Replacement of cytology screening with HPV testing is recommended and essential for cervical cancer elimination. HPV testing for primary screening was implemented in 12 laboratories within 9 Latin American countries, as part of the ESTAMPA cervical cancer screening study. Our observations provide information on critical operational aspects for HPV testing implementation in diverse resource settings.readiness of 12 laboratories to start HPV testing and their continuity capacity to maintain good quality HPV testing until end of recruitment or up to December 2021. Readiness was based on a checklist. Information from the study database; regular meetings and monitoring visits; and a questionnaire on laboratory operational aspects sent in May 2020 were used to assess continuity capacity. Compliance with seven basic requirements (readiness) and eight continuity requirements (continuity capacity) was scored  and totaled to classify readiness and continuity capacity as very limited, limited, moderate or high. Experiences, challenges, and enablers of the implementation process are also described.We describe the implementation process of HPV testing in ESTAMPA, focusing on laboratory aspects. We assess the high readiness, three moderate readiness, and of two laboratories new to HPV testing, one had limited readiness and the other very limited readiness. Two of seven laboratories with high readiness also showed high continuity capacity, one moderate continuity capacity, and the other four showed limited continuity capacity since they could not maintain good quality HPV testing over time. Among three laboratories with moderate readiness, one kept moderate continuity capacity and two reached high continuity capacity. The two laboratories new to HPV testing achieved high continuity capacity. Based on gained expertise, five laboratories have become part of national screening programs.Seven of 12 laboratories had High readiness of laboratories is an essential part of effective implementation of HPV testing. However, high readiness is insufficient to guarantee HPV testing high continuity capacity, for which a “culture of quality” should be established with regular training, robust monitoring and quality assurance systems tailored to local context. All efforts to strengthen HPV laboratories are valuable and crucial to guarantee effective implementation of HPV-based cervical screening. More than 600,000 new cases and 300,000 cervical cancer deaths occur every year; over 90% of these are in low-income and middle-income countries (LMIC) .Cytology-based screening has successfully reduced cervical cancer rates in places where it has been systematically implemented . HoweverPersistent infection with high-risk HPV is the leading cause of cervical cancer . SeveralIn the World Health Assembly  adopted Several tools are available to support countries with the implementation of HPV testing within cervical cancer screening –33. In pESTAMPA is a multicentric study of cervical cancer screening with HPV testing conducted in 12 study centers’ laboratories (SC1-12) in nine countries in Latin America. The study aims to evaluate the performance of different techniques and approaches to triage HPV positive women and to inform on how best to implement affordable and sustainable HPV-based screening programs in LMIC.The study protocol has been previously published . BrieflyDigene HC2 HPV DNA test  or COBAS HPV test . After HPV testing, aliquots of PC were prepared for future molecular triage. Digene HC2 sample conversion kit was used for conversion of samples collected on PC before HC2 HPV testing. HPV (HC2 or COBAS) was done following manufacturer instructions and ESTAMPA standard operating procedures (SOPs). For quality control (QC) of HPV testing, in some laboratories, about 10% of samples tested with HC2 or COBAS were retested either at the same laboratory using a different HPV technique or at and international hub with COBAS. In one center, samples from the first 900 recruited women were stored in the Digene Standard Transport Medium (STM) and subsequently tested with HC2. In this center, a sub-study evaluating the impact of operational factors on HPV positivity of HPV assays including HC2, COBAS and APTIMA  was conducted and COBAS results were assumed as QC of HC2 and APTIMA  were referred to colposcopy, 2-3 biopsies were collected from any observed lesions, and women diagnosed with cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2 +) were treated with LLETZ. At this colposcopy visit, a cervical sample was collected for HPV testing and other molecular triage tests. Women with negative colposcopy or histology showing lesions less severe than CIN2 (< CIN2) were invited for a follow-up visit at 18 months for a second HPV screen to complete ascertainment of disease. Women positive for HPV at this visit were referred to colposcopy and clinically managed as needed.Overall, women could have one, two, three or four HPV tests during the study, depending on their screening results and associated study visits  and on the sample being selected for QC.The main steps carried out to implement HPV testing in ESTAMPA laboratories  are descreadiness for HPV testing implementation in the laboratory. Before launching the study, local principal investigators willing to take part, were asked to identify a laboratory with adequate facilities as to carry out HPV testing for primary screening. Laboratory-based investigators could propose their own facilities or others thought more suitable for future participation in national HPV-based cervical screening program.(1) Assessment of Next, a checklist  was usedLaboratories were also asked whether they had personnel to perform the test; and whether they had established logistics for transport and storage of samples, management of reagents validity and delivery of results. We did not request specific arrangements for external quality assurance (EQA) in this checklist, but we proposed different QA measures as the study progressed.Based on this initial assessment, each study center developed a road map to address limitations and joined the project when ready to launch recruitment.(2) Initial site visit to start recruitment and HPV testing. The study covered the cost of HPV reagents and additional consumables where needed. Procurement was done internationally or in-country, depending on availability of local distributors and registration of products. Once consumables were in place  and laboratories were ready, a site visit by IARC researchers to launch the ESTAMPA study was organized.During this initial visit, training on the study protocol, study’s SOPs and good clinical practices was given to all study personnel over 1-2 days, followed by real-life recruitment. In parallel, the selected HPV testing laboratory was visited to verify that conditions were ready to start testing. When enough samples for a full- or a half-testing batch  had been collected, additional training on the study protocol, laboratory SOPs and overall sample handling from reception at the laboratory to delivery of results, was provided to all laboratory personnel.Next, using recently collected samples, hands-on training was given to 1-2 technicians on: (i) Running HPV testing if no previous experience, (ii) Performing conversion of samples collected in PC if HC2 testing was used, (iii) Preparing aliquots from PC vials, and (iv) Recording results on the study database. Lead investigators at each center made arrangements to repeat this training as needed when new laboratory personnel joined the study.As the study progressed initial and monitoring site visits were done by a team mostly composed by local researchers selected from study centers already recruiting with support from ESTAMPA researchers.continuity capacity of laboratories to perform good quality HPV testing. Laboratories’ continuity capacity was assessed throughout the study. Sources of information used for the assessment included: minutes from meetings with local investigators and laboratory managers, reports from monitoring visits, data provided by the study centralized web-system, and from a questionnaire on laboratory operational aspects ((3) Assessment of  aspects  sent to As laboratories joined the study, implementation of quality assurance processes was recommended, such as providing regular training to technicians on HPV testing and study’s SOPs, retesting of a subset of samples and annual subscription to EQA. The study covered the first year EQA fees for new laboratories which were encouraged to ensure funding for next subscriptions.The centralized web-system specifically developed for the study allowed regular checking on the progress of recruitment, the number of HPV tests carried out , the speed of uploading results, and statistics on clinical activities. Thus, the web-system provided effective indicators of the HPV testing capacity of laboratories, such as the volume of HPV testing and the HPV positivity over time. As over 75% of samples tested in each laboratory were collected at the initial screening visit, the number of recruited women per study center was used as a proxy of HPV testing volume, and the positivity of HPV testing at the time of enrolment was used as a proxy of overall HPV positivity, independently of the HPV detection technique used . Based on previously reported HPV prevalence among Latin American women –38, we aThe questionnaire sent to laboratory managers requested current details on HPV equipment status, annual subscriptions to EQA, training on HPV testing for current and new technicians, preparedness for procurement process of HPV and related laboratory supplies, availability of tracking systems for HPV reagents and laboratory supplies and for samples transport and storage and turnaround time of HPV results.As recruitment