Hepatitis and Liver Cancer A National Strategy for Prevention and Control of Hepatitis B and C (2010) / Chapter Skim
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3 Knowledge and Awareness About Chronic Hepatitis B and Hepatitis C
3 Knowledge and Awareness About Chronic Hepatitis B and Hepatitis C
Pages 79-108
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From page 79... ...
. The persistently high prevalence of chronic HBV infection can be attributed in part to immigration of chronically infected people from HBV-endemic regions -- including East Asia, Southeast Asia, and sub-Saharan Africa -- to the United States.
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From page 80... ...
• The clinical sequelae of chronic viral hepatitis. • he characteristics of at-risk persons who should be tested for T chronic HBV and HCV infection and vaccinated to protect them from hepatitis B
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From page 81... ...
. In a survey of primary care providers in San Francisco, all 91 respondents correctly answered that Chinese immigrants have a higher prevalence of chronic hepatitis B than non-Hispanic white or US-born Chinese people.
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From page 82... ...
Chu (2009) presented data at the 2009 International Symposium on Viral Hepatitis and Liver Disease that showed that only 18–30% of Asian American primary care providers who treat Asian American adult patients reported routinely testing them for HBV infection in their practice.
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From page 83... ...
(2008) found that although 95% would recommend testing of IDUs for HCV infection, only 81% would recommend HCV testing for people who received blood transfusions before 1992, and only 65% would recommend testing of incarcerated persons -- all populations that are at high risk for HCV infection and that fall within national testing guidelines.
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From page 84... ...
Some 50% of the providers reported that they routinely ask their patients about risk factors for HCV infection; 78% test for HCV infection among patients who have increased liver enzymes with or without HCV risk factors, and 70% test all patients who have risk factors regardless of liver enzyme levels. When presented with a scenario on how to treat a hypothetical patient for chronic HCV infection, 27% of the respondents did not know which therapy to use.
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From page 85... ...
Improved understanding of risk factors for acute and chronic HBV and HCV infections and collection of data on them, including country of birth and ethnicity, and the use of risk-factor screening will lead to increased identification of cases, increased provision of preventive resources, increased vaccination to protect those at risk for hepatitis B infection, and reduction in disparities in the burden of chronic viral hepatitis. On the basis of the evidence described above, the committee concludes that insufficient provider knowledge leads to critical missed opportunities for providers to educate patients about prevention of hepatitis B and hepa
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From page 86... ...
• nformation about hepatitis B and hepatitis C prevention, hepatitis I B immunization, and medical monitoring of chronically infected patients, specifically, o Information about methods of testing and interpretation of results. o Information about medical management and long-term care: < How to select candidates for antiviral therapy.
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From page 87... ...
Educational Institutions Schools of medicine, nursing, physician assistants, complementary and alternative medicine, and public health should develop improved curricula to ensure that their graduates are knowledgeable about chronic hepatitis B and hepatitis C The curricula should include information on disease prevalence, risk factors, preventive actions, appropriate diagnostics, selection of persons for testing, and appropriate followup for chronically infected patients and those susceptible to infection.
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From page 88... ...
. Substance-Abuse–Related Service Providers Staff of drug-treatment programs, needle-exchange programs, and correctional facilities should be participants in viral-hepatitis educational programs.
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From page 89... ...
. A precourse survey was administered; about half the participants did not know ways to prevent HBV transmission, the age group most likely to develop chronic infection, which blood test to use to diagnose chronic infection, or the risk of death from liver disease or cancer in people who had chronic hepatitis B
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From page 90... ...
A voluntary, anonymous survey of 153 male and female inmates of the Rhode Island Department of Corrections revealed that over half the 30% who reported having risk factors for HBV infection did not consider themselves
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From page 91... ...
For example, in China, there is pervasive discrimination against people who are chronically infected with hepatitis B, who are frequently expelled from schools, fired from jobs, and shunned by other community members despite the recent passage of national antidiscrimination laws (China Digital Times, 2009)
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From page 92... ...
