Recommendation 5-2. The Centers for Disease Control and Prevention, in conjunction with other federal agencies and state agencies, should provide resources for the expansion of community-based programs that provide hepatitis B screening, testing, and vaccination services that target foreign-born populations.

HBV and HCV infection rates in illicit-drug users are high, particularly in IDUs. HCV is easily transmitted among IDUs, and methods to promote safe injection can be considered essential for HCV control. However, safe-injection strategies alone are insufficient to control HCV transmission. Prevention of HCV infection is a function of multiple factors—safe-injection strategies, education, testing, and drug treatment—so an integrated approach that includes all these elements is more likely to be effective in preventing hepatitis C.

Although illicit-drug use is associated with many serious acute and chronic medical conditions, health-care use among drug users is lower than among persons who do not use illicit drugs. Health care for both IDUs and NIDUs is sporadic and typically received in hospital emergency rooms, corrections facilities, and STD clinics. Given that population’s poor access to health care and services, it is important to have prevention and care services in settings that IDUs and NIDUs are likely to frequent or to develop programs that will draw them into care.

Studies have shown that the first few years after onset of injection-drug use constitute a high-risk period in which the rate of HCV infection can exceed 40%. Preventing the transition from non-injection-drug use