progressed, many logistic activities were smoothly handled over to local investigators, including procurement of reagents and consumables if they became available in the country, and responsibility for maintaining adequate stocks. This transition facilitated implementation or expansion of HPV-based cervical screening programs.All collected data were used to assess whether laboratories were able to continue performing good quality HPV testing over time, from the first batch of testing up until end of recruitment or December 2021.readiness for HPV implementation. Monitoring, and operational questionnaires classifying eight continuity requirements (within the six domains), were used to assess the continuity capacity of laboratories to perform good quality HPV testing over time.Collected data from the readiness and continuity capacity assessments were summarized in six main domains: characteristics of the laboratory facility, personnel, procurement of reagents and consumables, tracking systems for reagents expiry and supplies, logistics for transport and storage and delivery of testing results. Responses to the initial checklist were classified into seven basic requirements (within the above six domains) and were used to assess the laboratory very limited (score ≤ 3), limited (score = 4-5), moderate (score = 6) and high (score = 7). Similarly, the continuity capacity of laboratories to perform HPV testing over time was classified as very limited (score ≤ 3), limited (score = 4-5), moderate (score = 6-7) and high (score = 8)  or non-compliant , and values were summed up to generate a total score (range = 0-7 for readiness and 0-8 for continuity capacity). Using the scores, the readiness of laboratories to start HPV testing at the time of initial assessment was classified as ore = 8) , 2.Twelve study centers with corresponding HPV laboratories, located in nine Latin American countries  participated in the ESTAMPA study. Eleven laboratories were part of public systems , and one offered service under a private system. Six laboratories had staff with experience in detecting HPV for clinical diagnosis and research at the initial assessment. Two of the remaining laboratories had experience in detecting HPV for research only, and two had experience in HPV detection for diagnosis but not for research. One laboratory was set up in a regional hospital, but the study team was based on a high-level expertise (diagnostics and research) HPV reference laboratory. Finally, one laboratory did not have previous experience in HPV detection or any other molecular diagnostics .Despite differences in recruitment targets  and year when recruitment and HPV testing started (2012 to 2017), among 42,502 women with valid HPV results recruited until December 2021, the overall yearly HPV positivity consistently ranged between 12 and 16% over time  .As the study provided all relevant consumables at the start, centers did not need to engage in direct procurement activities. However, all teams and particularly laboratory leads demonstrated awareness of current local regulations for purchasing in-country, and the ability to deal with importation of non-registered in-country consumables or to negotiate prices of testing kits and machine loaning as SC7.All laboratories had established logistics for transporting and storage samples (as per protocol), only (SC12) did not have a system to control the validity of laboratory reagents, and in addition to SC2 and SC3 did not have a system in place to return results to women, did not have a standard report template nor instructions on how to share results with participants.high readiness at initial assessment and three  had moderate readiness with only one essential requirement not fulfilled. Of two laboratories totally new to HPV testing, the one (SC7) supported by a high-level laboratory had limited readiness and the other one (SC12) very limited readiness.In summary, seven laboratories  had All laboratories offered appropriate training in HPV testing and laboratory study SOPs to new laboratory personnel, even if they were not assigned to HPV testing and gained or improved the ability to ensure timely procurement of HPV reagents and other consumables.Laboratories developed procurement plans, independently of whether the planning only involved preparing paperwork for customs clearance in advance or dealing with local distributors or purchasing the consumables . However, two laboratories  had difficulties coordinating supplies’ importation all over recruitment.Laboratory management systems  for tracking of reagents expiry and handling of samples (transport and storage) were incorporated or improved by all laboratories. However, three laboratories  needed the central team to send regular reminders to verify expiration dates throughout the study.Six laboratories struggled to consistently deliver results within one month. Four of them  had additional challenges linked to procurement of consumables, while the delays for the other two laboratories (SC2 and SC6) were largely related to the study setting. SC2 recruited in a remote location, and samples were shipped by air only 1-2 times per month. SC6 recruited in several centers concurrently in order to reach its recruitment target of 10,000 women. This meant that samples arrived at both laboratories in large batches and accumulated, causing delays with processing and turnaround of HPV results. In such cases, different measures were applied when to guarantee adequate follow-up of screen-positives .high continuity capacity as they fulfilled all criteria; two (SC2 and SC6) had moderate continuity capacity having only not fulfilled one requirement and four  showed limited continuity capacity.Overall, six laboratories  showed high readiness also showed high continuity capacity, one (SC6) showed moderate continuity capacity, and the other four  were not able to maintain good-quality HPV testing over time after an excellent start and showed limited continuity capacity. Among three laboratories with moderate readiness, one (SC2) kept moderate continuity capacity and two (SC3 and SC4) reached high continuity capacity. The two laboratories new to molecular testing  with subsequent limited and very limited readiness, respectively, achieved high continuity capacity.n = 497) having invalid HPV results. Immediate correcting measures to guarantee the safety of participants  were implemented in these three SCs.Five of the 12 laboratories are now or soon will be part of their national HPV-based screening program, including SC1 and SC7 with high continuity capacity, SC6 (moderate) and despite challenges during the study, SC9 and SC10 with limited continuity capacity based on their nature  and on the experience, increased installed capacity and lessons learnt throughout the study.The WHO recommends screening women with a high-performance test, such as HPV DNA testing, twice by age 35 and 45, and encourages countries to move from cytology- or VIA- to HPV-based cervical screening programs. However, most cervical screening worldwide is done with cytology and transition to HPV-based cervical screening should be carefully planned. There are several important factors to consider, such as the size of target population, the screening approach, women’s acceptance and participation in HPV testing, local availability of HPV testing platforms , laboratory installed capacity, availability of trained personnel, quality assurance, and other operational aspects.In our study, two main factors enabled successful performance of HPV laboratories as part of HPV introduction: the initial assessment of existing laboratory capacity and the regular support offered to participating laboratories throughout the study. The initial assessment identified limitations in the laboratory’s ability to perform HPV testing and helped laboratory teams to develop a road map  to address shortcomings before launching the study. In all laboratories, rapid training of new technicians, regardless of their role, was provided in order to minimize disruption of activities. The simple hands-on processing of both HPV tests used in the study (HC2 and COBAS) also helped train new personnel. The training was usually completed within a week, even where staff had no previous HPV testing experience.The ESTAMPA study aims to evaluate triage techniques for HPV positive women and contribute to the implementation of HPV-based cervical cancer screening in Latin America. Two baseline cervical samples were collected using a cytobrush washed in vials containing PreservCyt medium (PC) to assess the performance of different molecular triage techniques. HC2 testing is incompatible with PC and uses its own collection medium . This meant that study centers using HC2 had to prepare samples for testing using a conversion kit, adding on average 1.5 full working days per testing batch of 88 samples. Additionally, all laboratories (independently of the HPV test used) were requested to produce aliquots from both PC vials for future evaluation of molecular triage techniques. This process could take up to one full working day. Additionally, screened positives attended a colposcopy visit at which another sample for HPV testing was collected, and those not receiving treatment based on colposcopy and histology results were recalled at 18 months and had another HPV test, and aliquots were produced from samples once HPV tested. In real-life settings, laboratories may have more capacity for HPV testing as these extra research activities will not be required.The average HPV positivity over time was 14.1%, with some fluctuations related to debut and end of recruitment and testing at each center along the study. We detected HPV positivity values below 10% or above 16% (the inspection threshold) in some centers over time. This