2007; Larkin, 2007; McBride, 2008; San Francisco HepB Free, 2009; Tsai et al., 2008; Zola et al., 2009).

As discussed in Chapter 4, the ACIP recommends that all newborns, previously unvaccinated children and adolescents, and previously unvaccinated adults at high risk for infection be vaccinated against hepatitis B (Mast et al., 2005, 2006). The latter group includes adults at risk for infection by sexual exposure, IDUs, household contacts of chronically infected persons, developmentally disabled persons in long-term-care facilities, persons at risk for occupational exposure to HBV, hemodialysis patients, persons with chronic liver disease, and travelers to HBV-endemic regions, including Asia, Africa, much of Eastern Europe, the Amazon Basin, the Caribbean, and the Pacific Islands (see Box 4-1). There is a shortage of hepatitis B education, vaccine promotion, and awareness programs for nearly all those at-risk populations, and programs need to be developed to target HIV-positive people, IDUs, and people from highly HBV-endemic regions (Rein et al., 2009). Although a handful of studies have evaluated cross-sectional hepatitis B knowledge levels in some of the populations, the committee knows of no programs that have demonstrated a quantitative improvement in knowledge about hepatitis B after the implementation of a targeted, evidence-based educational program.

A potential model to target at-risk populations is to develop pilot sites similar to CDC’s Racial and Ethnic Approaches to Community Health, REACH 2010. The REACH 2010 program provided grants to communities to address services for specified illnesses in particular racial and ethnic populations. The program targeted blacks, American Indians, Alaska Natives, Asian Americans, Hispanics, and Pacific Islanders—all populations that have a high prevalence or incidence of hepatitis B and some hepatitis C also. Viral hepatitis was not part of the program (Collins, 2006; Giles et al., 2004).

Although fewer studies have been conducted to assess awareness of hepatitis C in specific populations, the literature suggests that knowledge about this disease is poor. In a cohort of 3,768 women who had or were at risk for HIV infection, about one-fourth of those with chronic HCV infection were not aware of their infection status (Cohen et al., 2007). Younger and black women were less likely to be aware of their HCV infection status, whereas women who had past alcohol treatment, a history of injection-drug use, or increased alanine aminotransferase (a liver enzyme) were more likely to be aware that they were positive for HCV infection. Of those aware of their chronic HCV infection, the health-care providers of 47% had recommended that they have a liver biopsy, and 56% of these had undergone a