exposure to educational materials about hepatitis C or that such materials do not communicate accurate information effectively.

HCV-positive patients perceive that health-care providers are judgmental toward those with HCV infection because of its association with illicit drug use (Janke et al., 2008). Numerous studies have shown that healthcare workers have extremely negative views of IDUs and characterize them as manipulative, unpleasant, and uncooperative (McLaughlin et al., 2000; Paterson et al., 2007). Such attitudes among health-care providers can have a number of deleterious effects, including discouraging of at-risk persons from accessing testing and other services and reducing the effectiveness of HCV education and counseling messages (Zickmund et al., 2003).

Additional research has examined HCV knowledge among drug-treatment providers. Research conducted with 104 members of the staffs of two drug-free and two methadone-maintenance treatment programs (MMTPs) in the New York metropolitan area demonstrated that knowledge about hepatitis C is inadequate (Strauss et al., 2006). Five of 20 items on an HCV knowledge assessment were not answered correctly by the majority of the participating staff, suggesting that staff may be systematically misinformed rather than merely uninformed about some important HCV issues that affect their clients. Total scores on the assessment averaged 70%, 71%, and 45% among the medically credentialed staff, noncredentialed staff in the MMTPs, and noncredentialed staff in the drug-free programs, respectively. The majority of those in the latter group had never participated in training specifically devoted to HCV; these staff may be sharing incorrect information with patients or, aware of their limitations in HCV knowledge, failing to provide patients much needed HCV information. It is critical that both medically credentialed and noncredentialed staff in the programs receive effective HCV training so that they can support their patients’ HCV education and information needs appropriately.

Recommendation

Many providers are not aware of the high prevalence of chronic hepatitis B and hepatitis C in some populations. Improved understanding of risk factors for acute and chronic HBV and HCV infections and collection of data on them, including country of birth and ethnicity, and the use of risk-factor screening will lead to increased identification of cases, increased provision of preventive resources, increased vaccination to protect those at risk for hepatitis B infection, and reduction in disparities in the burden of chronic viral hepatitis.

On the basis of the evidence described above, the committee concludes that insufficient provider knowledge leads to critical missed opportunities for providers to educate patients about prevention of hepatitis B and hepa-



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