triggered an immediate evaluation of the entire screening process by using the study centralized web-system, followed by a site visit to reinforce training and ensure safety of participants as needed. In most cases, low or high HPV positivity was usually associated with characteristics of the included study population. For instance, one center reported a consistently high positivity (>16%), most likely due to the recruitment of a referral population  (data not shown). Assessments suggested HPV testing problems only in one laboratory, where immediate evaluation of the HPV equipment and a plan to maintain good cleaning and calibration of laboratory equipment were requested. This laboratory could not comply with these measures and the study had to stop before reaching the recruitment target.high readiness requirements. Once testing started, laboratories faced challenges in achieving high continuity capacity for HPV testing. In some study centers, the recruitment rate was unexpectedly low at times, leading to several weeks of delay before enough samples for a whole testing batch were collected, sometimes leading to expiry of reagents before HPV testing and impacting the turnaround of HPV results. Corrective measures such as testing half batches were introduced; however, sometimes, even half-batch testing was not achievable, particularly during the COVID pandemic, and inevitably led to wastage of reagents. In addition, as HPV testing had not been rolled out in almost all participating countries during the study, collection medium and HPV testing reagents needed to be imported as local procurement was not possible. Local principal investigators had to quickly learn regulations to import unregistered products, logistics associated with customs clearance, and different aspects of the procurement process, including price negotiation and management of expiry and stock levels of consumables. Laboratories managers were encouraged to subscribe to international EQA schemes. Six laboratories had yearly subscription to EQA schemes before the start of the study as required by local policies. The study covered the first-year fees for other four laboratories, but only one of them managed to continue with subscriptions afterward. Fees for the remaining two laboratories were not provided by the study nor covered by the laboratory. The main reason for not ensuring funds for EQA, in addition to limited resources, was the lack of a “culture of quality”, as managers did not understand the importance of maintaining regular EQA not only for HPV testing but for other laboratory activities.Readiness for HPV testing was measured ahead of starting recruitment, and study teams whose laboratories were not fully ready to start, took several months (up to 3 years) to deal with shortcomings and they only started recruitment and testing once they fulfilled We did not observe any relationship between laboratory high continuity capacity and attainment and size of recruitment goals. Of six laboratories with high continuity capacity, two exceeded their original recruitment targets of 10,000 and 5,000 by 10% and 27%, one reached its target , one is still recruiting  and two aiming to recruit 5,000 had to stop at 67% and 88% attainment. The two with moderate continuity capacity reached their targets ; and none of the four showing limited continuity capacity completed recruitment, two originally targeted 500 and the other two 5,000 women. Of importance, independently of the level of continuity capacity, five laboratories will become or are already part of their national screening program. For instance, one laboratory with high continuity capacity that stopped recruitment because the HPV testing platform loan ended, and the equipment was retrieved by the manufacturer company is now part of the national program though using a different HPV testing platform but maintaining the laboratory staff trained on HPV testing for the study. The incorporation of these five laboratories into national programs demonstrates that all efforts in training, continued support, and engagement with and between local and regional stakeholders during the study, are certainly contributing to the implementation of HPV-based screening programs in Latin America.Most difficulties faced by laboratories reflect the early days of the HPV testing market. Currently, more than 250 HPV tests are available on the market, although most of them are not yet adequately validated , 39. It The main strengths of our results are: (1) The diversity of laboratories where HPV testing was performed, contributing with valuable information on the multiple challenges that countries may face during transition to, implementation and scale-up of HPV testing in primary screening; (2) The use of regular feedback given by the central coordinating team and most importantly through exchange of experiences and lessons through the strong ESTAMPA study network, which facilitated installing a “culture of quality” in laboratories, and (3) The demonstration that readiness and continuity capacity are good indicators of how HPV implementation is ongoing in terms of laboratory management and quality of HPV testing, and can be assessed using simple checklists and questionnaires. On the other hand, two limitations of our study are related to these simple tools. First, information provided by laboratory researchers or managers may be prone to reporting bias, and second, continuity capacity was assessed based on responses to a single-time questionnaire. Nevertheless, in our study, these limitations were mitigated by completing and verifying information through monitoring visits to all teams and their participating laboratories over time. However, it should be noted that in the context of a screening program, regular monitoring visits may not be feasible and other strategies may be needed to complete implementation assessment.The 12 laboratories participating in ESTAMPA were essential for study centers screening and overall study achievements, despite several of them being new to HPV testing or to its use in cervical screening and having faced challenges to adopt the technique into daily activities. The strong support provided by the study network facilitated overcoming most difficulties leading to 42,502 HPV screened women across 12 study centers. We have described here the process of introducing HPV testing in 12 laboratories across Latin America, we further plan to use data per HPV testing batch to evaluate and compare HPV performance across laboratories, over study visits  and over time.high readiness is essential for successfully implementing HPV testing in laboratories; however, high readiness is not sufficient to guarantee HPV testing high continuity capacity. Several aspects to achieve this high continuity capacity should be considered:In summary, our assessments confirm that as (1)A “culture of quality” in laboratories and across the cervical cancer screening spectrum should be established, including regular training on SOPs, robust monitoring and quality assurance systems  tailored to the installed capacity and local resources(2)Using a friendly and tailored to local context database, if possible centralized and web-based, to allow regular monitoring of the overall screening process, including laboratory and clinical activities, and feedback for improvement(3)Training on preparation of appropriate plans for HPV supplies procurement and stocking and on local regulations on products registration and importation of laboratory supplies should be provided to laboratory managers and leaders of cervical screening programs(4)Strategies to guarantee reasonable turnaround of HPV results to women should be in place to ensure that any screened woman receives her HPV results and that screened positives receive adequate and timely treatment and follow-up(5)Exchange of experiences and lessons learnt between multidisciplinary implementers from different settings and countries should be encouraged to apply most suitable implementation strategies according to context and define additional implementation research needs.The original contributions presented in this study are included in the article/The studies involving human participants were reviewed and approved by the Ethics Committee of the International Agency for Research on Cancer (IEC Project 12-27-A7), the Pan American Health Organization (PAHO) Ethics Committee and Ethical Committees in each of the study participating centers. The informed consent include details on the background, procedures of the study, risks and benefits, statement of confidentiality, specimen use and study staff to contact. The study is considered minimal risk as the procedures are standard practice in cervical cancer screening programs. The patients/participants provided their written informed consent to participate in this study.MA and RH conceived the ESTAMPA study and are the principal investigators responsible for its overall conduction. MAP, AF, GS, LM, CT, LF, VV, GV, AC-V, GR, AC, and CW are the local principal investigators responsible for recruitment, clinical management, and data collection. MAP, AF, and GS conceptualized the laboratory aspects of the study and together with MLR, MH, LM, MRP, CT, PH-N, FD, JA-S, MZ, and VV coordinated all laboratory activities including training of new technicians as needed. JL, AP, MB, LM, PM, YC, RC, DC, LG, AR, MR, MLB, and LC performed HPV testing. JV and AB provided statistical support and together with MA, MH, MLR, EL, and AR centrally coordinated the study. MA, RH, NB, and SL contributed to the funding acquisition and local capacity building. MLR and MA wrote the manuscript. MH, AB, JV, SL, NB, and RH contributed to the finalization of the manuscript. All authors reviewed and approved the final version of the manuscript.


