pregnant women. It also examined venues that provide services to at-risk groups: correctional facilities, community health facilities, STD and HIV clinics, shelter-based programs, and mobile health units. The committee offers recommendations to address major deficiencies for each group and health-care venue.

General Population

Most people who are chronically infected with HBV or HCV are unaware of their infection status. As treatments for chronic hepatitis B and C improve, it becomes critical to identify chronically infected people. Therefore, it is important that the general population have access to screening and testing services so that people who are at risk for viral hepatitis can be identified. The federal government is the largest purchaser of health insurance nationally and is well positioned to be the leader in the development and enforcement of guidelines to ensure that the people for whom it provides health care have access to risk-factor screening, serologic testing for HBV and HCV, and appropriate medical management.

Recommendation 5-1. Federally funded health-insurance programs—such as Medicare, Medicaid, and the Federal Employees Health Benefits Program—should incorporate guidelines for risk-factor screening for hepatitis B and hepatitis C as a required core component of preventive care so that at-risk people receive serologic testing for hepatitis B virus and hepatitis C virus and chronically infected patients receive appropriate medical management.

Foreign-Born Populations

Nearly half of US foreign-born people, or 6% of the total US population, originate in HBV-endemic countries. Thus, there is a growing urgency for culturally appropriate programs to provide hepatitis B screening and related services to this high-risk population. There is a pervasive lack of knowledge about hepatitis B among Asians and Pacific Islanders, and this is probably also the case for other foreign-born people in the United States. The lack of awareness in foreign-born populations from HBV-endemic countries is compounded by the gaps in knowledge and preventive practice among health-care and social-service providers, particularly those who serve a large number of foreign-born, high-risk patients. The committee believes that the needs of foreign-born people are best met with the approach outlined in Recommendations 3-1 and 3-2. The community-based approach as outlined in Recommendation 3-2 would be strengthened by additional resources to provide screening, testing, and vaccination services.

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