Take Action Against Hepatitis C

EDUCATION 

SESSION GUIDE

Based on Treatment Improvement Protocol (TIP) 53, 

Addressing Viral Hepatitis in People With Substance Use Disorders
Acknowledgments

This publication was written and produced under contract numbers 270-09-0307 and 270-

14-0445 by the Knowledge Application Program (KAP), a Joint Venture of JBS International, 

Inc., and The CDM Group, Inc., for the Substance Abuse and Mental Health Services 

Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Christina 

Currier and Suzanne Wise served as the Contracting Officer’s Representatives, and Candi 

Byrne served as KAP Project Coordinator.

Disclaimer

The views, opinions, and content of this publication are those of the authors and do not 

necessarily reflect the views, opinions, or policies of SAMHSA or HHS.

Public Domain Notice

All materials appearing in this document except those taken from copyrighted sources are 

in the public domain and may be reproduced or copied without permission from SAMHSA 

or the authors. Citation of the source is appreciated. However, this publication may not be 

reproduced or distributed for a fee without the specific, written authorization of the Office of 

Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

This publication may be ordered or downloaded from SAMHSA’s Publications Ordering 

webpage at http://store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 

(1-877-726-4727) (English and Español).

Recommended Citation

Substance Abuse and Mental Health Services Administration (2016). Take Action Against 

Hepatitis C: Education Session Guide. HHS Publication No. (SMA) 16-4966. Rockville, MD: 

Substance Abuse and Mental Health Services Administration.

Originating Office

Quality Improvement and Workforce Development Branch, Division of Services Improvement, 

Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services 

Administration, 5600 Fishers Lane, Rockville, MD 20857.

HHS Publication No. (SMA) 16-4966 

Printed 2016
CONTENTS

I. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

II. Outline for Education Session, Part A

For People Thinking About Getting a Screening Test

for the Hepatitis C Virus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

III. Outline for Education Session, Part B

For People With a Positive Hepatitis C Screening Test Result

or a Diagnosis of Hepatitis C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

IV. SAMHSA Resources ......................................57
This page intentionally left blank.
1

I. INTRODUCTION

Overview

This education session training guide provides counselors and other clinical staff with 

a scripted plan to use in conducting a hepatitis C education session with clients in 

behavioral health treatment and their family members. The education session is based 

on Treatment Improvement Protocol (TIP) 53, Addressing Viral Hepatitis in People With 

Substance Use Disorders, published by the Substance Abuse and Mental Health Services 

Administration (SAMHSA).

About TIP 53

Each TIP involves the development of topic-specific best-practice guidelines for the prevention 

and treatment of mental and substance use disorders. TIPs draw on the experience and 

knowledge of clinical, research, and administrative experts of various forms of treatment 

and prevention. TIPs are distributed to facilities and individuals across the country. TIP 53 

emphasizes steps substance use treatment counselors and administrators can take to 

educate clients about viral hepatitis, prevent hepatitis infection, and help clients who have viral 

hepatitis understand their treatment options and recover from their substance use disorders.

Training Design 

The education session has two parts, Part A and Part B.

Part A is for people who are thinking about getting a screening test for hepatitis C virus (HCV) 

infection and those who have made the decision to be screened.* 

*Screening refers to the recommended first stage of HCV testing, which is HCV antibody testing (anti-HCV). More

information can be found at www.hcvguidelines.org/full-report-view, under “HCV Testing and Linkage to Care.”

Some participants may have already been screened before the education session; for them, 

the session reinforces information, such as how to prevent infection and why it is important 

to be rescreened on a routine basis if they are engaging in risky behavior.

Part B is for people who have received a positive (reactive) HCV screen or a diagnosis of 

hepatitis C.

Family members of clients may also participate in each part of the education session.

Parts A and B are each designed for a small group of 6–12 people. Individual sessions may 

be offered to people who for any reason are uncomfortable in a group setting.

Each part takes approximately 50 minutes to deliver. This includes time for answering questions 

throughout the session. Depending on the group, more time may be needed for discussion.

Postsession follow-up with participants by a caseworker, counselor, or peer specialist 

can reinforce session information and help participants move to action (for example, get 

screened for HCV infection, undergo antiviral treatment).
2

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE

Preparation

To prepare for the education session, you are encouraged to read TIP 53, Addressing Viral 

Hepatitis in People With Substance Use Disorders. The TIP may be ordered or downloaded 

from SAMHSA’s Publications Ordering webpage at http://store.samhsa.gov. It is essential 

that you provide accurate, reliable information to clients and that you avoid bringing 

anecdotal information into the education session.

You should also be familiar with your program’s hepatitis-related services and the procedures for 

routing clients to services for screening, follow-up testing as needed, vaccination for hepatitis A 

and B, counseling, and hepatitis health care as needed, at your program or through referral.

The treatment regimens for HCV infection are rapidly evolving beyond those described in 

TIP 53. To lead Part B of the education session, you should familiarize yourself with current 

guidelines, which can be found at www.hcvguidelines.org. Note, however, that discussion 

of specific treatment regimens is beyond the scope of the education session. Any specific 

questions about medical treatment should be referred to a qualified clinician.

In addition, your state’s Viral Hepatitis Prevention Coordinator may serve as a valuable source 

of information on issues related to HCV screening. A list of coordinators and state viral hepatitis 

websites is available at www.cdc.gov/hepatitis/Partners/HepatitisCoordsList.htm.

