Perceptions Of Hepatitis Research Articles

“They feel shame sometime, but that is why we need to talk to them…we need to tell them how important it is not to feel shame”: Hepatitis B related shame and improving hepatitis B care in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory, according to the Aboriginal health workforce

BackgroundThe Aboriginal health workforce has unique insights given their healthcare experience and interactions with their communities. The aims of this project were to explore their perceptions of hepatitis B related shame and ways to improve hepatitis B care in Aboriginal and Torres Strait Islander communities of Northern Territory’s Top End, Australia.MethodsWe conducted a qualitative study with guidance from the Menzies School of Health Research Infectious Diseases Indigenous Reference Group. The Aboriginal health workforce was asked to participate in semi-structured interviews exploring hepatitis B related shame and ways to improve hepatitis B care. Qualitative data were evaluated using reflexive thematic analysis.ResultsThere were fifteen semi-structured interviews with participants representing eight different communities. The experience of shame was reported by the Aboriginal health workforce to be common for individuals diagnosed with hepatitis B and comprised feelings of fear related to transmitting the virus, to being isolated, and to being at fault. Shame was mediated by poor health literacy, communication, the lack of culturally safe spaces and was perpetuated by intersecting stereotypes. Improvements in care can be achieved by utilising the Aboriginal health workforce more effectively, improving communication and the availability of culturally safe spaces, emphasising community connection, and reframing hepatitis B as a chronic condition.ConclusionsHepatitis B related shame was an important issue and impactful in Aboriginal and Torres Strait Islander communities in the Top End of the Northern Territory. There were many facets to shame in these communities and it was mediated by several factors. The Aboriginal health workforce has emphasised several pathways to improve care and diminish the impact of shame, such as improving communication and the availability of culturally safe spaces.

Perception of Hepatitis B Infection: A National Survey on Knowledge, Practice, and Beliefs (KPB) of HBV in Nigeria

Hepatitis B continues to be a significant public health issue, contributing to substantial global morbidity and mortality. This study employed an electronic-based cross-sectional survey to assess the knowledge, practices, and beliefs regarding hepatitis B among a sample of 3,589 participants from Nigeria. Data were collected between June and September 2023 using Google Forms, with participants recruited via social media. The questionnaire, designed based on similar studies and validated by experts, consisted of six sections addressing sociodemographic characteristics, knowledge of hepatitis B, related practices, and beliefs about the infection and those infected. The study population consisted of 2,945 males (67.0%) and 1,184 females (33.0%), with most participants (83.5%) aged between 21 and 30 years. A majority held bachelor’s degrees (70.1%), and 46.4% were pursuing health-related educational majors. The geographical distribution included participants from 12 Nigerian states and the Federal Capital Territory, with Benue State having the highest representation (58.8%). The survey showed a moderately high awareness of hepatitis B (93.8% had heard of it), but only 66.0% knew it was caused by a virus, and 28.9% were aware that hepatitis B is curable. A considerable gap in vaccination coverage was identified, with 51.5% reporting being vaccinated and 48.5% unaware of the correct dosage for full vaccination. Participants displayed moderate knowledge of transmission routes, with 70.1% recognizing blood and blood products as a transmission medium, but only 44.4% aware that contaminated blades or needles also posed risks. Point-biserial correlation analysis revealed that factors such as travel history, educational background, smoking status, and alcohol consumption were significantly associated with higher knowledge scores (p < 0.05). Practices regarding hepatitis B screening and vaccination were varied, with 63.9% of participants having been screened for the infection, and 96.9% willing to seek treatment if diagnosed. However, 17.5% did not know where to get screened, and 21.7% reported not knowing where to get vaccinated. The survey also highlighted misconceptions about hepatitis B, with 17.5% of participants believing in spiritual protection against the virus. This study emphasizes the need for targeted public health interventions in Nigeria to improve hepatitis B awareness, screening, and vaccination, particularly among populations with lower educational attainment and rural settlements. Efforts should focus on dispelling myths, increasing access to vaccines, and promoting screening to meet the World Health Organization’s hepatitis elimination goals.

Perceptions of hepatitis C treatment and reinfection risk among HIV-positive men who have sex with men and engage in high risk behaviours for hepatitis C transmission: The CEASE qualitative study.

