about transmission and risks of HBV infection and that it promote testing, vaccination, and medical management.

Rein et al. (2009) estimated that there are 55 active community-based hepatitis B outreach programs in the country that were targeting mostly APIs, of which they contacted 31. Although those programs have done much to inform APIs about hepatitis B, there is a need for additional programs that target APIs, given the burden of hepatitis B within that population.

There is also a need for education programs that target foreign-born people from other HBV-endemic regions. The models used by programs designed for APIs could be modified to address the needs of other populations. Community-based education and screening programs—including outreach at cultural festivals, health fairs, and places of worship—have been shown to be effective in improving APIs’ knowledge about hepatitis B (Chao et al., 2009a; Hsu et al., 2007; Juon et al., 2008; Lin et al., 2007) and could potentially be effective with other ethnic populations. Each year, around 20,000 people are tested through those programs, and HBsAg is detected in about 8% of the tested population (Rein et al., 2009). Some 30% of the programs were supported by local government funding, 27% by state funding, and 10% by federal funding. Other sources include pharmaceutical and insurance companies, research and service grants, community hospitals, and other private funding sources (Rein et al., 2009).

Rein et al. (2009) also found that there were few or no hepatitis B outreach programs in most regions of the United States (the Southeast, the Midwest, and the Southwest outside of California and the Houston area). Education and prevention programs should be expanded to provide services in underserved regions of the United States given that the highest rates of acute hepatitis B incidence are in the south (Daniels et al., 2009).

Correctional Facilities

About 2 million people are incarcerated in the US correctional system. The major risk factors for viral hepatitis in people in correctional facilities are injection-drug use, tattooing, and sexual activity (see Chapters 4 and 5 for additional information about incarcerated populations). Because people in the correctional system are more likely to be infected or to become infected with HBV and HCV than the US general population, it is important to provide educational opportunities about hepatitis B and hepatitis C in correctional facilities. Increased knowledge and awareness about the diseases will lead to a greater understanding among inmates about how to prevent them, the advantages of hepatitis B vaccination, why they should be tested for chronic hepatitis B and hepatitis C, and what to do about a positive test result for either infection. Niveau (2006) reviewed risk factors



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