Outlines are provided for Part A and Part B in Sections II and III, respectively. Each outline 

includes trainer directions (in bold italics) and scripts to accompany slides. Thoroughly 

familiarize yourself with the outline before leading a training session.

Materials and Equipment

You should have the following materials and equipment on hand for your session:

● Computer and projector equipment.

● Part A slides: Download the slides from http://store.samhsa.gov. Before the training, 

customize Slide A14 with information on how people can access screening for HCV 

infection and/or vaccination against hepatitis A and B at your program or through referral. 

If the services are offsite, the slide should include addresses, email and phone contact 

information, and maps or directions. The slide should include contact information for the 

staff member who will be available after the session to answer questions privately. 

● Part B slides: Download the slides from http://store.samhsa.gov. Before the training, 

customize Slide B17 with information on how people can obtain hepatitis A and B 

vaccinations, hepatitis-related counseling or advocacy assistance, and hepatitis health 

care at your program or through referral. If the services are offsite, the slide should 

include addresses, email and phone contact information, and maps or directions. The 

slide should include contact information for the staff member who will be available after 

the session to answer questions privately. 

● Chart paper and easel, blackboard, or whiteboard: Prepare a means for recording 

participant questions in a visible manner. You will be referring back to these questions at 

the end of Parts A and B.
3

Introduction

● Resources handout: As a participant take-home resource, prepare copies of Slide A14

(for Part A of the education session) or B17 (for Part B).

● Booklet: As a second take-home resource, provide each participant with a copy of

SAMHSA’s booklet Take Action Against Hepatitis C: For People in Recovery From Mental

Illness or Addiction. The booklet is available through http://store.samhsa.gov.

Learning Objectives, Part A—For People Thinking About Getting a 

Screening Test for the Hepatitis C Virus 

This training provides participants with an understanding of:

● The role of the liver.

● Hepatitis C virus and disease.

● Ways to avoid becoming infected and infecting others.

● The screening test for the hepatitis C virus.

● Vaccination against other forms of viral hepatitis (A and B).

A review of key points at the end of the education session will help ensure that participants 

have understood the material and have had their questions answered. Participants should 

be provided with information on how to get any remaining questions answered privately.

Action Objective, Part A

At the end of the education session, participants can be asked to consider an action they each 

can take to protect themselves and others from HCV infection and to protect themselves from 

hepatitis A and B. Participants will receive SAMHSA’s booklet Take Action Against Hepatitis C

and a handout on how to access resources. Participants may benefit from a follow-up session 

with a caseworker, counselor, or peer specialist to solidify their commitment to action.

Learning Objectives, Part B—For People With a Positive Hepatitis C 

Screening Test Result or a Diagnosis of Hepatitis C 

This training provides participants with an understanding of:

● The role of the liver.

● Hepatitis C virus and disease.

● Ways to avoid infecting others and becoming reinfected.

● Vaccination against other forms of viral hepatitis (A and B).

● Next steps after a positive screening test result.

● Hepatitis C treatment.
4

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE

Action Objective, Part B

After the education session, participants can be asked to consider an action they each can 

take to protect others against HCV infection and themselves against reinfection, protect 

themselves from hepatitis A and B, or follow up with medical evaluation or care as needed. 

Participants will receive SAMHSA’s booklet Take Action Against Hepatitis C and a handout 

on how to access resources. Participants may benefit from a follow-up session with a 

caseworker, counselor, or peer specialist to solidify their commitment to action.

Staying Within One’s Scope of Practice

When conducting the education session and otherwise interacting with clients about their 

hepatitis questions and concerns, follow the guidelines of your certifications or credentials. 

Typically, a counselor’s scope of practice includes providing educational information and 

providing guidance in the decision-making process, but it does not include offering a 

diagnosis or advocating for a particular decision. Seek supervision if you have any questions 

concerning your scope of practice.

To avoid misdirecting a client in an area in which you are not qualified to advise, direct clients 

needing a consultation or medical evaluation to find an appropriately trained clinician using 

the handout you have prepared. This empowers clients to seek information themselves, and it 

affirms your own role as a source of reliable information and guidance.
5

II. OUTLINE FOR EDUCATION SESSION, PART A—

FOR PEOPLE THINKING ABOUT GETTING A 

SCREENING TEST FOR THE HEPATITIS C VIRUS

Session Agenda 

Time Allotted Topics Slides

10 minutes Welcome and Overview Slides A1–A6

30 minutes Hepatitis C and Screening Information Slides A7–A15

10 minutes Review and Commitment to Action Slides A16–A18
6

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE

Welcome and Overview

10 minutes

PART A: Slide A1

Show this slide while participants are gathering in the room.
7

Outline for Education Session, Part A

Slide A2

Start the session with this slide.

● Welcome participants.

● Introduce yourself and any cotrainers or staff members who are present.

● Orient participants to the training facility (including location of restrooms) and the

session length (50 minutes).

● Appeal to participants to maintain confidentiality about personal information that is

shared within the group. Explain that participants will be welcome to ask questions

after each slide is presented. Address any other ground rules you wish to establish

for the session.
8

Slide A3

Trainer: The goal for this 50-minute education session is to share information about a serious 

disease called hepatitis C, so that you can take action to protect yourself and others in your 

community against it.

First, we will cover some facts about the role of the liver and the effects of hepatitis C on liver 

health and overall health.

We’ll talk about what you can do to prevent becoming infected with the hepatitis C virus. This is 

the virus that causes hepatitis C disease. We’ll also talk about what you can do to help prevent 

spreading the virus.