Globally, treatment uptake for hepatitis C virus (HCV) infection among HIV-HCV coinfected men who have sex with men (MSM) has substantially increased since the advent of interferon-free direct-acting antivirals (DAA). However, HIV-positive MSM who engage in high risk behaviours are at an increased risk of HCV reinfection post-treatment. The aim of this study was to investigate perceptions of HCV diagnosis, treatment and reinfection risk among HCV-HIV coinfected MSM who engage in drug use and/or high risk sexual behavior in Sydney, Australia. Participants were recruited from the Control and Elimination within AuStralia of HEpatitis C from people living with HIV (CEASE) cohort (n=402) who reported engaging in drug use and/or high risk sexual behavior for transmission of HCV infection. Participants were interviewed about their perceptions of HCV diagnosis, treatment, and reinfection risk. Interview data were transcribed, coded, and analyzed thematically. Of 33 participants interviewed (mean age 49 years), many participants were 'shocked' by their HCV diagnosis. Participants who believed they acquired HCV infection through sexual exposure felt it was important that their healthcare practitioner agreed with their perspective to mitigate stigmatizing experiences. Overall, participants expressed high satisfaction with their treatment experience due to long-standing therapeutic relationships with their HIV physician. Many participants expressed knowledge of how to prevent HCV reinfection from injection drug use, yet other than condom usage, most were unsure how to reduce high risk sexual activity with such discussions occurring less frequently with healthcare practitioners. Findings indicate that MSM who engage in drug use and high risk sexual activity would benefit from additional education on reducing reinfection risk through sexual activity and services to reduce substance use, if requested.

Knowledge, Perception and Uptake of Vaccine of Hepatitis B Virus among Residents of Ondo State

Hepatitis B virus (HBV) is one of the viral diseases that is threatening the global health. This study was carried out to analyze knowledge, perception of hepatitis B virus and its vaccine uptake among residents of ondo state, south west of Nigeria. The study was a descriptive survey that involved the use of questionnaire to facilitate the sampling and interview of respondents. This included recruiting residents who gave their consent in three communities (Ile-Oluji, Ondo and Owo) at three different senatorial districts (south, central and North) of the state (one community per senatorial district). Four hundred and fifty consented to participate in the study and were selected. A validated self-administered questionnaire was used for data collection. Descriptive statistics and Chi-square tests were used to analyze the data. It was observed that the Knowledge of the subject matter needed much improvement in all the towns, especially the undeveloped ones in the state on awareness, perception and knowledge of the virus and the availability of its vaccine uptake.

Knowledge and Perceptions of Hepatitis B and Hepatocellular Carcinoma Screening Guidelines Among Trainees: A Tale of Three Centers.

Hepatitis B (HBV), the leading cause of hepatocellular carcinoma (HCC) worldwide, disproportionately affects minorities in the USA. Undiagnosed HBV precludes HCC screening and contributes to late-stage cancer presentation and decreased survival. Barriers to HBV and HCC screening include lack of insurance and limited diffusion of guidelines. We aimed to assess knowledge about HBV and HCC screening indications and explore barriers to screening. We surveyed trainees from the University of Miami/Jackson Memorial Hospitals, Palmetto General Hospital, and Mount Sinai Medical Center. We assessed knowledge using clinical vignettes. We performed bivariate and Chi-squared analyses. There were 183 respondents; median age was 31 and 52% were male. The sample was 35% Hispanic, 29% White, 18% Asian, and 9% Black. Training department was Internal Medicine, 71%; Family Medicine, 11%; Infectious Diseases, 6%; or Gastroenterology, 7%. Only 59% correctly estimated national HBV prevalence; 25% correctly estimated global prevalence. In vignettes with behavioral risk factors, trainees correctly advised screening, 63-96%. However, when the risk factor was the birthplace, correct responses ranged from 33 to 53%. Overall, 45% chose an incorrect combination of HBV screening tests. Perceived barriers to screening included limited expertise in screening of immigrants and limited patient education. Respondents were more likely to recommend HCC screening in cirrhotic patients versus non-cirrhotic HBV patients. Key barriers to HCC screening included uncertainty about HCC guidelines and patient financial barriers. Knowledge of HBV and HCC screening recommendations is suboptimal among trainees. Efforts to broadly disseminate HBV and HCC guidelines through targeted educational interventions are needed.

