facilities will increase the likelihood that at-risk and HCV-infected persons in these settings receive consistent and accurate information.

Alternative-Care Providers

Alternative-care providers would also benefit from participating in educational programs about viral hepatitis. In California, four annual educational symposia, in 2004–2007, were arranged by a collaboration of academic, professional, and community-based organizations to improve HBV-related knowledge among traditional Chinese medicine practitioners and acupuncturists—providers who serve a largely API population, a patient population that has a high prevalence of chronic hepatitis B and the associated risk of hepatocellular carcinoma (Chang et al., 2007). A precourse survey was administered; about half the participants did not know ways to prevent HBV transmission, the age group most likely to develop chronic infection, which blood test to use to diagnose chronic infection, or the risk of death from liver disease or cancer in people who had chronic hepatitis B. The postcourse survey showed a statistically significant improvement in HBV-related knowledge: about 80% of participants were able to answer questions about prevention and diagnosis of and treatment for HBV infection correctly.

COMMUNITY KNOWLEDGE AND AWARENESS

The committee has found that knowledge and awareness about hepatitis B and hepatitis C are lacking in members of the public and, most important, in members of specific at-risk populations. Lack of knowledge and awareness about hepatitis B and hepatitis C in the community often leads to misinformation, missing of opportunities for prevention and treatment, and stigmatization of infected populations. The consequences for members of at-risk communities are important in that missing opportunities for prevention can lead to infection of additional people with HBV and HCV. Once infected, they frequently are unaware of their infection and so run the risk of unknowingly infecting others and of not receiving appropriate medical management. Although there have been no large-scale, population-based, controlled studies of community knowledge about hepatitis B and hepatitis C, all published surveys have shown that knowledge about these diseases is sparse.

Hepatitis B

As mentioned earlier, APIs are at high risk for chronic hepatitis B. A number of studies have assessed awareness and knowledge about hepatitis B



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