I’ll tell you about a simple screening test for the hepatitis C virus. We’ll cover how you can get 

this test and what you can do with the results.

We’ll also talk about vaccination against two other common forms of viral hepatitis, A and B.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
9

Outline for Education Session, Part A

Slide A4

Trainer: At the end of our session today, I’ll ask you to think about what you have learned 

and consider an action you can take to protect yourself against hepatitis C.
10

Slide A5

Trainer: To start, I’d like to find out a few things about you. I’m going to ask two questions. 

When I ask a question, raise your hand if your answer is yes, if you are comfortable sharing 

this information.

● Do you know about hepatitis C?

● Have you ever had a screening test for the hepatitis C virus?

Use participants’ responses to gauge their awareness of hepatitis C and their familiarity 

with screening, and to reaffirm the objective of the education session: to help participants 

decide what action to take.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
11

Outline for Education Session, Part A

Slide A6

Trainer: Now I’m going to ask another question. What questions do you have about hepatitis C 

that you would like answered today? Raise your hand so I can call on you.

Responses will vary. They may include: 

● How is hepatitis C different from hepatitis A and B?

● Am I at risk for hepatitis C?

● Is this the same as HIV/AIDS?

● My partner found out he has hepatitis. What does that mean for me?

Clarify any questions as needed. Affirm each question by copying it onto chart paper or 

a board.

Trainer: At the end of our session today, we’ll revisit the questions you have, to make sure 

we’ve answered them all.
12

Hepatitis C and Screening Information

30 minutes

Slide A7

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: Hepatitis C is a disease that causes scarring and inflammation of the liver. 

“Inflammation” means that the liver is swollen, tender, and painful. A scarred and inflamed 

liver cannot perform its many functions as well as a healthy liver can. Left untreated over time, 

hepatitis C can lead to potentially deadly liver diseases such as cirrhosis and liver cancer.

To understand how the disease can affect you, you need to know what the liver does. What 

does it do?

Field responses.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
13

Outline for Education Session, Part A

Slide A8

Trainer: Here’s an overview of what the liver does. The liver is a large organ in the middle of 

your body, above the stomach (place hand in the location of your liver). It doesn’t do just 

one job—it does many jobs:

● The liver cleans harmful toxins out of your bloodstream. Examples of toxins include

pesticide chemicals, some herbal remedies, and fumes from gasoline or solvents that

produce a high when sniffed.

● It makes enzymes, proteins, and other materials your body uses to maintain good health.

For example, the liver produces a fluid called bile that helps with digestion and clotting

factors to stop bleeding.

● It processes many medicines so they can be used by your body. It also processes alcohol

and many drugs.

● It stores sugars, fats, and vitamins, and it releases them when you need them.

Foods that you eat and liquids that you drink are digested by your body in the stomach and 

intestines. What you consume is broken down into parts, such as sugars, fats, vitamins, 

minerals, and waste products. All of this is absorbed into the bloodstream from the intestines. 

The blood then passes through the liver, where nutrients are converted into forms the body 

can use. It is also in the liver where the waste products are mixed with bile and moved down 

the intestines, to go out of the body. 

Answer any questions about the information covered in this slide.
14

Slide A9

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: If you become infected with the hepatitis C virus, you are at risk of developing 

hepatitis C disease. Some people get rid of the virus on their own, that is, without medical 

treatment. However, most people who are infected with the hepatitis C virus go on to develop 

chronic hepatitis C. “Chronic” means that the hepatitis infection lasts 6 months or more.

With chronic hepatitis C, the liver becomes less able to turn food into energy and useful 

nutrients. It also becomes less able to process drugs and alcohol and to clean waste 

products out of the body. 

This wears your body down and can make you feel weak, tired, and feverish. You might also 

feel bloated and full. You might lose your appetite and lose weight too. Your skin and eyes 

might become yellowish. 

But it can take years for these symptoms to show up. When they do, the liver is already 

damaged. Untreated hepatitis C can result in severe illness or death.

Answer any questions about the information covered in this slide.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
15

Outline for Education Session, Part A

Slide A10

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: The hepatitis C virus lives in the blood. This means that if the blood of someone who 

has the virus gets inside your bloodstream, you can get infected too. Even small specks of 

blood can pass on infection. Here is some information about how infection is passed on:

● Injecting drugs is the most common way people get infected.

● Virus-infected blood can be passed on by sharing drug equipment and rinse water. This 

includes injection equipment and also equipment used for snorting drugs.

● Unsterilized needles that are used for tattooing and piercing can also pass on specks of 

blood containing the virus.

● Sharing razors or toothbrushes is also a risk for spreading the virus.

● Cuts, sores, burns, or other wounds can be pathways for infected blood to get inside you. 

This includes genital sores from a sexually transmitted disease.

● It is possible to pick up the hepatitis C virus from having sex with somebody who is 

infected, although this is uncommon. However, the rate of infection is higher in people 

who have many sex partners.
16

The hepatitis C virus cannot be spread by:

● Sneezing or coughing.

● Sharing eating utensils or drinking glasses.

● Hugging and other forms of casual contact.

Ask participants for their thoughts on something they can do, in their own lives, to prevent 

infection with the hepatitis C virus. Answer any questions about the information covered 

in this slide.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
17

Outline for Education Session, Part A

Slide A11

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: We just discussed the behaviors that can put you at risk for infection with the 

hepatitis C virus. If you share any of these risks, it is a good idea to get a screening test, to 

see whether you have been exposed. 