Overview of clinical guidelines on the management of hepatitis E

Perceptions of hepatitis E have transformed over the past decade. This infection was common only in some developing countries. It is known now that hepatitis E occurs in most high - income countries and is largely a zoonotic infection. The review analyzes the relevant key publications and recommendations on the diagnosis and treatment of hepatitis E. Theproblems of diagnosis, treatment and prevention of hepatitis E caused by genotypes 3 and 4 are highlighted. It is shown that with symptoms of acute hepatitis for hepatitis E virus infection (HEV) it is advisable to test not only travelers returning from areas endemic for 1 or 2 genotypes (Asia, Africa, Mexico) and pregnant women, but also all patients, after excluding other reasons for changing liver tests. Testing for HEV is also recommended for patients with chronic liver disease with unexplained deterioration, for patients with immunosuppression and changes of liver tests, for patients with systemic manifestations of diseases of the nervous system. A combination of serological testing and nucleic acid amplification methods are recommended for the diagnosis of HEV infection. Treatment of HEV infection includes the use of antiviral therapy in severe cases; if possible, for patients who underwent transplantation of solid organs - a reduction in doses of immunosuppressive drugs for pregnant women - intensive therapy. Prevention of HEV infection is aimed at people with chronic liver diseases and receiving immunosuppressive therapy who should be excluded from the use of mollusks and poorly fried pig, boar and deer meat.

THU-420-Examination of patient and provider perceptions of hepatitis C care in Rwanda

THU-420-Examination of patient and provider perceptions of hepatitis C care in Rwanda

\u201cIt\u2019s just in that sea of things that I never cared about\u201d: perception of hepatitis B amongst university students in Aberdeen, North-East Scotland

BackgroundA significant proportion of international students at UK universities are from regions with medium to high hepatitis B prevalence rates. Understanding the perception of students regarding hepatitis B infection is crucial for the development of appropriate information and services for this population group.MethodsTwenty semi-structured interviews were conducted with students from the University of Aberdeen. The following key areas were covered: knowledge, awareness, practices including testing, cultural and social aspects and general attitudes to health information and services. Interviews were transcribed verbatim and coded using a framework analysis approach.ResultsThe participants acknowledged hepatitis B to be a serious disease yet did not consider themselves to be at risk. They felt able to go to their General Practitioner if concerned about hepatitis B but emphasised that there was no indication that this was required. There was a general lack of knowledge about the disease including confusion over other types of hepatitis. This was linked to the perceived lack of attention given to hepatitis B in, for example, sexual health education and disease awareness raising campaigns. The participants expressed a desire for information on hepatitis B to be relevant to the student population, easy to understand, socially acceptable and easily accessible on student portals and social media platforms.ConclusionsOur study suggests that students in Aberdeen, North East Scotland lack knowledge and awareness of hepatitis B and do not perceive themselves as being at risk of hepatitis B infection. There is a need for more tailored hepatitis B messages to be incorporated into a range of contexts with clearer risk communication for the student population.

Liver transplantation for hepatitis C virus (HCV) non-viremic recipients with HCV viremic donors.

In the context of organ shortage, the opioid epidemic, and effective direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV), more HCV-infected donor organs may be used for liver transplantation. Current data regarding outcomes after donor-derived HCV in previously non-viremic liver transplant recipients are limited. Clinical data for adult liver transplant recipients with donor-derived HCV infection from March 2017 to January 2018 at our institution were extracted from the medical record. Ten patients received livers from donors known to be infected with HCV based on positive nucleic acid testing. Seven had a prior diagnosis of HCV and were treated before liver transplantation. All recipients were non-viremic at the time of transplantation. All 10 recipients derived hepatitis C infection from their donor and achieved sustained virologic response at 12weeks posttreatment with DAA-based regimens, with a median time from transplant to treatment initiation of 43days (IQR 20-59). There have been no instances of graft loss or death, with median follow-up of 380days (IQR 263-434) posttransplant. Transplantation of HCV-viremic livers into non-viremic recipients results in acceptable short-term outcomes. Such strategies may be used to expand the donor pool and increase access to liver transplantation.

Changes in practice and perception of hepatitis C and liver transplantation: Results of a national survey.