Various studies have reported the vaccine’s efficacy against coronavirus disease 2019; however, there has been little discussion regarding the test frequency since the emergence of the Omicron strain. In this context, the United Kingdom has abolished its free testing program. Our analysis revealed that the decrease in case fatality rate was heavily influenced by vaccination coverage rather than the testing frequency. However, the effectiveness of testing frequency should not be underestimated and therefore needs further validation. Moreover, several studies have reported on the efficacy of the vaccination with the emergence of new variants and with each progressive third and fourth dose administrated. However, the discussions regarding the testing frequency have been limited. Moreover, the government of the United Kingdom (UK) has considered withdrawing the free testing system from April 1, 2022, and will recommend annual vaccination in the future (3); however, the scientific evidence underlying this decision seems weak. Therefore, we assessed the impact of vaccination coverage and testing frequency on COVID-19 case fatality rates (CFR) using data from nine countries  (4). Since its adoption, Covid-Pass has been reported to have contributed to approximately 30% reduction in cases and deaths (5). Therefore, we selected geographically proximate European countries without this system as of February 11, 2022, when the Omicron variant was prevalent, to reduce possible confounders (4).Vaccination and frequent testing and tracking are effective measures to reduce the fatality rate from coronavirus disease 2019 (COVID-19) Our analyses suggest that vaccination contributes more toward the reduction of CFR than the testing frequency, which partially support the UK’s new policy. This finding suggests that, in terms of CFR after increased vaccination population coverage, the previous consensus that frequent testing is an effective infection control measure is no longer applicable for Omicron variants, which have a shorter incubation period and a lower severity rate compared to the Delta variant. This is an ecological study, and it is difficult to make a definitive statement regarding the causal relationship. Recently, testing is charged in the UK, France, Germany, and elsewhere. However, considering various infection control measures and those individuals that choose not to get vaccinated, the impact of test frequency should be streamlined in the future using local individual data.Akihiko Ozaki received personal fees from MNES Inc. outside the submitted work. Furthermore, Tetsuya Tanimoto received personal fees from MNES Inc and Bionics co., ltd. outside the submitted work.Conception and designing of the study; Kaneda YData collection; Kaneda YData analysis and interpretation; Kaneda Y, Akashima SWriting this paper; Kaneda YCritical revision of the paper; Tanimoto T, Takahashi K, Ozaki AAll the authors read the final draft and approved submission.


Given increasing rates of visual impairment worldwide, we call on national health plans and global development agencies to urgently focus funding and resources toward vision and eye health, with an emphasis on data collection surrounding new and changing burden of eye disease. Despite the successes of the VISION 2020 global initiative, large economic and societal consequences still exist across the life span from vision impairment and blindness, which have not yet been addressed by the global health community.There remains a lack of reliable global data on vision health, especially in the case of childhood blindness and vision impairment.Historically, vision has been poorly represented in global health budgeting and finance, which objectively reflects its lack of prioritization on the overall global health agenda.We need greater investment in cost-effective strategies to prevent and treat a rapidly increasing global burden of ocular disease because of an aging and changing population. The Global Burden of Disease study found that instead of reaching the WHO target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, the overall prevalence of avoidable vision impairment increased from 3.92% in 2010 to 4.34% in 2020.Despite recent data showing the rapidly increasing global burden of eye disease, vision has not been prioritized on the global health agenda.The causes of blindness and low vision globally have shifted over time because of socioeconomic development and the evolution of disease processes and environmental conditions. Of the estimated 30 million people who were blind in 1990, the main causes included cataract (48.8%), trachoma (15.5%), and glaucoma (13.5%).––In 2010, the definitions of low vision were revised to include uncorrected refractive error. At that time, the main causes of visual impairment overall were uncorrected refractive error (43%) and cataracts (33%).,,In addition, urbanization and increased near work led to a rapid increase in the prevalence of myopia and high myopia in schoolchildren, especially in east and southeast Asia, where both genetic and environmental risk factors coexisted.,,,By 2020, presbyopia and mild visual impairment were included in epidemiological data for the first time, with an estimated 510 million people affected by uncorrected presbyopia.,,As shown by these data, disease burden has been shifting from communicable disease and vitamin A deficiency to noncommunicable and age-related conditions. In 2015, an estimated 75% of the global blind population was aged 50 years and older, with associated increasing rates of glaucoma, cataracts, and age-related macular degeneration.In 1999, VISION 2020 initially chose to create a framework for national programs to focus on diseases that cause blindness with proven interventions: cataract, trachoma, onchocerciasis, and vitamin A deficiency. VISION 2020 acknowledged that cataract, glaucoma, and diabetic retinopathy all require an increase in trained ophthalmologists, expansion of clinics and clinical staff, and provision of low-cost surgical services. Rather than including these investments, VISION 2020 placed the burden of funding these programs largely on national resources and patient payment, creating large financial barriers to accessing eye care for LMICs. Studies in sub-Saharan Africa and east Asia have found that cataract surgery, though highly cost-effective on a global or national scale, can impose an out-of-pocket cost as high as half the average annual household income of the patient.Often, the global health and vision communities work in distinct silos with minimal communication across sectors, centers, and initiatives. Internally, competition for funding between the 2 communities can impede sustainable and large-scale collaborations. Lack of collaboration may be a reason for poor investment in global eye health. Although government expenditure on eye health is not well tracked,The average annual funding for all eye health globally was less than 0.06% of total global health funding.,,Vision funding, blindness prevention programs, and measuring visual outcomes are critical to meet the growing needs of a rapidly changing global population. Developing and tracking indicators are essential to assessments of whether these programs are achieving their desired effects. Unfortunately, progress indicators established by VISION 2020 were not monitored closely in many countries.Uncorrected refractive errors were initially not included in much of the VISION 2020 visual impairment data sets. International studies varied on measuring best spectacle-corrected versus presenting visual acuity.,,,Addressing childhood vision loss is particularly urgent because of the neuroplasticity of the visual system in children; for example, even uncorrected refractive error can result in permanent vision loss not correctable with glasses due to amblyopia . Nonetheless, low-income countries suffer from limited and unreliable data about childhood blindness and visual impairment.,There are a variety of cost-effective strategies to reduce global visual impairment in the modern era . One is One strategy to reduce global visual impairment is to focus funding on the most rapidly growing and impactful diseases that affect vision.Cataracts remain the leading cause of blindness and can only be corrected by surgical treatment, requiring the creation of eye care systems and community outreach. In low-income countries, cataract surgery is as cost effective as the bacille Calmette-Guerin vaccine. Cataract surgery in Nepal is the most cost-effective surgical interventions at US$7.29 per disability-adjusted life year averted—equal to cost per disability-adjusted life year averted from bed nets for malaria prevention.,Finally, comprehensive policies and investment in training and screening programs are needed to better address ROP blindness worldwide.Finally, the only way to ensure that progress is being made and that vision health strategies are keeping up with a changing global population is if the global health community actively engages in tracking progress toward specific goals in vision health. Funding and financial interventions related to vision health need to be separately tracked and measured to assess progress. The uncertainties in current data on visual disabilities, particularly among children, could be reduced with population-based studies conducted at the national level following a standardized classification system with results reported by age and sex.Understanding the rapidly increasing burden of global visual disability as well as projected increases in the future, global financial investment in cost-effective strategies to address vision health is imperative. Furthermore, financial incentives for collaboration across disciplines could break existing silos and create bridges across sectors in vision and global health. The COVID-19 pandemic highlighted global inequities in access to care and the ability to achieve a productive and meaningful life. Vision health across the life span is central to that challenge. We hope that this article serves as a call to action to refocus our global strategy on the rapidly changing landscape of vision health and put sight back on the map.


