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The goals of
hepatitis C prevention and control efforts are: 1) to reduce the
incidence of new infections by reducing HCV transmission; and 2) to
reduce the risk of chronic liver disease in HCV-infected individuals
through appropriate medical management and counseling.
These goals
can be achieved by identifying persons at risk for infection and
providing them with education, risk reduction counseling, HCV
testing, and appropriate medical services including substance abuse
treatment. Preventing or changing behaviors and activities that
place persons at risk for HCV infection should reduce disease
transmission. Appropriate testing, medical management and substance
abuse counseling and treatment should reduce the risk of chronic
liver disease. Implementation of the following activities is
required to achieve these prevention goals.
Identifying
persons at risk for infection.
Because of the large number of Americans infected with HCV,
identification of these persons through testing is a high priority.
Testing should be routinely offered to persons most likely to be
infected with HCV. In addition, anyone who wishes to know their HCV
infection status should be provided the opportunity for testing. In
all instances, testing should be accompanied by appropriate
counseling and referral for medical follow-up.
Persons
for whom routine HCV testing is recommended
Persons who ever injected illegal drugs, including
those who injected once or a few times many years ago.
Persons who received a blood transfusion or organ
transplant before July 1992.
Persons who received clotting factor concentrates
before 1987.
Persons who were ever on long-term dialysis.
Children born to HCV-positive women.
Healthcare, emergency medical, and public safety
workers after needlesticks, sharps, or mucosal exposures
to HCV-positive blood.
Persons with evidence of chronic
liver disease.
To identify
persons who should be counseled and tested for HCV, health care
professionals in primary care, specialty, and public health settings
should routinely question patients about risk factors for infection,
including history of injecting drug use. Current injecting drug
users are often not seen in primary care or other traditional health
care settings. However, targeted outreach in other settings may be
particularly effective in reaching this population. These settings
include correctional institutions, drug treatment programs, programs
for high risk youth, HIV counseling and testing sites, and STD
clinics.
Persons
infected with HCV because of medical risk factors (e.g.,
transfusion, hemophilia, chronic hemodialysis) should be identified
by health care professionals and through educational efforts
provided by patient organizations. Many of these persons have been
tested for HCV and testing should be encouraged for those not
previously tested.
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Health care professionals in primary care, specialty, and
public health settings should routinely question
patients about risk factors for HCV infection.
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Health Education and Communication. Achieving high levels of awareness concerning hepatitis C
prevention and maximizing the number of infected persons identified
require education and communication directed at health care and
public health professionals, persons in groups at risk for
infection, and the general public.
Health Care
Professionals
Education of health care professionals requires:
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Continuing medical education programs such as found at
www.cdc.gov/hepatitis and development of clinical and public
health practice guidelines to facilitate the incorporation of
recommendations for the prevention of HCV infection and its
consequences2
into clinical and public health practice
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Development and dissemination of materials to aid
health care professionals in identifying persons at risk for HCV
infection during primary and specialty health care visits, at
clinics that provide public health services, in drug outreach
and substance abuse treatment programs, and in correctional
health programs.
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Periodic updates of guidelines for the diagnosis,
treatment and prevention of hepatitis C and continuing medical
education programs to disseminate this information at the local
and national level.
At-Risk
Populations
Development and distribution of educational messages for groups of
persons at increased risk for infection should include persons
transfused prior to July 1992;incarcerated populations; substance
abusers including those in treatment and outreach programs; persons
at risk for HIV/AIDS and STDs; and persons attending other community
health programs.
Recent data
indicate that prevalence of HCV infection among incarcerated
populations is 3-5 times greater than prevalence in the general
population. In addition, messages need to be developed for
individuals who may have experimented with injecting drug use only
in the distant past, since these persons may not regard themselves
as being at risk for infection because they did not become long-term
or habitual users.
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HCV prevalence among prison inmates is 3-5 times greater
than in the general population. |
General
Public
Culturally-sensitive, multimedia advertising and education in
English, Spanish and other languages are needed to increase public
awareness about HCV infection; risk factors for infection; the need
for counseling, testing, and medical management to prevent chronic
liver disease; and how to differentiate hepatitis C from other types
of hepatitis.
These include:
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Materials for use in clinic and other health care
waiting rooms, correctional settings, drug treatment and
prevention programs, and outreach programs for persons at risk
for HIV/AIDS.
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A full-time, national hepatitis hotline and
information line (1-888-4HEP-CDC) that provides both recorded
information and interactive counseling.
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A web site (www.cdc.gov/hepatitis)
that provides information about frequently asked questions,
patient and provider educational materials, and hyperlinks to
other sites which provide information on viral hepatitis.