The Asian American Hepatitis B Program, a collaboration of community groups and academic and community health centers in New York City, provides hepatitis B screening, vaccination, and treatment. The program found that about 15% of newly tested persons had chronic HBV infection, all of whom were born outside the United States and half of whom had been in the country for more than 10 years (CDC, 2006)
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From page 93... ...
. The latter group includes adults at risk for infection by sexual exposure, IDUs, household contacts of chronically infected persons, developmentally disabled persons in long-term-care facilities, persons at risk for occupational exposure to HBV, hemodialysis patients, persons with chronic liver disease, and travelers to HBV-endemic regions, including Asia, Africa, much of Eastern Europe, the Amazon Basin, the Caribbean, and the Pacific Islands (see Box 4-1)
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From page 94... ...
. Among IDUs who have chronic HCV infection and are aware of their infection, the pattern is similar: the majority understand that they can transmit their infection by passing on their used syringes to others, but there is less certainty regarding the shared use of cookers, cottons, and rinse water (Rhodes and Treloar, 2008; Wright et al., 2005)
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From page 95... ...
. Many patients who have HCV infection wish to disclose their HCV status to family, intimate partners, and others in an effort to protect them from infection and to obtain psychosocial support.
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From page 96... ...
Fewer than half of all the patients correctly endorsed facts concerning HCV transmission, the duration of hepatitis C treatment, the potential effectiveness of hepatitis C medication in active drug users, the course of HCV infection, and the possibility of spontaneous clearance of the infection. To address the knowledge gaps, all the programs offered at least one form of hepatitis C education: all offered one-on-one sessions with staff, 12 of the programs offered hepatitis C education in a group format, and 11 offered education through pamphlets and books.
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From page 97... ...
Programs should be evaluated to ensure that they are effectively targeting the general public and at-risk people and populations. The general public should be targeted because HBV and HCV infections occur in people not easily identifiable as belonging to an at-risk population or people who fail to report potential risk factors (Daniels et al., 2009)
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From page 98... ...
Large employers, such as multinational corporations, are potentially important partners in hepatitis prevention and control in that they provide health benefits to about two-thirds of Americans who have health insurance and are commonly employers of foreign-born people from HBV-endemic countries both in the United States and overseas. The lack of knowledge and awareness about hepatitis B and hepatitis C in the general population suggests that integration of viral-hepatitis and liver-health education into existing health-education curricula in schools will help to eliminate the stigma of those chronically infected and improve prevention of viral hepatitis.
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From page 99... ...
The major risk factors for viral hepatitis in people in correctional facilities are injection-drug use, tattooing, and sexual activity (see Chapters 4 and 5 for additional information about incarcerated populations)
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From page 100... ...
Perinatal Facilities That Care for Pregnant Women The risk of chronic infection after exposure to HBV is highest in early life, and most people who have chronic hepatitis B were infected at birth or during early childhood. Each year in the United States, about 24,000 HBsAg-positive women give birth and about 1,000 newborns develop chronic HBV infection (Ward, 2008)
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From page 101... ...
There is a need to develop a novel program to educate pregnant women in perinatal-care facilities about hepatitis B to prevent perinatal transmission, to refer women who are chronically infected for medical care, and to refer family and household contacts for testing, vaccination, and care if needed. REFERENCES Altekruse, S
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From page 102... ...
2009a. The Jade Rib bon Campaign: A model program for community outreach and education to prevent liver cancer in Asian Americans.
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From page 103... ...
2007. A peer-education intervention to reduce injection risk behaviors for HIV and hepatitis C virus infection in young injection drug users.
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From page 104... ...
2008. Public health model for prevention of liver cancer among Asian Americans.
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From page 105... ...
2008. Hepatitis B virus-induced liver cancer in Asian Americans: A preventable disease.
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From page 106... ...
Journal of Viral Hepatitis 8(5)
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From page 107... ...
2007. Hepatitis B and liver cancer knowledge and preventive practices among Asian Americans in the San Francisco bay area, Califor nia.
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