and social-service providers; the second addresses the topic with reference to the general population and at-risk populations. Each section begins by describing what is known about the levels of knowledge and awareness about hepatitis B and hepatitis C and how gaps in education about these diseases are affecting prevention, screening and testing, and treatment opportunities. Those summaries are followed by the committee’s recommendations for addressing the gaps and the rationale and supportive evidence for the recommendations.


The committee found that knowledge about chronic hepatitis B and hepatitis C among health-care providers, particularly primary-care providers (for example, physicians, physician assistants, and nurse practitioners), and social-service providers (for example, staff of drug-treatment programs, needle-exchange programs, and immigrant services centers) is generally poor. Although there have been no large-scale, controlled studies of health-care providers’ knowledge about chronic hepatitis B and hepatitis C, it is clear that knowledge has been imperfect among providers in all the surveys whose results have been published. Subjects of deficient knowledge include

  • The prevalence of chronic hepatitis B and hepatitis C in the general and high-risk populations in the United States.

  • The clinical sequelae of chronic viral hepatitis.

  • The characteristics of at-risk persons who should be tested for chronic HBV and HCV infection and vaccinated to protect them from hepatitis B.

  • The approaches to primary and secondary prevention in addition to hepatitis B vaccination.

  • The proper methods of testing and interpretation of test results.

  • The proper followup management for chronic infection.

Provider guidelines for hepatitis screening, prevention, treatment, and followup have been in place for decades and are updated regularly (CDC, 1991, 1998, 2005, 2008b, 2008c; Ghany et al., 2009; Lok and McMahon, 2009; Mast et al., 2005, 2006). However, current studies of provider knowledge about chronic viral hepatitis have not identified why health-care providers fail to follow national recommended guidelines.

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