recommendations or guidelines, 34% of family physicians surveyed by Ferrante et al. would nevertheless recommend it. Of the respondents, 31% did not know what to do next or would refer a patient to a specialist after a positive test for HCV antibody, and 2% incorrectly assured patients that those who tested positive were immune to HCV. Physicians in practice for more than 20 years were found to have the lowest level of knowledge about HCV risk factors, whereas those in practice for 5 years or less had the highest knowledge level.

A survey of 593 fellows of the American College of Obstetricians and Gynecologists (ACOG), half of whom considered themselves to be primary care providers, assessed screening and counseling practices for HCV infection. About half (49%) reported that they tested for HCV infection in all obstetric and gynecologic patients who self-reported ever having injected illicit drugs, and 35% tested all patients who reported having received blood transfusions before 1992 (Boaz et al., 2003). Nearly half counseled HCV-infected patients to avoid breastfeeding, and 70% counseled HCV-infected patients to use condoms with their steady sexual partners; both kinds of advice are inconsistent with recommendations of CDC (CDC, 1998) and ACOG (2000, as cited in Boaz et al., 2003). Only 64% recommended that patients who had HCV infection avoid alcohol, which has been found to increase the risk of disease progression (Ascione et al., 2007).

An earlier mailed survey of 1,412 primary care providers in the United States also assessed knowledge about risk factors for HCV infection and management of hepatitis C (Shehab et al., 2001). Nearly three-fourths (73%) of the respondents had seen fewer than five hepatitis C patients within the preceding year, and almost half (44%) had no experience with treatment for HCV infection. Almost all knew the most common risk factors for HCV infection—injection-drug use, blood transfusion during the 1980s, and multiple sex partners. One-fourth incorrectly indicated that blood transfusion continues to be a risk factor, and 19% erroneously believed that casual household contact is a major risk factor. Some 50% of the providers reported that they routinely ask their patients about risk factors for HCV infection; 78% test for HCV infection among patients who have increased liver enzymes with or without HCV risk factors, and 70% test all patients who have risk factors regardless of liver enzyme levels. When presented with a scenario on how to treat a hypothetical patient for chronic HCV infection, 27% of the respondents did not know which therapy to use. A previous study by the same researchers had also found substantial gaps in primary care providers’ knowledge about hepatitis C (Shehab et al., 1999). The gaps persisted even though 95% of the respondents in the 2001 study reported having used at least one educational tool about hepatitis C in the preceding 2 years; this suggests that primary care providers misreport their



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