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TABLE OF CONTENTS
National
Hepatitis C Prevention Strategy 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.
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.
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
At-Risk Populations
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.
General Public
These include:
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.
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.
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.
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.
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(888)4-HEP-CDC
This page last reviewed October 1, 2004 All
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