were first-time users of mobile health-van services (Mimiaga et al., 2008). Mobile vans have some drawbacks. Shrestha et al. (2008) reviewed the cost effectiveness of clinic-based versus mobile outreach efforts to identify HIV cases. They found that the cost of providing a new HIV diagnosis was considerably higher in the outreach settings than in the clinic (Clark et al., 2008). However, a clinic setting is effective only if clients are drawn to the facility. Hence, innovative approaches of this type should be considered for hard-to-reach populations.

Recommendation

Integration of viral hepatitis services into venues such as STD-HIV clinics, shelters, and mobile health units, is likely to have long-term benefits because most of the people who use these types of clinics engage in high-risk behaviors or are in high-risk settings. Therefore, the committee offers the following recommendation:

Recommendation 5-10. The Health Resources and Services Administration and the Centers for Disease Control and Prevention should provide resources and guidance to integrate comprehensive viral hepatitis services into settings that serve high-risk populations such as STD clinics, sites for HIV services and care, homeless shelters, and mobile health units.

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Alter, M. J. 2006. Epidemiology of viral hepatitis and HIV co-infection. Journal of Hepatology 44(Suppl 1):S6-S9.

Alter, M. J., W. L. Kuhnert, and L. Finelli. 2003. Guidelines for laboratory testing and result reporting of antibody to hepatitis C virus. Centers for Disease Control and Prevention. Morbidity and Morality Weekly: Recommendations and Reports 52(RR-3):1-13, 15; quiz CE11-CE14.

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