Ask participants to share their ideas on why it might be a good idea to get screened. 

Address concerns and answer any questions about the information covered in this slide.
18

Slide A12

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: Let’s talk about what actually happens in a screening test. A small blood sample 

is either drawn from a vein or obtained from a fingerstick. The blood is then tested to see 

whether you have ever been infected with the hepatitis C virus. Depending on the screening 

method, you might get your results during the same visit or you might have to return later to 

learn your results.

The test will provide a positive or negative result. Your healthcare provider may use the word 

“reactive” for a positive result and “nonreactive” for a negative result. 

A negative result means that you have not been infected or that infection with the hepatitis C

virus has occurred within the last 6 months and cannot yet be detected. You should get a 

screening test every year if you are continuing to engage in any of the risky activities we 

already discussed, especially using drugs or taking part in high-risk sex. You can also take 

steps to avoid future infection. 

A positive result means that you are infected or that you were once infected but aren’t now. 

If you test positive, you will need further tests to confirm that you have the hepatitis C virus 

and to determine your health status. 

Ask participants whether they are comfortable with the idea of screening. Answer any 

questions about the information covered in this slide.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
19

Outline for Education Session, Part A

Slide A13

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: Let’s talk about the reasons for vaccination. There is no vaccine for hepatitis C. You 

can prevent infection with the hepatitis C virus only by avoiding contact with infected blood.

However, there are vaccines that work against two other types of viral hepatitis—hepatitis A 

and hepatitis B. 

Hepatitis A is very contagious, and it is spread by ingesting something that has come into 

contact with the fecal matter from a person who is infected with the hepatitis A virus. Sharing 

drug use equipment and poor hygiene habits, such as not washing your hands, can increase 

your risk of getting hepatitis A. Symptoms include fatigue, nausea, vomiting, and abdominal 

pain. Hepatitis A rarely kills, but the illness can be more severe in people who are older, have 

a damaged liver, have HIV/AIDS, or have other forms of hepatitis. Most people who become 

sick with hepatitis A recover within 6 months. Once you recover from hepatitis A, you cannot 

be infected with the hepatitis A virus again. You are immune. 

Hepatitis B is also very contagious. It is spread when blood or other infected body fluids, 

such as semen, enter your body. Hepatitis B is spread through shared injection drug 

equipment (including needles and syringes), accidental needle sticks, and unprotected 

sex with a partner who has the virus. Unlike hepatitis A, it is not spread by consuming 

contaminated food and water.
20

Symptoms are similar to those for hepatitis A. However, some people who are infected do 

not have any symptoms. Some people get rid of the virus on their own, without medical 

treatment. Others, however, will develop chronic hepatitis B, which puts them at risk for liver 

damage. Hepatitis B can be dangerous, especially for people who have weakened immune 

systems—for example, people who have HIV/AIDS.

If you have never been infected with the hepatitis A or B viruses, your healthcare provider 

may advise you to get the vaccines. The shots for hepatitis A and B can be given separately 

or combined. Either way, you get a series of shots, not just one. You need to have all the 

shots to get the protection.

Ask participants who have been vaccinated how they made their decision. Answer any 

questions about the information covered in this slide.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
21

Outline for Education Session, Part A

Slide A14

As explained in the Materials and Equipment section, Slide A14 should provide information 

on how to access follow-up services (for screening, vaccination, counseling, and hepatitis 

health care) at your program or through referral. Review the resources and explain how 

they can be accessed.
22

Slide A15

Refer to the questions raised at the beginning of the session that you copied onto the 

chart paper. Facilitate a brief discussion, calling on participants to use the information 

they have learned to answer the questions. Affirm or correct responses. Counsel 

participants to take specific medical questions to their healthcare providers.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
23

Outline for Education Session, Part A

Review and Commitment to Action

10 minutes

Slide A16

Trainer: Let’s review. Today we’ve been talking about hepatitis C. This is a disease that 

harms the liver. If you have untreated hepatitis C, your liver can become damaged over time. 

Because the liver is important to many functions of the body, a damaged liver can make you 

very sick and can lead to death.

We also talked about how to avoid infection with the hepatitis C virus and how to get a 

screening test for the virus.

Finally, we talked about how you can protect yourself from hepatitis A and B. These are 

two other forms of viral hepatitis that are less common than hepatitis C. Infection with the 

hepatitis A or B virus, for adults who are newly infected, is usually less severe than infection 

with the hepatitis C virus, but it can sometimes present serious health problems. That’s why 

vaccination is recommended. Vaccines can protect you from the viruses that cause hepatitis 

A and B.
24

Distribute the two handouts: the companion booklet, Take Action Against Hepatitis C, and 

the Resources handout. Direct participants’ attention to the contact information for the 

staff member who will be available to answer questions privately. Use this opportunity to 

schedule screening and vaccinations, at your program or at a referred location.

Before we close, let’s review some specific actions you can take against hepatitis C.

Review the bullets, which repeat the titles from some of the previous slides. 

● Respect your liver.

One way you can show respect is to recognize that what you do to your body affects how 

you feel and your overall health.

● Learn the facts about hepatitis C.

You’ve taken this action today, by participating in this education session. If you have 

additional questions, ask me now. Explain how questions can also be answered 

privately after the session.

● Avoid infection.

Let’s review how you can avoid infection with the hepatitis C virus. 

(1) If you are using needles (for drug use, tattooing, or piercing) or any drug works, make 

sure they are sterile and don’t share them. Disposable needles and syringes that 

come in new, unopened packaging are sterile. Reusing needles is not safe, although 

bleaching them can reduce risk.