Many factors affect the teaching of massively open online courses (MOOCs). In this study, to explore the factors that influence the effective teaching of MOOCs, a large number of relevant studies are analyzed. Based on grounded theory, semi-structured interviews were conducted with 30 students and teachers who used MOOCs for online teaching. The interview data were subjected to four research processes –open coding, axial coding, selective coding, and saturation testing– to explore the factors influencing MOOCs’ effective teaching and the interactions between them. The results demonstrate that: (1) Effective teachers, effective tuition, effective communication, active online learning, social support guarantees, and online course design have important positive effects on effective teaching, while only certain online learning behaviors will seriously affect the teaching effectiveness of MOOC, resulting in negative effects. (2) Effective communication is essential for effective teaching in MOOCs; effective teachers are the leading factor, thus teachers should take the initiative to study and understand the students to understand their various learning needs and difficulties. (3) Reasonable and effective classroom teaching design is key to improving MOOCs’ teaching efficiency. (4) E-learning is respected, cared for, and valued by society, including cognition, emotion, and learning platform support from family, school, teachers, and classmates, and has an important impact on students’ motivation and the effects of online learning. The results of this study further clarify factors influencing effective teaching of MOOCs, thus helping to enrich and supplement the theory of effective teaching and evaluation and providing theoretical guidance for teachers to effectively implement MOOC teaching. Doing Well in the Organization and Management of Online Teaching in Colleges and Universities during the Epidemic Prevention and Control Period on February 5, 2020; these guidelines specify the teaching policy of “online teaching and online learning”, within which massively open online courses (MOOCs) are one of the approaches used for crisis management. Under this framework, colleges and universities require students to take MOOCs to acquire new knowledge and ensure the continuity of their education  To explore the factors influencing the effective teaching of MOOCs in the context of an epidemic situation and what indicators can be used to measure effective teaching in MOOCs;(2) To analyze the relationships between various influencing factors and the effective teaching of MOOCs and to evaluate the effective teaching of MOOCs by analyzing these factors.To achieve these objectives, in this study, the grounded theory method is used to comprehensively and systematically review the representative literature related to evaluating effective teaching both locally and abroad. Through interviews with university students who have conducted MOOC teaching in various parts of the country, the factors influencing MOOC teaching in the context of the COVID-19 epidemic are summarized. This allows: (1) further analysis of the relationship between each measurement indicator and effective teaching, (2) formation of an effective teaching evaluation system of MOOCs, and (3) construction of an effective teaching evaluation influencing factor model. Finally, teaching behaviors in MOOCs that are beneficial to improving students’ learning performance are analyzed and explored to help future MOOCs effectively evaluate teaching, provide substantive suggestions for improving online teaching effectiveness, and further improve online teaching evaluation systems.Effective Teaching Methods  has obtained the good teaching effect, students cannot easily get distracted and offline classes, because the rain classroom management system automatically records the student online learning behavior. Meanwhile, with rain class, teachers can push the pre-class preview courseware with MOOC videos, exercises and voice to students’ mobile phones, so that teachers and students can communicate and give feedback in time. Rain classroom can cover every teaching link of pre-class, in-class, and after-class, providing complete three-dimensional data support for teachers and students, personalized statements, automatic task reminder, so that teaching and learning are more clear. Teachers can assist MOOCs teaching through rain classroom, so as to have a real-time and more comprehensive understanding of students’ learning status and facilitate targeted teaching.Effective teaching and effective practice complement one another. As an old saying goes, “sharp tools make good work.” Thus, teachers’ lesson preparation is particularly important, and the effort in advance directly determines the success or failure of specific operations. No matter how teaching is reformed, lesson preparation remains crucial, especially for teachers who lack MOOC teaching experience. Teachers should master the operating processes for MOOCs before classes to avoid low-level technical mistakes during lectures. In addition, they should be familiar with video materials and PPT courseware in MOOCs. Assignments also form an integral part of teaching. They are not only an effective means to consolidate and apply knowledge but also help to cultivate students’ ability to transfer their knowledge and work independently; in addition, assignments can provide timely and insightful feedback on teaching effects. To better consolidate teaching content, students are required to complete after-class exercises on MOOC platforms after each class and upload screenshots confirming the completion of the homework to the course QQ group or WeChat group for teachers to check and evaluate. When assigning homework, particular attention should be given to providing some enlightening and controversial questions rather than solely questions with a defined, standard answer, thus providing learners with a situation to which they can comprehensively apply the knowledge they have learned from the course to solve problems . For leaReasonable and effective classroom teaching design is key to improving the efficiency of network-based teaching of MOOCs. Teachers are the organizers and guides of classroom teaching in MOOCs. To achieve excellent online MOOC classroom teaching design, the course teacher must comprehensively consider aspects including effective communication with students on the network platform, sharing of knowledge, methods, and experience, exchanging feelings, experiences and ideas, promoting the effective implementation of network teaching, and ensuring positive interactions between course participants. MOOC teaching requires increased time and energy investment in the early stages of planning and process maintenance ; in partEffective teaching organization and management ensure effective teaching. Social support guarantees refer to respect, care, and attention from society during the process of online learning, including cognitive, emotional, and learning platform support from families, schools, teachers, and classmates, which have an important impact on students’ online learning motivation and effectiveness. With the emergence of numerous online teaching platforms, such as Rain Classroom, DingTalk, ZOOM Class, and Tencent Class, selecting the correct one is increasingly important because improper selection will negatively impact both teaching effect and quality. The biggest challenge involved in network teaching is not only to fully leverage the advantages of the rich resources and flexibility of network teaching platforms but also to avoid the disadvantages caused by poor interactions between teachers and students. A smooth and stable network environment is also a basic condition of online learning, ensuring that students can continue to conduct online learning effectively.In this paper, teachers’ and students’ MOOC teaching behavior was taken as the research object, and grounded theory was used to conduct semi-structured interviews with 30 university teachers and students who use MOOC teaching platforms. Based on existing research, the mechanisms influencing effective teaching in MOOCs were explored and explained in detail from the perspectives of students and teachers. An evaluation model of students’ MOOC learning behaviors and effective teaching was then constructed, which reveals and comprehensively analyzes the main factors that promote effective teaching in MOOCs, thus providing new insights into how to enrich the system of teaching of MOOCs. The study’s results show that effective teaching of MOOCs in an epidemic situation can be measured by constructing a multidimensional indicator system that considers (1) effective teaching, (2) effective teachers, (3) effective communication, (4) students’ online learning behaviors, (5) social support guarantees, and (6) online course design. The above six factors have important positive impacts on learning through MOOCs; among these factors, only certain online learning behaviors will negatively influence the effects of MOOC teaching and produce negative outcomes. Therefore, based on the findings in this paper, corresponding suggestions are proposed, such as attaching importance to group cooperative learning in MOOCs and cultivating MOOCs learners’ sense of learning responsibility. The results of this study have important theoretical implications for understanding the connotations of effective teaching of MOOCs, thus