24(4), 262-267.
6. emro.who.int. (2018). Plan of Action for the Prevention, Care & Treatment of Viral Hepatitis, Egypt 2014-2018. Retrieved from https://www.emro.who.int/images/stories/egypt/VH_Plan_of_Action_FINAL_PRINT1.pdf
7. World Health Organization., (2018)Global health sector strategy on viral hepatitis 2016-2021.Retrieved from: https://www.who.int/hepatitis/strategy2016-2021/ghss-hep/en/
8. Grajales III, F. J., Sheps, S., Ho, K., Novak-Lauscher, H., & Eysenbach, G. (2014). Social media: a review and tutorial of applications in medicine and health care. Journal of medical Internet research, 16(2), pp. 5-7.
9. Elgharably, A., Gomaa, A. I., Crossey, M. M., Norsworthy, P. J., Waked, I., & Taylor-Robinson, S. D. (2017). Hepatitis C in Egypt–past, present, and future. International journal of general medicine, 10, 1-6.
10. Estes, C., Abdel?Kareem, M., Abdel?Razek, W., Abdel?Sameea, E., Abuzeid, M., Gomaa, A., ... & Waked, I. (2015). Economic burden of hepatitis C in Egypt: the future impact of highly effective therapies. Alimentary pharmacology & therapeutics, 42(6), 696-706.
11. Jabbour, S., & Yamout, R. (Eds.). (2012). Public health in the Arab World. Cambridge University Press. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=nujQ7LqE-bsC&oi=fnd&pg=PR7&dq=Public+Health+in+the+Arab+World&ots=c03sEahr7h&sig=RUPx9AeqvnkdeudDu9Xfr8srCpI#v=onepage&q=Public%20Health%20in%20the%20Arab%20World&f=false
12. Chung, J. E. (2015). Antismoking campaign videos on YouTube and audience response: Application of social media assessment metrics. Computers in Human Behavior, 51, 114-121.DOI: https://doi.org/10.1016/j.chb.2015.04.061
13. Zhang, J., Brackbill, D., Yang, S., & Centola, D. (2015). Efficacy and causal mechanism of an online social media intervention to increase physical activity: results of a randomized controlled trial. Preventive medicine reports, 2, 651-657. DOI: https://doi.org/10.1016/j.pmedr.2015.08.005
14. Oermann, M. (2007). Annual Review of Nursing Education.Cambridge University Press. Retrived from: https://journals.lww.com/neponline/Citation/2005/01000/Annual_Review_of_Nursing_Education,_Vol__1.16.aspx
15. Ventola, C. L. (2014). Social media and health care professionals: benefits, risks, and best practices. Pharmacy and Therapeutics, 39(7), 491. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/
16. CDC Social Media Best Practices. (2018). CDC Social Media Tools, Guidelines & Best Practices. cdc.gov. Retrieved 16 April 2018, from https://www.cdc.gov/socialmedia/tools/guidelines/index.htm
17. gov. (2018). Facebook Guidelines Best Practices | Social Media | CDC. Cdc.gov. Retrieved 16 April 2018, from https://www.cdc.gov/socialmedia/tools/guidelines/facebook-guidelines.html
18. Kandeel, A., Genedy, M., El?Refai, S., Funk, A. L., Fontanet, A., & Talaat, M. (2017). The prevalence of hepatitis C virus infection in Egypt 2015: implications for future policy on prevention and treatment. Liver International, 37(1), 45-53.
19. World Health Organization. (2017). Global hepatitis report 2017. World Health Organization.