(2) Cover cuts and sores. They are open doors for infected blood from other people to 

enter your body.

(3) Don’t share toothbrushes or razors, because small specks of blood can be passed on 

this way.

(4) Practice safe sex. You are not likely to get infected with the hepatitis C virus from sex, 

but it can happen.

(5) Take care of your body so it is strong enough to fight infection.

● Get a screening test.

It’s important to know whether you are free of the hepatitis C virus or not. That way you 

know what action to take to keep yourself healthy.

● Face your fears about the test. 

If you still have concerns after this session, please discuss them with a counselor. 

Remind participants that if they still have concerns, a staff member will be available 

after the session to answer questions.

● Get vaccinated against hepatitis A and B if advised to do so. 

Let’s review again how you can get screened and vaccinated.

Again refer participants to the Resources handout.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
25

Outline for Education Session, Part A

Slide A17

Trainer: To wrap up, I’d like you to take a few minutes to think about what you have learned 

today. As you do this, consider an action you can take to protect yourself against hepatitis C.

Provide time for quiet reflection. Answer any remaining questions.
26

Slide A18

Thank participants for their time.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
27

III. OUTLINE FOR EDUCATION SESSION, PART B—

FOR PEOPLE WITH A POSITIVE HEPATITIS C 

SCREENING TEST RESULT OR A DIAGNOSIS OF 

HEPATITIS C

Session Agenda

Time Allotted Topics Slides

10 minutes Welcome and Overview Slides B1–B6

30 minutes Hepatitis C and Treatment Information Slides B7–B18

10 minutes Review and Commitment to Action Slides B19–B22
28

Welcome and Overview 

10 minutes

PART B: Slide B1

Show this slide while participants are gathering in the room.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
29

Outline for Education Session, Part B

Slide B2

Start the session with this slide.

● Welcome participants.

● Introduce yourself and any cotrainers or staff members who are present.

● Orient participants to the training facility (including location of restrooms) and the 

session length (50 minutes).

● Appeal to participants to maintain confidentiality about personal information that is 

shared within the group. Explain that participants will be welcome to ask questions 

after each slide is presented. Address any other ground rules you wish to establish 

for the session.
30

Slide B3

Trainer: The goal for this 50-minute education session is to share information about what 

it means if your hepatitis C screening test is positive or if you have been diagnosed with 

hepatitis C disease. This information can help you take action to protect your health.

First, we’ll cover some facts about the role of the liver. We’ll talk about the effects of the 

hepatitis C virus on liver health and overall health. 

We’ll share information on what you can do to avoid infecting others with the hepatitis C 

virus and the importance of vaccination against two other common forms of viral hepatitis, 

A and B.

We’ll also talk about next steps after a positive result on your screening test for the 

hepatitis C virus and about treatment options if you have hepatitis C.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
31

Outline for Education Session, Part B

Slide B4

Trainer: At the end of our session today, I’ll ask you to consider an action you can take to 

protect your health and the health of others in your community.
32

Slide B5

Trainer: To start, I’d like to find out a few things about you. I’m going to ask two questions. 

When I ask a question, raise your hand if your answer is yes, if you are comfortable sharing 

this information.

● Do you know what it means if your screening test for the hepatitis C virus comes back

positive? (Your healthcare provider may refer to this as a “reactive” test result.)

● Do you know what it means to have a diagnosis of hepatitis C?

Use participants’ responses to gauge their familiarity with screening, hepatitis C 

diagnosis, and treatment and to reaffirm the objective of the education session: to help 

participants decide what action to take.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
33

Outline for Education Session, Part B

Slide B6

Trainer: Now I’m going to ask another question. What questions do you have about hepatitis C 

that you would like answered today? Raise your hand so I can call on you.

Responses will vary. They may include: 

● How did I get infected?

● Is hepatitis C different from HIV/AIDS?

● How can I be infected if I don’t feel sick?

● How do I protect my partner from infection?

Clarify any questions as needed. Affirm each question by copying it onto chart paper.

Trainer: At the end of our session today, we’ll revisit the questions you have, to make sure 

we’ve answered them all.
34

Hepatitis C and Treatment Information

30 minutes

Slide B7

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: Hepatitis C is a disease that causes scarring and inflammation of the liver. 

“Inflammation” means that the liver is swollen, tender, and painful. A scarred and inflamed 

liver cannot perform its many functions as well as a healthy liver can. Left untreated over time, 

hepatitis C can lead to potentially deadly liver diseases such as cirrhosis and liver cancer.

To understand how the disease can affect you, you need to know what the liver does. What 

does it do?

Field responses.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
35

Outline for Education Session, Part B

Slide B8

Trainer: Here’s an overview of what the liver does. The liver is a large organ in the middle of 

your body, above the stomach (place hand in the location of your liver). It doesn’t do just 

one job—it does many jobs:

● The liver cleans harmful toxins out of your bloodstream. Examples of toxins include 

pesticide chemicals, some herbal remedies, and fumes from gasoline or solvents that 

produce a high when sniffed.

● It makes enzymes, proteins, and other materials your body uses to maintain good health. 

For example, the liver produces a fluid called bile that helps with digestion and clotting 

factors to stop bleeding.

● It processes many medicines so they can be used by your body. It also processes alcohol 

and many drugs. 

● It stores sugars, fats, and vitamins, and it releases them when you need them.

