fectious blood on injection equipment can result in infection—methods to promote safe injection can be considered essential for HCV control. Safe-injection strategies require access to sterile syringes and other equipment and education to promote adoption and maintenance of safe behavior. HCV testing and counseling to increase awareness of infection status will also support safe practices. Access to sterile syringes and other equipment can be increased through a combination of SEPs, pharmacy sales, and other methods, such as the use of syringe-vending machines (Islam et al., 2008; McDonald, 2009; Moatti et al., 2001). Drug treatment will reduce injection frequency and assist a modest proportion of injectors to achieve abstinence. Research has shown that none of those approaches by itself is sufficient to eliminate HCV transmission. Because HCV prevention is a function of multiple factors—safe-injection strategies, education, testing, and drug treatment—an integrated program that includes all these essential elements is more likely to be effective in preventing hepatitis C (see Figure 5-2).
Recommendation 5-3. Federal, state, and local agencies should expand programs to reduce the risk of hepatitis C virus infection through injection-drug use by providing comprehensive hepatitis C virus prevention programs. At a minimum, the programs should include access to sterile needle syringes and drug-preparation equipment because the shared use of these materials has been shown to lead to transmission of hepatitis C virus.
Recommendation 5-4. Federal and state governments should expand services to reduce the harm caused by chronic hepatitis B and hepati-