enriching and supplementing the theory of effective teaching and evaluation. These results can also provide practical guidance for teachers to effectively implement the teaching of MOOCs and promote the improvement of MOOC teaching quality. The theoretical contribution of this paper lies in exploring the key factors affecting MOOCS effective teaching during the epidemic period, and constructing a model of MOOC learning behavior and effective teaching evaluation, which provides a theoretical basis for teaching managers in universities to set up MOOC teaching evaluation index system. At the same time, this paper expands the application scope of grounded theory, especially in MOOC education research combined with the epidemic background.Based on the findings of this study, the following policy implications are proposed:(1) Innovate teaching evaluation methods and set up a comprehensive evaluation index system combining “teacher teaching” and “student learning”. Existing MOOCs achieve their most effective teaching based on the teaching content, teaching methods, teaching attitude, and teaching effect . These f(2) Improve the evaluation index system and increase qualitative incentive evaluation. In addition, fully explore the learning evaluation function of MOOCs platform, improve the evaluation mode, emphasize dynamic process evaluation, and improve the degree of cooperation and enthusiasm of course teachers. For example, MOOC teaching managers in colleges and universities could consider setting up qualitative incentive evaluations, issuing questionnaires to identify and evaluate students’ opinions on educators’ teaching before they start teaching MOOCs, and encouraging students to provide positive feedback and praise to teachers as appropriate. At the end of the evaluation in this study, students were asked to conduct a qualitative incentive evaluation of the teacher’s MOOC teaching. First, the progress achieved by the teacher during the course was described, and then any shortcomings of the teacher’s MOOCs teaching were highlighted. These types of constructive, qualitative comments help to ensure that teachers feel that students are paying attention and are interested in their teaching. Through encouraging feedback, teachers can enhance their confidence and enthusiasm in teaching, improve the quality of MOOC teaching, and tailor their teaching style based on students’ comments.Due to time constraints, there are certain limitations in the research process in this work. For example, in this study, we only investigated students and teachers who are MOOC users and did not interview MOOC platform software developers. Therefore, the conclusions of this study are limited to analysis only from the perspective of MOOC teaching platform users. Accordingly, in future research, we plan to conduct field research on software developers to further verify and expand the study’s conclusions from multiple perspectives.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.The studies involving human participants were reviewed and approved by Research Ethics Committee of Guangzhou University. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.JL and XW were contributed to conception of the study. JL was performed the formal analysis. XW was conducted the validation. YY wrote the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.


Research partnerships between universities and communities following the principles of community-based participatory research (CBPR) have the potential to eliminate cycles of health disparities. The purpose of this article is to describe the process of establishing a community-campus network with a distinct mission and vision of developing trusting and successful research partnerships that are sustained and effective. In 2019, Morgan CARES was established to facilitate community engagement by founding a community center “within” a low-income residential neighborhood as a safe and accessible hub for creating a vibrant learning community. A community needs assessment and asset mapping was conducted and several necessary resources and services were provided to maximize networking opportunities, nurture innovative ideas and proposals, and provide seed funding. Lessons learned informed the optimization of a theoretical model that has guided the development and implementation of the program’s key components. By December 2021, Morgan CARES had recruited 222 community and 137 academic members representing diverse expertise from across Baltimore City. We also successfully established new partnerships and funded a total of 17 small community-academic awards. Although in its early stages, Morgan CARES has established a dynamic learning community following a conceptual framework that could guide future similar initiatives. Active participation of under-privileged communities in research has received increasing attention and funding over the past several decades for various reasons. Paulo Freire, the Brazilian educator, founded the basic principles of action research based on his endeavors aimed at empowering poor Brazilian workers through adult literacy education so they can be emancipated from the barriers that limited their potential . By usinFollowing CBPR principles have proven to be challenging to achieve. Throughout the literature, a few distinctive features are described to distinguish CBPR studies from traditional academic research, such as: having a community advisory board or council overseeing the project  and, invMany educational materials and funding opportunities for developing CBPR studies currently exist, but few programs actively provide logistical  or capacity-building opportunities  to start and maintain effective and balanced partnerships ,12. WhilSimilarly, Morgan State University (MSU), an HBCU  in Baltimore City, has worked intentionally over the past 20 years using the CBPR approach and has a history of working in the community with community engagement activities and programs. In 2010, MSU recognized those neighborhoods within a one-mile radius of the campus as the “Morgan Community Mile” and encouraged all academic programs and departments to actively collaborate with the residents and community leaders to enhance health, safety, economic status, and educational outcomes through innovative initiatives ,15,16,17Furthermore, through the CEASE (Communities Engaged and Advocating for a Smoke-Free Environment) project, a successful tobacco treatment program was developed involving a partnership between academic researchers and poor underserved neighboring communities of Baltimore City . In addiThe purpose of this article is to show how a trust-building needs assessment process, supported by an engaged steering committee, can be used to develop a sustainable community and academic partner-enhanced co-learning research environment using the Morgan CARES Model adapted from existing CBPR models. envisions healthy communities where equity exists without struggle. Designed by researchers with extensive experience in public health, community-based, and clinical research, and community partners with extensive project implementation experience, Morgan CARES is serious about building capacity for community engagement while addressing health disparities. The overall function, leadership, and direction of Morgan CARES is governed by a Steering Committee consisting of 12  members with a broad spectrum of community experience and expertise. The committee provides programmatic oversight including strategic planning initiatives recommendations to ensure that Morgan CARES retains a balance between community and academic perspectives. Funding for the operation of the Center was partially sub-awarded to a non-profit organization  with strong community ties and relationships with equity-oriented local groups and leaders to serve as a fiscal sponsor [MSU’s Center for Urban Health Disparities Research and Innovation launched its Community Engagement Core, called the Morgan CARES (Community-Aligned REsearch Solutions) program, in 2019 to tackle the issues of community engagement using the CBPR approach through funding from NIH’s National Institute of Minority Health and Health Disparities (NIMHD) . Morgan  sponsor .Morgan CARES Community Center (MCCC) serves as the physically accessible space for creating a dynamic learning community where community and academic members network, share knowledge and resources, and work toward eliminating health disparities while producing new generalizable knowledge. MCCC also provides a wide range of free services including office space for meetings, a kitchenette, a space for CBPR projects that involve youth, and access to computers and printers for community use. Partnerships are formed and strengthened through research training, technical support, workshops, classes, and community events and activities. The community center is surrounded by four neighboring underserved urban communities, depicted using a Geographic Information Systems (GIS) mapping tool map in , all of Many households live below the poverty level and have high rates of unemployment. Only an average of 9% of the population 25 years of age and older have completed a college degree (or more). In these same areas, health-related problems are entrenched with the highest rates of mortality due to heart disease, cancer, and HIV. Life expectancy at birth is between 66–70 years compared to 73.6 years for Baltimore City. These documented snapshots