Foods that you eat and liquids that you drink are digested by your body in the stomach and 

intestines. What you consume is broken down into parts, such as sugars, fats, vitamins, 

minerals, and waste products. All of this is absorbed into the bloodstream from the intestines. 

The blood then passes through the liver, where nutrients are converted into forms the body 

can use. It is also in the liver where the waste products are mixed with bile and moved down 

the intestines, to go out of the body. 

Answer any questions about the information covered in this slide.
36

Slide B9

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: If you become infected with the hepatitis C virus, you are at risk of developing 

hepatitis C disease. Some people get rid of the virus on their own, that is, without medical 

treatment. However, most people who are infected with the hepatitis C virus go on to develop 

chronic hepatitis C. “Chronic” means that the hepatitis infection lasts 6 months or more.

With chronic hepatitis C, the liver becomes less able to turn food into energy and other 

useful nutrients. It also becomes less able to process drugs and alcohol and to clean waste 

products out of the body. 

This wears your body down and can make you feel weak, tired, and feverish. You might also 

feel bloated and full. You might lose your appetite and lose weight too. Your skin and eyes 

might become yellowish. 

But it can take years for these symptoms to show up. When they do, the liver is already 

damaged. Untreated hepatitis C can result in severe illness or death.

Answer any questions about the information covered in this slide.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
37

Outline for Education Session, Part B

Slide B10

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: You probably want to know how you might have become infected with the hepatitis C 

virus. If you understand this, you can know how to avoid infecting others and how to avoid 

getting reinfected yourself.

The hepatitis C virus lives in the blood. This means that if the blood of someone who has the 

virus gets inside your bloodstream, you can get infected too. Even small specks of blood can 

pass on infection. Here is some information about how infection is passed on:

● Injecting drugs is the most common way people get infected.

● Virus-infected blood can be passed on by sharing drug equipment and rinse water. This 

includes injection equipment and also equipment used for snorting drugs.

● Unsterilized needles that are used for tattooing and piercing can also pass on specks of 

blood containing the hepatitis C virus.

● Sharing razors or toothbrushes is also a risk for spreading the virus.

● Cuts, sores, burns, or other wounds can be pathways for infected blood to get inside you. 

This includes genital sores from a sexually transmitted disease.
38

● It is possible to pick up the hepatitis C virus from having sex with somebody who is 

infected, although this is uncommon. However, the rate of infection is higher in people 

who have many sex partners.

The hepatitis C virus cannot be spread by:

● Sneezing or coughing.

● Sharing eating utensils or drinking glasses.

● Hugging and other forms of casual contact.

Ask participants for their thoughts on something they can do, in their own lives, to 

prevent infecting others with the hepatitis C virus or becoming reinfected.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
39

Outline for Education Session, Part B

Slide B11

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: There is no vaccine for hepatitis C. You can prevent infection with the hepatitis C 

virus only by avoiding contact with infected blood.

However, there are vaccines that work against two other types of viral hepatitis—hepatitis A 

and hepatitis B.

Hepatitis A is very contagious, and it is spread by ingesting something that has come into 

contact with the fecal matter from a person who is infected with the hepatitis A virus. Sharing 

drug use equipment and poor hygiene habits, such as not washing your hands, can increase 

your risk of getting hepatitis A. Symptoms include fatigue, nausea, vomiting, and abdominal 

pain. Hepatitis A rarely kills, but the illness can be more severe in people who are older, have 

a damaged liver, have HIV/AIDS, or have other forms of hepatitis. Most people who become 

sick with hepatitis A recover within 6 months. Once you recover from hepatitis A, you cannot 

be infected with the hepatitis A virus again. You are immune. 

Hepatitis B is also very contagious. It is spread when blood or other infected body fluids, 

such as semen, enter your body. Hepatitis B is spread through shared injection drug 
40

equipment (including needles and syringes), accidental needle sticks, and unprotected 

sex with a partner who has the virus. Unlike hepatitis A, it is not spread by consuming 

contaminated food and water.

Symptoms are similar to those for hepatitis A. However, some people who are infected do 

not have any symptoms. Some people get rid of the virus on their own, without medical 

treatment. Others, however, will develop chronic hepatitis B, which puts them at risk for liver 

damage. Hepatitis B can be dangerous, especially for people who have weakened immune 

systems—for example, people who have HIV/AIDS.

If you have never been infected with the hepatitis A or B viruses, your healthcare provider 

may advise you to get the vaccines. The shots for hepatitis A and B can be given separately 

or combined. Either way, you get a series of shots, not just one. You need to have all the 

shots to get the protection.

Reinforce the message that people who already have a positive screen for hepatitis C 

infection or a diagnosis of hepatitis C disease may benefit from vaccination for hepatitis 

A and B; however, they should consult with their healthcare providers.

Ask participants who have been vaccinated how they made their decision. Answer any 

questions about the information covered in this slide.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
41

Outline for Education Session, Part B

Slide B12

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: If your screening test for the hepatitis C virus has come back positive, this means 

that at some point you were infected with the hepatitis C virus, and you may still have the 

infection in your body. You will be advised to get a second blood test. This is to find out 

whether the virus has stayed in your body and turned into a chronic disease. If that second 

test shows that the virus is still present, other blood tests will help you learn your prognosis, 

which means a prediction of the probable course and outcome of your hepatitis. 

These blood tests may include:

● A liver panel (also known as liver function tests)—to find out about the health of your liver.

● Viral load tests—to get an idea of how you might respond to treatment.

● Genotype tests—to find out the exact type of hepatitis C virus you have and to get an idea 

of which treatment would be best for you.