With new practice guidelines, it is important to understand how liver transplant (LT) centers have incorporated direct-acting antivirals (DAAs) into the management of hepatitis C virus-infected (HCV+) candidates and recipients. To explore how DAAs have affected LT centers' willingness to treat HCV+ candidates and recipients and to use HCV+ donors, we surveyed high volume US LT centers (11/2014-12/2015) regarding practices for HCV+ candidates, recipients, and donors, before vs after DAAs. We used the Scientific Registry of Transplant Recipients to compare centers' number of LTs, HCV+ recipients, and HCV+ donors in the years before (1/1/2012-12/31/2013) and after (1/1/2016-12/31/2017) survey administration. Of 80 centers contacted, 57 (71.3%) responded, representing 69.0% of the total volume of LTs in 2013. After DAAs, most centers increased treating candidates with low (≤15) model for end-stage liver disease (MELD) (85.2%), intermediate/high (>15) MELD (92.6%), and hepatocellular carcinoma (79.6%). There was consensus to treat low MELD candidates (90.8% "most of the time/always"), but less certainty for intermediate/high MELD candidates (48.2% "sometimes"). Universal post-LT HCV treatment increased (7.4% vs 57.4%). After DAAs, 42.6% were more willing to use HCV+ donors for HCV+ candidates, and 38.9% were willing to consider using HCV+ donors for HCV- candidates. Overall, with DAAs, centers were more willing to treat HCV+ candidates and recipients and to use HCV+ donors; recent recommendations may help to guide treatment decisions for intermediate/high MELD candidates.

Knowledge and perceptions of hepatitis C infection and pesticides use in two rural villages in Egypt.

BackgroundHepatocellular carcinoma (HCC), one of the most fatal types of malignancy, is increasing worldwide, and particularly in Egypt where there is a confluence of its contributing factors, including high prevalence of hepatitis C virus (HCV) infection, widespread use of pesticides, and diets that are contaminated by aflatoxin B1 (AFB1) in rural areas. We investigated knowledge, attitudes, and prevention practices related to HCV infection and pesticides use in rural Egypt, where over half of the population resides and agriculture is the predominant occupation.MethodsFrom two rural villages we recruited 67 residents aged 18–80 years, who completed a 40-item survey that included questions about demographics, knowledge of and protective measures relevant to pesticides use in the home and in agriculture, awareness and perceptions of HCV infection and its treatment and prevention.ResultsAmong the 67 study participants, gender distribution was equal, the mean age was 47.2, and one third never attended school. More than 50% reported using pesticides at home, but fewer reported having some knowledge about its health effects. Twelve participants were agricultural workers, and 11 of them applied pesticides in the field and knew about their toxicity; however only one person was correctly using the appropriate protective equipment. Among all the participants, 52 did not know what causes HCV infection, and 42 of those who knew it was a virus mentioned incorrect modes of transmission; and 30 did not know the disease manifestations.ConclusionIn rural Egypt, there is a significant lack of knowledge of HCV infection and its transmission mode and limited use of protective measures against pesticides despite familiarity with these chemicals.

Perception of hepatitis B virus infection reactivation-related issues among specialists managing hematologic malignancies: result of an Italian survey

Hepatitis B virus (HBV) reactivation strongly affects the practice of physicians dealing with hematological malignancies. In this respect, in collaboration with the Italian Lymphoma Foundation we developed a descriptive study of the real-life approach of physicians caring for patients with these diseases. A questionnaire was designed to explore the perception of HBV reactivation-related issues. Fifty-nine Italian Lymphoma Foundation-affiliated institutions participated, and 504 questionnaires were sent out. Forty institutions (67.8%) returned 154 (30.5%) completed questionnaires. The largest majority (91.5%, 141/154) were aware of possible HBV reactivation as a consequence of immunosuppression. Most of the participants providing an answer (93.3%; 126/135) performed universal screening, and were aware of strategies for managing reactivation (96.4%, 132/137). Specialists treating lymphoma show a high level of awareness concerning the management of HBV reactivation under immunosuppression. However, uncertainties regarding the issue of HBV reactivation still emerge in this setting, and thus continuing collaborative effort between hepatologists and hematologists is necessary.

