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Journal of Public Health Management & Practice:
Original Article

Hepatitis C Prevention Programs: Assessment of Local Health Department Capacity

Fraser, Michael R. PhD; Buffington, Joanna MD, MPH, MS; Lipson, Leigh; Meit, Michael MA, MPH

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Abstract

Hepatitis C virus (HCV) infection is the most common bloodborne infection in the United States. To determine the capacity of local health departments to respond to concerns about HCV, local health officers were surveyed regarding HCV programs and needs. Of 612 respondents, fewer reported offering HCV services (education, counseling, testing) compared with those for HIV. Most respondents reported that technical assistance would be needed for HCV services and that such services should be integrated into existing HIV programs. Many local health departments may be unprepared for a growing need for public HCV services; integrated HCV-HIV programs should be considered.

HEPATITIS C VIRUS (HCV) infection is the most common chronic bloodborne infection in the United States. First identified in 1988, HCV is estimated to have infected as many as 242,000 persons in the United States annually during the 1980s. 1,2 Since 1989, the annual number of new infections has declined substantially to approximately 40,000 new infections by 1998. Most persons infected (75% to 85%), however, will remain chronically infected. A national survey conducted from 1988 to 1994 found that an estimated 2.7 million Americans are chronically infected with HCV, most of whom were age 30 to 49 years at the time of the survey. Today, an estimated 8,000 to 10,000 persons die from HCV-related liver disease annually. Because the serious consequences of chronic liver disease (cirrhosis, liver cancer) from HCV that may occur in up to 20 percent of persons with chronic infection do not become apparent for 10 to 20 years after infection, the number of persons dying from HCV is likely to rise substantially during the next decade without improved interventions. Most infected persons are not aware of their infection because they are not clinically ill; however, they serve as a source of transmission to others and are at risk for chronic liver disease, including cirrhosis and liver cancer.

The Centers for Disease Control and Prevention (CDC) has outlined two major goals of HCV prevention and control efforts: (1) to reduce the incidence of new infections by reducing HCV transmission and (2) to reduce the risk of chronic liver disease in HCV-infected persons through appropriate medical management and counseling. These goals can be achieved by identifying persons at risk for infection and providing them with education, counseling, HCV testing, and appropriate medical services, either directly or through referral. Access to these types of services should be available in both the private and public sector. Preventing or changing behaviors and activities that place persons at risk of HCV infection (such as sharing a needle or anything that may have blood on it) should reduce disease transmission. Appropriate counseling (e.g., to reduce or eliminate alcohol consumption), testing, and medical management (e.g., evaluation for chronic liver disease and possible treatment, immunization against hepatitis A) for persons found to be infected should reduce the risk of chronic liver disease in those already infected.

CDC and partners in health have begun a national campaign to increase awareness about HCV and encourage persons at risk for infection to seek counseling and testing. In order to assess the capacity and needs of local health departments (LHDs) to respond to potential increases in public demand for information and services for HCV, a survey of local health officers was conducted during 1999.

© Aspen Publishers, Inc.

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