You may also be advised to undergo an exam by ultrasound. With this exam, pictures are 

taken that show the inside of your body. In some cases, a biopsy is performed instead. This 

means that a tiny piece of your liver is removed. These exams are done to find out how much 

damage has been done to your liver.
42

You may be tempted to put off these tests. But now is better than later. It’s in your best 

interest to learn how your body is being affected by hepatitis C infection. And the test results 

are important for making treatment decisions.

Ask participants to suggest other reasons for getting a full medical exam. Address 

concerns and answer any questions about the information covered in this slide.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
43

Outline for Education Session, Part B

Slide B13

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: If you have hepatitis C disease, you may be advised to undergo antiviral treatment. This 

means that you will take strong medicines, in pill or shot form, to kill the virus.

There are several types of antiviral treatment. The newer treatments have fewer side effects 

than older treatments and are very effective. They provide a cure in most cases. 

The treatment you receive will depend on several factors, including the exact genetic type of 

hepatitis C that you have. The course of treatment can last a few months or more, depending 

on the particular treatment regimen.

Ask your healthcare provider about the pros and cons of your treatment options. It will be 

your choice whether to go ahead with your recommended treatment, to delay treatment until 

a later time, or not to have it. Your choice will depend on several things, such as the stage of 

your disease and other information you learn from your medical exam and test results.

Your current life circumstances also will affect your decision. Some people choose to get 

stronger in their recovery before dealing with antiviral treatment. But many people in recovery 

choose to start treatment right away.
44

Note: Hepatitis treatment regimens are rapidly evolving, and discussion of specific 

treatment options is beyond the scope of the education session. Specific questions 

about medical treatment should be referred to a qualified clinician. See Preparation 

guidance, page 2.

Ask participants to share their thoughts about whether and when to start antiviral 

treatment. Answer any questions about the information covered in this slide.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
45

Outline for Education Session, Part B

Slide B14

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: Antiviral treatment for hepatitis C can be successful even if: 

● You are affected by mental illness.

● You have not yet stopped active substance use.

● You are new to recovery from alcohol or drug use.

● You have had relapses.

● You have another disease, such as HIV/AIDS. 

● You are on medicines for mental illness or addiction treatment.

You should know that sometimes a medicine does not work properly when you take it 

with another medicine. This is called an interaction. If you take both antiviral and recovery 

medicines, your hepatitis care providers will monitor you closely for interactions. If one 

occurs, your medicines may be adjusted.

Having HIV or a history of addiction or mental illness are not reasons to be denied antiviral 

treatment. You may need an advocate to help you talk with your medical providers if you feel 

you are being unfairly excluded from antiviral treatment. 

Ask participants to share ideas on how they can advocate for themselves concerning 

hepatitis C treatment. Answer any questions about the information covered in this slide.
46

Slide B15

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: If you have hepatitis C, antiviral treatment can make you feel better than you have in 

a long time.

Untreated hepatitis C can make you feel unwell without knowing why. This can make you 

depressed. When your hepatitis C is treated, you should begin to feel better. This can help lift 

your mood.

In some cases, though, antiviral treatment for hepatitis C can trigger mental health 

symptoms, such as anxiety, irritability, and depression. If you already have these symptoms, 

antiviral treatment can sometimes make them worse. Let your care providers know if you 

need help with them.

Your care providers will work with you for good mental health while you undergo treatment.

Ask participants to share any concerns they have about maintaining good mental health 

while undergoing treatment for hepatitis C. Answer any questions about the information 

covered in this slide.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
47

Outline for Education Session, Part B

Slide B16

Provide time for participants to read the cartoon silently to themselves. Or, read the 

cartoon aloud to the participants.

Trainer: You can take action to preserve your health, whether you have received a positive 

result on your screening test for the hepatitis C virus or a diagnosis of hepatitis C. 

We already talked about the importance of getting vaccinated against two other forms of 

hepatitis—hepatitis A and hepatitis B.

Having hepatitis is one more reason to stay solid in recovery. You should not drink, because 

consuming alcohol can be hard on the liver, which is already being injured by the hepatitis 

infection. And you should not inject drugs, because that puts you at risk for reinfection with 

hepatitis C plus infection with other viruses such as HIV.

Some herbal treatments and medicines can be hard on the liver and should be avoided. 

Some examples include the herbs kava and St. John’s wort and large doses of the pain 

reliever acetaminophen. But there are many others. It’s very important that you tell your 

healthcare provider about all herbal treatments and medicines you are using in any form—

pill, capsule, tablet, or liquid (such as tea). Also mention any treatments you apply to your 

skin, such as with poultices or patches.
48

It’s also important to stick to healthy living habits. This includes getting exercise, a good 

night’s sleep, and balanced meals. Finally, a positive attitude can help. This means taking a 

proactive approach to problems rather than passively suffering with the stress. And it means 

paying more attention to positive thoughts than to negative ones. A positive approach can 

help you feel better and can positively affect your health.

Participants may have questions about healthy living habits (such as what kind of 

exercise, how much sleep, what kind of foods). This is a huge topic. Balance discussion 

against the time available. Tell participants where and how they can obtain more 

information about healthy living.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
49

Outline for Education Session, Part B

Slide B17

As explained in the Materials and Equipment section, Slide B17 should give participants 

information on how to:

● Access follow-up services or referral for a medical exam for their positive screen.

● Follow up with a medical provider about their hepatitis C diagnosis, if they are not 

currently under medical care. 

