in San Diego that began to offer risk-factor screening, laboratory testing, and immunizations services in 1998 (Gunn et al., 2007); the program included risk-factor screening of 21,631 people and found that about 69% of patients offered the hepatitis B vaccine accepted it.

A study of risk factors for hepatitis C and laboratory testing of people who sought care at an STD clinic found that 4.9% of the 3,367 attendees who were tested for HCV infection were positive (Gunn et al., 2003). Almost 85% of those who tested positive learned of their infection for the first time through this screening process.

Subiadur et al. (2007) found that viral hepatitis prevention services can be incorporated into a busy STD clinic if staff and resources are available. Similarly, an evaluation of Texas’s HCV program found that staff did not find it difficult to integrate hepatitis C services if sufficient resources were available, such as access to laboratory testing and adequate staffing levels (Heseltine and McFarlane, 2007).

Integrating viral hepatitis services into existing programs increases the opportunity for people to identify other unmet health needs or conditions. A study that assessed the integration of viral hepatitis services (vaccination and screening) into a New York City STD clinic found that the services attracted at-risk people to the clinic and that they benefited from the other services offered (Hennessy et al., 2007). Of 8,778 people in the STD clinic who received hepatitis services, 279 (3%) were self-reported IDUs and 161 (58% of these) reported that the availability of hepatitis services was the primary reason for their clinic visit. Among the 161, 12 new STDs and two HIV infections were diagnosed. IDUs made up only a small proportion of those who attended STD clinics in this demonstration project, but it seems clear that some IDUs will seek hepatitis services if they are offered without charge.

As with STD clinics, there are data that indicate that viral hepatitis prevention and care can be integrated into HIV clinics. The USPHS guidelines for management of opportunistic infections in HIV-infected persons include guidance for detection and management of chronic viral hepatitis (CDC, 2002). The guidelines call for testing of all HIV-infected persons for chronic hepatitis B and hepatitis C and for provision of hepatitis A and hepatitis B vaccination to those who are susceptible. In addition, there are guidelines for medical treatment of those who are chronically infected. There are data that suggest that a much lower proportion of patients actually receive treatment for chronic viral hepatitis. A study of 845 HIV–HCV coinfected patients who attended the Johns Hopkins HIV Clinic in Baltimore found 277 were referred for hepatitis C care. Of those patients referred to care, only 185 of these came for more than one appointment, 125 completed a pretreatment assessment, and 29 started HCV treatment (Mehta et al., 2006).



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