Perceptions of Hepatitis B among African Immigrants in New York City: An Opportunity to Increase Awareness and Avoid Stigma

Purpose: Hepatitis B virus (HBV) is highly endemic in sub-Saharan Africa, and a recent dramatic increase in immigration to the U.S. from this region highlights the importance of screening and linkage to care in this community. As part of a larger screening program at our institution, this pilot study examines barriers and facilitators of viral hepatitis screening and linkage to care programs among African foreign-born persons living in New York City. Methods: We used community-based participatory qualitative research methods to identify major themes of African participants' knowledge, attitudes and behaviors towards HBV. Through respondentdriven sampling, we recruited 39 participants and conducted 4 focus groups between October, 2011 and October, 2012 to assess modifiers of screening behavior. Results: Participants' median age was 39 years, 79% were uninsured, 82% were unemployed, and 70% had moved to the U.S. within the past 10 years. Five major themes emerged as barriers, and two emerged as facilitators of screening and linkage to care. Barriers to HBV screening included a general lack of knowledge, the virus' long latency period, fatalism, fear of cost associated with seeking care, and concerns over the confidentiality of results. In contrast, knowledge of the opportunity for prevention through a vaccine, and the availability of treatment emerged as important cognitive facilitators of screening and linkage to care. From these themes, an over-riding narrative emerged that participants perceived the general low level of knowledge as an important opportunity for framing the discourse around HBV in their community, so as to increase awareness but avoid generating stigma against imputed immoral behavior associated with transmission. Conclusion: This guiding narrative and the behavior modifiers identified in this study have important implications for improving the ongoing viral hepatitis screening and linkage to care programs being conducted in this high-prevalence and difficult-to-reach African foreign-born group.

Changes in Patientsʼ Knowledge and Perception of Hepatitis C Infection in the United States: Data from the National Health and Nutrition Examination Survey (NHANES)

Purpose: Chronic hepatitis C infection affects liver and is a significant cause of morbidity and mortality in the United States. There has been a gradual decline in hepatitis C infection but this decline is not similar in all age groups. This disparity may be due to lack of awareness of their infection or access to treatment. Methods: We conducted a secondary analysis of the survey data of patients who tested positive for hepatitis C infection and interviewed during NHANES (2001-2001) and NHANES (2007-2008). We included all adult patients (18 years or older) who tested positive for hepatitis C antibody and were interviewed as a part of hepatitis C follow-up survey. Results: A total of 87 and 88 patients were found to have hepatitis C during the years 2001-2002 and 2007-2008, respectively. The number of patients who previously are aware of hepatitis C was higher in 2007-2008 compared to 2001-2002 (94% vs. 71%, respectively) (P<0.001). Patients' understanding of hepatitis C transmission has decreased with a higher number of patients believing that hepatitis C could be transmitted from shaking hands (16% (2007-2008) vs. 7% (2001-2002); a lower number of patients understood that injecting drugs transmitted hepatitis C (75% (2007-2008) vs.83% (2001-2002) (P<0.005). There was overall improvement in number of patients who had received liver biopsy (68% (2007-2008) vs. 19% (2001-2002) (P<.005). Conclusion: There is a reduction in the knowledge of hepatitis C transmission from 2001-2001 to 2007-2008.

Knowledge of Hepatitis B Vaccine among Operating Room Personnel in Nigeria and Their Vaccination Status

Background. Hepatitis B virus (HBV) infection is a well recognised occupational health hazard preventable by vaccination. Objectives. To determine the knowledge of operating room personnel (ORP) in Nigeria about the Hepatitis B vaccine, their perception of Hepatitis B vaccination and vaccination status against HBV. Methods. Four university hospitals were selected by simple random sampling. A structured questionnaire was administered to 228 ORP after obtaining consent. Result. Only 26.8% of ORP were vaccinated against HBV. The primary reason for not being vaccinated or for defaulting from vaccination was lack of time. Differences in age, sex, duration of practice and respondent's institution between vaccinated and unvaccinated ORP were not significant (P > 0.05). The majority (86.8%) had the awareness of the existence of Hepatitis B vaccine. 83.8% of respondents believed that the vaccine should be given to the ORP as part of work place safety measures. The majority were aware of the modes of transmission of HBV infection. 78.9% of respondents believed that Hepatitis B vaccine is safe and 81.1% would recommend it to another staff. Conclusion. Despite a good knowledge about HBV infection and vaccine, most of ORP are still not vaccinated. Hepatitis B vaccination should be a prerequisite for working in the theatre, hence putting surgical patients at reduced risk.