● Receive vaccination against hepatitis A and B. 

Review the resources and explain how they can be accessed. 
50

Slide B18

Refer to the questions raised at the beginning of the session that were copied onto the 

chart paper. Facilitate a brief discussion, calling on participants to use the information 

they have learned to answer the questions. Affirm or correct responses. Counsel 

participants to take specific medical questions to their healthcare providers.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
51

Outline for Education Session, Part B

Review and Commitment to Action

10 minutes

Slide B19

Trainer: Let’s review. Today we’ve been talking about hepatitis C. This is a disease that 

harms the liver. If you have untreated hepatitis C, your liver can become damaged over time. 

Because the liver is important to many functions of the body, a damaged liver can make you 

very sick and can even be fatal.

We talked about how you can protect yourself and others from hepatitis C infection 

or reinfection.

We talked about how you can protect yourself from hepatitis A and B. These are two other 

forms of viral hepatitis that are less common than hepatitis C. Infection with the hepatitis 

A or B virus, for adults who are newly infected, is usually less severe than infection with the 

hepatitis C virus, but it can sometimes present serious health problems. That’s why vaccination 

is recommended. Vaccines can protect you from the viruses that cause hepatitis A and B.

Finally, we talked about how you can follow up on your positive screening test result for the 

hepatitis C virus or on your hepatitis C diagnosis. A positive screening test result means 

that at some point you were infected with the hepatitis C virus, and you may still have the 
52

infection in your body. You will need another test to learn whether the virus is still present. A 

diagnosis means that you have a confirmed case of hepatitis C. Treatment can help prevent 

the infection from damaging your health.

Distribute the two handouts: the companion booklet, Take Action Against Hepatitis C, and 

the Resources handout. Direct participants’ attention to the contact information for the staff 

member who will be available to answer questions privately. Use this opportunity to schedule 

vaccinations and other hepatitis follow-up care at your program or through referral.

Before we close, let’s review some specific actions you can take against hepatitis C.

Review the bullets, which repeat some of the titles from previous slides.

● Respect your liver.

One way you can show respect is to recognize that what you do to your body affects how 

you feel and your overall health.

● Learn the facts about hepatitis C.

You’ve taken this action today, by participating in this education session. If you have 

additional questions, ask me now. Explain how questions can also be answered 

privately after the session.

● Avoid infecting others and getting reinfected.

Let’s review how you can do this.

(1) If you are using needles (for drug use, tattooing, or piercing) or any drug works, make 

sure they are sterile and don’t share them. Disposable needles and syringes that 

come in new, unopened packaging are sterile. Reusing needles is not safe, although 

bleaching them can reduce risk.

(2) Cover cuts and sores, because they are open doors for infected blood from other 

people to enter your body.

(3) Don’t share toothbrushes or razors, because small specks of blood can be passed on 

this way.

(4) Practice safe sex. You’re not likely to get infected with the hepatitis C virus from sex, but it 

can happen.

(5) Take care of your body so it is strong enough to fight infection.

● Get vaccinated against hepatitis A and B.

● Get further tests. 

This includes the follow-up test to a positive screening test result and, if advised, a full 

medical exam for hepatitis C.

● If you have a hepatitis C diagnosis, consider your treatment options.

You can choose to start treatment now, or later, but the important thing is to get 

information on your choices so you can make a good decision. Let’s review again the 

Resources to help you with these last three points. Again refer participants to the 

Resources list. 

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
53

Outline for Education Session, Part B

● Advocate for yourself.

Antiviral treatment can be successful and provide a cure even if you have other health issues,

such as mental illness, a substance use disorder, or another disease, including HIV/AIDS.

● Aim for good mental health with treatment for hepatitis C.

Untreated hepatitis C can make you feel lousy, which can make you depressed.

Treatment for hepatitis C should improve your health and your mood, too. If getting

through treatment is hard on your mental health, talk with your care providers so they

can make adjustments.

● Take good care of yourself.

There’s a lot to this, so with the next slide, we’ll review the specific things you can do.
54

Slide B20

Review the points contained in the cartoon.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
55

Outline for Education Session, Part B

Slide B21

Trainer: To wrap up, I’d like you to take a few minutes to think about what you have learned 

today. As you reflect, consider an action you can take to protect yourself against hepatitis C.

Provide time for quiet reflection. Answer any remaining questions.
56

Slide B22

Thank participants for their time.

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
57

IV. SAMHSA RESOURCES

TIP 53: Addressing Viral Hepatitis in People With Substance 

Use Disorders

Quick Guide for Clinicians and Administrators Based on TIP 53

KAP Keys for Clinicians Based on TIP 53

Take Action Against Hepatitis C: For People in Recovery From 

Mental Illness or Addiction

Two ways to obtain FREE consumer publications from SAMHSA’s Knowledge Application 

Program (KAP):

1. Download or order from the SAMHSA Store at http://store.samhsa.gov.

2. Call 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).

Many KAP consumer publications are also available for download from the SAMHSA Store 

in Cambodian (Khmer), Chinese, Korean, Russian, Spanish, and Vietnamese.
NOTES

TAKE ACTION AGAINST HEPATITIS C: EDUCATION SESSION GUIDE
This page intentionally left blank.
Please share your thoughts about this publication by completing a brief online survey at:

https://www.surveymonkey.com/r/KAPPFS

The survey takes about 7 minutes to complete and is anonymous.

Your feedback will help SAMHSA develop future products.

HHS Publication No. (SMA) 16-4966

Printed 2016