of the state of health in East Baltimore shown here are not relevant to just this region of the city; similarities are found throughout low-income neighborhoods in Baltimore City. With this knowledge, Morgan CARES believes that working toward the goals of health equity, by partnering with community stakeholders across Baltimore City, is not only possible but necessary.The Morgan CARES Model is designed to provide a framework for conducting CBPR work in communities to address health disparities and is guided by Wallerstein’s CBPR conceptual framework on CBPR partnership success ,23. FiguConnection is the initial stage where academic and community members learn about each other and their research interest. For example, a first-time member would complete a form that captures the reasons for their interest in joining the network. From there, all members have access to information sessions to learn the benefits of joining Morgan CARES, and introductory training to gain knowledge of how Morgan CARES aims to work towards addressing public health challenges in local communities, and community events. (2) Partnership Development occurs when participants commit to increasing their engagement from the “Membership” level to the “Partnership” level. The Member will provide information about their research interest and expertise. The Morgan CARES administrative team uses this information to match the partner, (academic or community) with individuals who have complementary attributes and interests. It is within this stage that partners receive supportive services including targeted communications for advanced training, networking opportunities, and discussion forums. Though individuals join with different levels of skills, we provide space for reciprocal exchange and bidirectional learning. (3) Innovation. Once connections with potential partners have been made, matched partners (community-academia) begin to discuss project ideas, formalize their commitment to work together, and design a research project. Partners would also attend advanced targeted training and other specific skill-building opportunities that support the development of their proposal including consultation on grant-writing, proposal preparation, and proposal revision. Partners would receive ongoing support services for their project needs including technical assistance and seed funding opportunities. (4) Collaborative Action. It is expected that funding (or other resources) has been secured and partnerships have initiated project activities. Partners have access to MCCC at low or no-cost to support project implementation and activities including technical assistance, and logistical support to further sustain their collaborative activities. (5) Outcome and Impact. Analyses conducted to determine outcomes and research results are formalized into reports that can be shared. These results may be made available to various stakeholders, such as the scientific communities and non-scientific communities, policymakers, students, faculty members, and other interested parties. In addition, partners may receive supportive services such as technical assistance and targeted learning activities to help sustain projects and partnerships including professional writing, grant sourcing, data management, and linkage to additional resources or services. During this stage, partnership teams can use additional support to report their findings. Following dissemination, seed-funded projects have the potential to mature into larger projects that promote changes in health policy and programming, as well as impact health behaviors within communities.The Morgan CARES Model has five stages: (1) n = 25) within a mile radius of the MCCC. The information gleaned from these efforts informed the initial development of activities to support Morgan CARES Community Award initiative. The second needs assessment was conducted to identify the programming needs for groups doing work in the community. Several community-based organizations, faith-based groups, and other resident leaders participated in the four (4) key informant interviews and two (2) focus groups (n = 29). Interviews and focus groups were conducted based on the type of work individuals were involved in and facilitated by MCCC staff and researchers. Examples of interview questions included “Can you tell me about yourself and a brief history of your work in the community?”; “What barriers or challenges does your organization currently face?” and “What does successful community engagement look like?” All interviews and focus groups were conducted virtually utilizing the Zoom® platform. Interviews were documented by hand-written notes, audio recordings, and transcriptions using Panopto.As the first step in connecting and developing strategies for health and wellness projects, Morgan CARES began with a community needs assessment to set the stage for building a trusting, mutually beneficial relationship. The first needs assessment conducted was specific to developing the activities to support the Community Award Initiative. There were four (4) key informant interviews, and three (3) focus groups conducted with community residents and other stakeholders (The Community Award is an initiative that provides seed funding of up to $2000 (each) for up to ten (10) innovative, small, health-related projects each award cycle. The goal of this award is to support the formation, strengthening, and maintenance of community-campus collaborative partnership teams in the production of meaningful initiatives that could be scaled to improve health equity in Baltimore City. The Community Award process involves community leaders and academic experts connecting and partnering that follows a sequential process based on the Morgan CARES model that first begins with joining the network to become a “Member” .According to the Morgan CARES model, the initial step is about providing representatives from nonprofits, academia, and faith- and community-based organizations with opportunities to connect with others in the network and target issues that directly impact their community. By joining the network as a “Member”, individuals will receive updates about Morgan CARES from regular e-newsletters, email announcements, information and resource sharing, opportunities for funding, access to the Morgan CARES Community Center space, events and activities, mentorship, and support with external projects . Participants could express interest in increasing their engagement from the “Membership” to “Partnership” level. The partnership includes community partners getting linked (matchmaking) to potential academic partners based on common research interests for the purpose of collaborating on health-related projects, programs, and initiatives. A partner receives benefits such as priority access to training sessions, workshops, the MCCC, professional development, and eligibility for the Morgan CARES Community Award. Partnership teams include co-leads: at least one Community Lead and one Academic Lead (from MSU).Once community-academic partners have identified a research problem, the partners work together to co-develop an innovative project proposal that can research solutions to improve health. In this stage, the team develops a project plan that explains how funding would be used to address these needs. The specific roles of each partner are also discussed in addition to the sequential steps needed to achieve the aims and the expected impact on community health. All project teams have access to training, seminars, workshops, technical assistance, and consultations provided by Morgan CARES to support the development of proposals. All proposals must include components based on co-identified needs such as the project title, timeline, aim, type of project, focal community, description of health problem, activities and timelines, expected impact on community health, amount requested, budget, additional funding, and ethical considerations. Eligible applications must be submitted by a community-academic partnership, have a project timeline of 1 year or less, contribute to the overall improvement of health, target a specific group or community, be committed to disseminating the results, and expand the project and partnership. Partners submit proposal applications for review by the submission deadline. All applications go through a three-step review process. The first step is the Administrative Review by the Morgan CARES Administrative team, an initial review to check each application for completion. Only completed applications move forward to the second review step, the External Review. At this step, one or more expert reviewer(s) in a relevant field (who are not affiliated with the Morgan CARES Program) examine and score the proposals. The top-scoring proposals are provided to the Steering Committee Review Task Force, who then review and rank the proposals they feel should be funded. Following a discussion among the Task Force members, the top proposals are selected for funding by the Morgan CARES Community Awards Program.At this step, project funding has been secured, and community-academia partners have commenced implementing the project activities. Teams engage in ongoing training, workshops, seminars, and networking activities that support the progress of the project’s success. Each team submits a collaborative Mid-Project Report that gives updates on the project status and the summary of progress. A Mid-Project