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Regional or local sources that provide accurate
information to concerned persons or groups in a culturally
sensitive manner and in the language that is best understood by
the requestor.
Counseling,
Testing, and Medical Referral.
Identification of persons at risk for HCV infection should initiate
both counseling and testing, however, counseling can be performed
without testing.
Individuals
with ongoing risk factors for HCV infection should receive
client-centered education and counseling which concentrates on
changing behaviors that place them at risk for infection. These
behaviors include substance abuse, sharing of injection drug use
equipment, and high risk sexual practices. In addition to risk
reduction counseling, at-risk persons should be referred to
appropriate harm reduction programs, including treatment for
substance abuse and syringe and needle exchange sites. In addition,
these persons should receive hepatitis A and hepatitis B
vaccination.
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At-risk persons should be immunized with hepatitis A and
hepatitis B vaccine, as appropriate. |
HCV testing is
required to identify infected persons at risk for chronic liver
disease and for transmitting HCV to others. When testing is
performed, HCV positive individuals require: 1) counseling to
reduce the risk of HCV transmission to others; 2) medical referral
to determine the extent of their liver disease; and, if appropriate,
3) counseling to limit their alcohol intake, antiviral treatment,
immunization with hepatitis A, hepatitis B, pneumococcal and
influenza vaccines, and treatment for alcohol or drug abuse. HCV
negative persons with ongoing risk factors require counseling
concerning ways to reduce their risk for infection, referral to
substance abuse treatment if appropriate, and immunization with
hepatitis A and hepatitis B vaccines.
Hepatitis C
counseling should be performed in a consistent, client-centered
structure. Counseling materials are currently being developed and
have not been extensively evaluated for effectiveness.
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Integration of HCV counseling and testing into existing
programs may enhance identification of persons at risk for
HIV and HBV infection. |
Based on
current experience in counseling persons at risk for HCV infection
or with hepatitis C, a wide variety of information must be available
to the counselor. This includes information on harm reduction for
persons at continued risk for infection, the meaning of positive
test results, the importance of medical evaluation for chronic liver
disease, the health outcomes of HCV infection and hepatitis C, the
risk of transmission to family members or other contacts, and
immunization to prevent infection with hepatitis A, hepatitis B, and
other diseases.
Staff training
is required for effective hepatitis C counseling and health
education. While many hepatitis C prevention messages are similar to
those for HIV, several aspects of hepatitis C prevention are
different and must be integrated into counseling and testing
activities to best meet the needs of the client.
In addition,
culturally appropriate health education materials will be required
for use by health care providers, and patient support groups.
While the
capacity for HCV (antibody) testing exists in all blood banks and
most hospital and private diagnostic laboratories, a recent survey3
showed that less than 50 percent of state and local public health
laboratories have the capacity to perform any type of HCV testing.
As with HIV testing, HCV antibody testing requires the laboratory
capacity to perform supplemental testing to confirm that the initial
test result represents a "true positive" and that the client does
not receive incorrect information concerning his or her HCV
infection status. To determine whether a person has chronic HCV
infection requires nucleic acid testing for HCV RNA (‘PCR testing’).
While this type of testing was only available in research
laboratories several years ago, it is now becoming better
standardized and available in many diagnostic laboratories.
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Less than 50 percent of state and local public health
laboratories have the capacity to perform HCV testing.
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Counseling and
testing sites should provide referral for the medical evaluation of
persons who test HCV-positive. The initial medical evaluation of an
HCV positive individual does not require a specialist (e.g.,
hepatologist, gastroenterologist).
However, the
referral physician should be familiar with the interpretation of the
diagnostic work-up required to ascertain whether a patient has
chronic HCV infection and evidence of liver disease. In addition,
the physician should have contact with specialists expert in the
treatment and management of chronic hepatitis C.
Integration
of Hepatitis C Prevention into Other Prevention Services.
The
similar modes of transmission of HIV, HBV and HCV present a unique
opportunity to provide prevention services at a single client visit.
Integration of services to prevent bloodborne viral infections is a
relatively new concept. There is limited experience with combining
counseling, testing, prevention, immunization, and treatment
services for these diseases in HIV/AIDS prevention sites, STD
clinics, drug treatment sites, and correctional health programs.
However, data from several demonstration projects indicate that
integration of HCV counseling and testing into existing public
health programs is feasible and may enhance identification of
persons with risk behaviors for other bloodborne virus infections,
such as HIV and HBV. |
Hepatitis C Index:
Hepatitis C Health Info
Hepatitis C Fact Sheet
Hepatitis C Infection in the USA
Hepatitis C - Prevention & Control
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