Perception of Hepatitis C Risk among Injecting Drug Users Who Obtain Injecting Equipment from Pharmacies in Western Australia

This study describes perceptions of hepatitis C (HCV) risk among people who inject drugs (PWID) in Western Australia (WA), and seeks to determine the relationship between perceptions of risk and injecting equipment sharing practices. One hundred and forty five participants recruited from 30 high-distributing pharmacies throughout WA completed surveys during a two-week period. Respondents reported that they did not see themselves as highly susceptible to HCV and did not believe HCV was a severe condition. Forty-three percent of respondents reported sharing injecting equipment in the past month. In multivariate analysis, sharing injecting equipment was associated with lower self-efficacy for sterile equipment use, being unemployed, and being male. These findings suggest that high self-efficacy protects against sharing injecting equipment with others. Psychosocial factors warrant close scrutiny and attention in future research and HCV prevention programs for PWID.

Hepatitis B in Moroccan health care workers

To evaluate knowledge and perception of hepatitis B, including prevention, among Moroccan health care workers (HCWs) and to estimate seroprevalence of hepatitis B and vaccine coverage (VC). Four hundred and twenty HCWs were randomly selected and stratified by site: 120 in Rabat, 140 in Taza and 160 in Témara-Skhirat. The study included an anonymous questionnaire about knowledge of hepatitis B and its prevention and a serological survey. Oral statements and vaccine registers were used to analyse the VC of the HCWs. Serological testing and VC were analysed according to the occupational exposure. Participation rates in the questionnaire and serological tests were 68% (285/420) and 66% (276/420), respectively. Fifteen (5%) HCWs had a history of hepatitis B. All HCWs considered that hepatitis B virus (HBV) infection may be acquired through blood exposure. Vaccination was acknowledged as a necessary means against HBV transmission by 276 (98%) HCWs. Forty-two per cent HCWs had no HBV serological markers. The prevalence of hepatitis B surface antigen was 1%. The mean prevalence of hepatitis B core antibody (anti-HBc) was 28% and was significantly higher (P < 0.05) among nursing auxiliaries (57%), nurses (30%), medical physicians (31%) and midwives (25%) than among laboratory technicians (13%). According to the vaccination registers (available in two sites), VC (> or =3 doses) was 55%. VC was 75% among midwives, 61% among nurses, 53% among nursing auxiliaries and 38% among medical staff. Of the fully vaccinated HCWs without anti-HBc, 51% had serological evidence of protection. HBV vaccines should be more readily available for Moroccan HCWs by reinforcing current vaccination programmes.

Living with chronic hepatitis C means `you just haven't got a normal life any more'

To explore psychosocial factors that impact on quality of life for people living with self-reported chronic hepatitis C. A purposeful sample of 70 people who were self-identified as being hepatitis C virus (HCV)-positive was recruited through a variety of institutions and community agencies. Semi-structured interviews were held with 12 groups and 21 individuals. A qualitative grounded-theory methodology was used for data collection and analysis. Experiences of physical and psychological symptoms, stigma and discrimination, and living with an infectious disease, were explored using matrices. Phenomena emerging from the data included previously undocumented illness 'attacks' that were associated with depressive symptoms and a perception of hepatitis C as fatal. Uncertainty related to disease progression and transmission of the virus were common experiences among participants. A universal experience was fear and anxiety about stigma and discrimination. The findings of this study indicate that chronic hepatitis C has a pervasive impact on quality of life with a complexity that has not been explored with quantitative research approaches. Primary healthcare professionals need to be alert to the psychological and social impacts of chronic hepatitis C and to avoid behaviours that lead to perceptions of stigma and discrimination. The research indicates a need for further investigation into the relationship between psychosocial factors, disease management and disease progression.

Prison Officers' Concerns About Blood Borne Viral Infections

Abstract: Prison officers' knowledge and perceptions of hepatitis B, hepatitis C and HIV were explored by conducting a cross‐sectional survey in four Dublin prisons with high rates of blood borne viral infections among the inmates. Most officers (87%) reported not knowing enough about these diseases to enable them to take the necessary precautions at work. Longer serving and senior officers were less fearful and less anxious about contracting the infections. Officers who had received hepatitis B vaccination were no less worried about hepatitis B than unvaccinated colleagues. Training on blood borne viruses had little effect on prison officers' knowledge or perception of blood borne viral infections.