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Lack
of Awareness of Hepatitis C Risk
Among
Persons Who Received Blood
Transfusions
Before 1990
American Journal of Public Health
January 2001
Vol. 91, No. 1
Hepatitis C virus (Hepatitis C Virus) is the most common chronic bloodborne virus
infection in the United States, with an estimated 2.7 million
persons chronically infected.' The Centers for Disease Control
and Prevention (CDC) recommends that persons with known risk
factors for Hepatitis C Virus infection be identified and offered counseling
and testing! This includes persons who may have been infected
by blood transfusions received before July 1992, when
multi-antigen anti-Hepatitis C Virus tests to screen donors came into use.
To identify such persons, a general aware- ness campaign is under way to
complement direct notification efforts launched by blood
collection agencies and transfusion services in March 1999.3
The direct notification efforts will identify and inform
people who received transfusions from donors who later tested
positive for Hepatitis C Virus antibody, but the notification efforts will
miss many other transfusion recipients who may be at risk. In
preparation for this campaign, the CDC directed audience
research among transfusion recipients to deten11ine their
knowledge and actions regarding Hepatitis C Virus
Focus groups were conducted among persons 35 to 60 years old who received
blood transfusions before 1990. Participants were recruited
through advertisements offering cash incentives in local
publications. In 9 focus groups (6-11 participants each, with
male, female, White, African American, and Hispanic
participants) conducted in 6 US cities, trained moderators
explored topics related to Hepatitis C Virus
Most participants had heard of hepatitis C, but few were aware of the
differences between hepatitis A, hepatitis B, and hepatitis C.
Most who had heard of Hepatitis C Virus reported hearing of it primarily
from family or friends; many had also heard about Hepatitis C Virus through
the media (newspapers, magazines, television). Although most
knew that Hepatitis C Virus could be contracted through exposure to infected
blood most were unaware that they were at risk from their
blood transfusions. Several in each group believed
incorrectly, that there was a vaccine for Hepatitis C Virus and that an Hepatitis C Virus
test is included in routine blood tests. Few were aware that
treatment exists.
A few participants in each
group, on learning that their transfusions may have put them
at risk for infection, reported that they would do nothing
because they felt healthy. Most reported that they would call
their doctors or clinics about testing but said they would not
seek testing in a public clinic specializing in sexually
transmitted diseases, even if the service were free. The
primary reason reported for seeking testing was to find out
whether they were infected, and if so, how to keep from
infecting family and friends. When asked about potential
barriers to testing, most replied that there were none. Few
participants indicated that confidentiality; health care
access, insurance, cost, or stigma would present a barrier to
getting tested.
Identification of persons at
risk for Hepatitis C Virus infection provides the opportunity for counseling
and testing to determine their infection status, for medical
evaluation to determine their disease status if infected, and
for antiviral therapy, if appropriate. Identification also
provides infected persons an opportunity to obtain information
about pre- venting further liver damage (e.g., by not drinking
alcohol) and preventing transmission of Hepatitis C Virus to others.
Two major limitations of this
study are that persons recruited with a cash incentive may not
represent all persons who received transfusions before 1990
and that participants may be unwilling to share information
with a group. Despite the limitations, these results suggest
that persons who received transfusions before 1990 know little
about Hepatitis C Virus and are unaware of their risk. If informed, however,
such persons are likely to seek testing from their own health
providers rather than from public clinics specializing in
sexually transmitted diseases.
The lack of awareness regarding Hepatitis C Virus infection and risk among transfusion
recipients suggests that specifically targeted campaigns may
be necessary to increase the numbers of persons who received
transfusions before 1992 who seek appropriate counseling and
testing. Such campaigns are currently under way by CDC and
other health organizations.
Katherine
Sharp, MPH Simon Choi, PhD
Joanna Buffington, MD, MPH
Randy Rowel, PhD
Johanna M.
Hinman, MPH
Katherine Sharp, MPH Simon
Choi, PhD
References
- Alter MJ,
Kruszon-Moran D, Nainan OV, et al.
The prevalence of hepatitis C virus infection in
the United States, 1988 through 1994.
N Eng J Med.
1999; 341: 556-562
- Centers for
Disease Control and Prevention, Recommendation for
prevention and control of hepatitis C virus (Hepatitis C Virus)
infection and Hepatitis C Virus-related chronic disease.
MMWR Morb. Mortal Wkly Rep. 1998; 47 (RR-19)
- Food and Drug
Administration, Center for Biologics Evaluation and
Research. Guidance
for industry.
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