Partnership Evaluation survey is also completed individually, which assesses aspects of the partnership experience thus far. Lastly, upon completion of project activities, project teams evaluate the outcomes and impact of their project. This stage also includes steps of identifying funding sources that support the continuation of the project and plans for sharing project outcomes with the community through dissemination efforts, activities, and materials. All awardee teams complete a Final Project Report and Partnership Evaluation that addresses skill development throughout the process describes any needs for improvement and plans for sustainability and future collaborations.2) CBPR Conceptual Model to evaluate the outcome and impact of the community award initiatives overall [2 tool, data included indicators for success for each stage measuring: (1) capacity ; (2) commitment to collective empowerment and relationships ; (3) relationships ; (4) community engagement in research actions and synergy ; and (5) outcomes to measure partner and partnership transformation  and projected out projected outcomes  leaders had pre-existing relationships, while the majority of community leaders required linkage and matchmaking services to identify connections with academic faculty and students at MSU. Additionally, over 75% of community leaders already had an idea for their project. Workshop and consultation sessions were provided to support partnerships in every stage: proposal development, seed funding award, implementation, and findings dissemination. Over the past 2 years , Morgan CARES  conducted over 187 activities with 969 persons in attendance . Group cThe seed funding from Morgan CARES created a real impact in our local community by allowing ideas to expand, grow, and essentially come to life. Overall, 46 complete proposals ((Cohort 1 (2020–2021) and Cohort 2 (2021–2022)) were submitted and went through the competitive review process detailed in the “Methods” section. Recommendations were made based on the outcome of the review process, and projects were either recommended for funding pending “minor revisions” or “major revisions”, or they were “recommended for resubmission, pending major revisions”. Seventeen (17) projects received $2000 of funding to carry out their projects, though two (2) were discontinued. Partnerships whose projects were not funded and “recommended for resubmission” received one-on-one assistance to help develop proposals further based on reviewer comments. Three (3) projects that were recommended for resubmission from Cohort 1 and were resubmitted in Cohort 2 received funding. As described in There is an abundance of community-engaged research examining health disparities in underserved communities and primarily focusing on reducing disparities through conducting translational research. There are very few programs, however, with explicit missions of enhancing the capacity for conducting CBPR and facilitating research partnerships with underserved communities ,12. PartMorgan CARES has had two unique outcomes that can be useful in moving CBPR methods forward: (1) we created a well-constructed and appointed community learning space where both community members and academics can meet in a common place; (2) and we developed a Community Award program that provide support activities tailored to building community-academic partnerships. CBPR is based on a trust-building process , and MorTo effectively make a difference through CBPR, key community stakeholders must be properly engaged. Stakeholders including community members, nonprofit organizations, activists, medical professionals, and policymakers that focus on health equity are required to be equipped with a better understanding of why there are continued cycles of health disparities in underserved communities ,12,34. IMorgan CARES has used its model to create the infrastructure needed to implement small grants with academic/community partners. (Tools created for this process are available upon request). A key implementation strategy leading to the success of our program included following partners through all steps of research. We watched partnerships evolve into what the Morgan CARES team believed was possible, building collaborative relationships between community and academia. We carefully monitored partnerships’ progress and provided the necessary resources, relevant to each stage of the Morgan CARES model, as such to ensure accountability and the impact of relationships. Partnership evaluation was also an essential part of the Morgan CARES program as it helped in strategic planning, redefining strategies, taking appropriate actions based on recommendations, and improving resources to build capacity and sustain successful CBPR . We chosOther challenges for CBPR work include difficulty in finding faculty to commit to CBPR due to a lack of funding. For the successful implementation of this program, small grants should be increased considerably to allow our community partners to be adequately compensated for the time that is put into these projects. In this way, the faculty would be willing to make this investment. In addition, seed funding was used to create a pathway that aid in building the community-academic relationship; however, there should be a pathway for continued funding that is guaranteed to support the formed partnership. Despite these challenges, our work is moving in the same direction as NIMHD by opening doors for this work to move and can be funded appropriately.In conclusion, this article describes the relevance and significance of the Morgan CARES community center and how it plays a crucial part in creating the opportunity to build research projects that can promote health equity in underserved neighborhoods in our communities. Although still in its early stages, the Morgan CARES approach is a successful model and provides the groundwork for other community engagement cores to follow in the development of critical strategies for integrating sustainable support for CBPR. Morgan CARES has a well-appointed space for people to meet and has created the means of building trusting relationships within our neighborhoods, despite historical challenges, and fostering a co-learning environment. The disparity in health based on where you live is worldwide and has been attributed to the inequitable distribution of resources necessary to support health and wellbeing. Therefore, developing an infrastructure within communities that focus on fostering relationships is an important first step in moving toward solutions with key community members to enhance overall health outcomes.


Several quality improvement programs have been successfully created with very promising results.3 One great example of quality improvement initiative is the ImproveCareNow (ICN) pediatric network that includes over 100 pediatric IBD centers mainly in the United States but also internationally.4 Another collaborative work to improve learning health systems (LHS) is the Crohn’s and Colitis Foundations’ IBD Qorus LHS.5 This is a network of over 50 academic and private IBD practices that work together toward improving healthcare outcomes in adults with IBD and have already lead to reductions in emergency room visits, hospitalizations, and opioid use in adults with IBD.6In its 2018 impact report, Crohn’s and Colitis Canada (CCC), the significant health and economic burden of inflammatory bowel disease (IBD) was highlighted.In any of these networks, and to allow clinicians and administrators to improve the healthcare system, collecting accurate data on the provided services, quality measures, and healthcare outcomes is prudent for the success of LHS. Several data sources exist and include administrative databases, electronic health records (EHRs), and patient self-reported data with pros and cons in each option.7 compared patient self-reported data on medication utilization, vaccinations, and some other aspects of healthcare use such as emergency department visits and hospitalization, to EHR within 4 sites of the IBD Qorus LHS. They analyzed data from 328 IBD patients who were surveyed about utilization of some healthcare services, mainly IBD-related emergency department visits, hospitalizations, and computerized tomography scans that they received in 6-month period before the survey. The agreement between patient-reported and EHR-obtained data was reassuring and ranged from 89% to 96%. At the time of patients’ visit, the agreement between self-reported medication use and the EHR was 92% for both corticosteroid and opioid use. On the other hand, the agreement between self-reported and EHR-reported vaccination status was 61% agreement for influenza vaccinations in the previous year and 68% agreement for pneumococcal vaccinations that were ever received. The study results are important and concordant with other studies that showed that, despite a relatively long recall period, patient self-reported data on hospital utilization and medication are usually accurate and reliable.9 However, and as mentioned by the authors, the study conclusions are limited by the lack of the exact survey completion rate and hence the probability of selection bias.In this issue of Crohn’s & Colitis 360, Van Deen et alOverall, this work is a confirming step on the reliability of patient-reported data and clearly signifies the importance of partnership between patients and healthcare personnel toward improving healthcare systems.