prevalence of chronic HBV infection and HBV-related liver cancer (Asian Liver Center, 2009). The Harm Reduction Coalition is an example of an organization that develops and disseminates hepatitis C information among illicit-drug users (Harm Reduction Coalition, 2009). Information regarding the activities and programs supported by NGOs are presented primarily in Chapter 3.

Health services provided by federal agencies, state and local governments, and NGOs do not form part of a coordinated national campaign. Existing efforts at interagency information exchange, intermittent meetings to share plans and results, and joint administration of funds for some grants are not sufficient for the scale of the health burden presented by hepatitis B and hepatitis C. The lack of an accountable entity to lead a coordinated national effort has led to missed opportunities for prevention and identification of and treatment for chronic HBV and HCV infections.

COMPONENTS OF VIRAL HEPATITIS SERVICES

The committee has identified five core functions for comprehensive viral hepatitis services—(1) community outreach, (2) prevention, (3) identification of infected persons, (4) social and peer support, and (5) medical management (Box 5-3). Community outreach and immunization for primary prevention are discussed in depth in Chapters 3 and 4, respectively. Identification of infected persons, harm reduction, and medical management are reviewed below.

Identification of Infected Persons

There are two goals for identifying people chronically infected with HBV and HCV: to prevent transmission to close contacts (for example, through sharing of needles and other paraphernalia and through household and sexual contacts) and to reduce the risk of chronic liver disease through medical treatment and support. The identification of HBV-infected and HCV-infected people requires engagement of at-risk people and activism by the health-care–provider community. As discussed in Chapter 3, culturally relevant, accessible, and trusted sources of communication are required to increase awareness and promote use of appropriate services. Health-care and social-service providers, particularly primary-care providers, should be knowledgeable about chronic HBV and HCV infection and identify patients who are at risk because of their behavior or previous potential exposure to HBV or HCV. Programs and venues that serve at-risk populations—such as foreign-born people from HBV-endemic countries, the uninsured and underinsured, illicit-drug users, and homeless people—should also be knowl-



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