Initiating and Maintaining a Hepatitis C Support Group: A How-To Program Guide

	Objective: At a minimum, these groups provide opportunity for social interaction.
	May be loosely defined, although participants usually share some characteristics.
	Benefits: Vicarious learning, sharing of resources.
	Patient-led vs. provider-led?
	See considerations under "Co-facilitation" below. Process-oriented vs. topic-oriented? Topic could be predefined or ad hoc, based on the needs of the members. Process groups are less structured, but no less challenging to ensure effectiveness (see information under "Therapy Group" below).
	Size of group: 8-12 members optimal for process-oriented group.
	May be open to family members.

Example: Group for patients undergoing interferon treatment

	Objective: Learning more than mutual support.
	Organized around a topical objective.
	Often a series of meetings of defined duration.
	Topics established in advance.
	Topical expert leads the presentation, although a facilitator usually is also present.
	Social support is a byproduct rather than a primary goal.
	Usually open to family members.

Example: Guest lectures for hepatitis C patients and their family members

	Objective: Mental health intervention.
	Led and facilitated by a mental health professional.
	Size limited depending on nature of group.
	May be either ongoing or time-limited.
	Usually organized around common diagnosis or diagnoses among patients.
	Usually closed to family members or others.

Example: Psychotherapy group for patients with both post-traumatic stress disorder and hepatitis C

	Objective: To promote and maintain abstinence from substance use.
	Focused topic and/or mutual support -- e.g., Alcoholics Anonymous, CODA (Co-Dependents Anonymous).
	Usually ongoing.
	Drop-in approach common.

Example: Group for HVC patients recovering from intravenous drug use

Using two facilitators in any group has several advantages:

	While one facilitator is taking a more active role by speaking to or facilitating the group, the other facilitator can attend to the process or system issues of the group, making note of followup issues for after the group meeting and offering a crucial second point-of-view.
	Having two facilitators offers a chance to model positive interpersonal skills: facilitators can openly disagree on subjects and demonstrate constructive resolution.
	Practically, having two facilitators means the group can continue even on days when one facilitator is absent.

We strongly encourage having at least one peer facilitator for the group. Many veterans may prefer leadership from another veteran who also has HCV: such a peer facilitator models successful coping skills and offers personal knowledge and experience with HCV and treatment. Some veterans see a peer as a more credible source of information than a professional. Ideal peer facilitators are often patients who have already assumed some type of advocacy role regarding their health care or the care of other veterans. Peer facilitators can be recruited by providers, at educational events, through local veterans service organizations, and at other community venues.

Having a professional facilitator ensures that the interpersonal aspects of the group are therapeutic, regardless of the group's type (e.g., educational vs. process). The professional facilitator should train and mentor the peer facilitator in developing basic group skills just as the peer facilitator should train and mentor the professional facilitator in the personal experience of having HCV. This training can be formal or informal, but the most important learning occurs with continuous feedback and discussion with debriefing after group sessions. We recommend training peer facilitators in at least the following areas:

	Communication skills: e.g., "I" statements, empathy, active listening
	Motivational interviewing: e.g., developing discrepancy, rolling with resistance
	Basic group and system principles and interventions: e.g., group roles, group developmental stages, fostering cohesion
	Facilitation strategies and techniques: e.g., redirecting, rewarding group behavior, handling disruptive behavior, tolerating awkward silences

Please consult Appendix D for elaboration on these topics.

All that being said, groups can be successfully run by one or two facilitators, peer or professional. In areas with limited VA resources, a group organizer may have to find creative ways to start a group using community resources. Although VA professional facilitators may be unavailable to lead an HCV group, they still may have the time to mentor peer facilitators, individually or as a team, in group skills. Having a well-run therapeutic group that addresses patients' needs is more important than adhering to a predetermined format for which there are no local resources.

Peer facilitators should be approved VA volunteers who have gone through appropriate orientations and safety checks to ensure patients' safety, confidentiality, and well-being.

It is crucial that before the group begins, the facilitators agree on their roles and how they will manage the group together. Facilitators may decide to be completely equal in leadership and division of labor or to divide their responsibilities differently: one facilitator may be the leader while the other plays a more secondary role, or one may be in charge of the group's process (e.g., the professional facilitator) while the other is in charge of the content (e.g., the peer facilitator). How the responsibilities are divided is not as important as having the division clear and agreed upon by the facilitators. When a volunteer or peer facilitates, the professional facilitator or other VA employee should make clear to members the boundaries on the volunteer's participation.

Early on, start building a list of contacts to use as potential speakers at your meetings. Keep in mind that many speakers need several months' lead time to commit to a specific date or time.

Speakers should be familiar with hepatitis C patients and possess a thorough knowledge of the topic or their specific content area. Speakers whose presentations you have attended and enjoyed and those who are adept at drawing people into discussions are best to invite. See Appendix G for potential content areas you may want to address.

You may also want to consider having physicians, nurses, social workers, or psychologists attend the group sessions from time to time (or as guest speakers) to act as further resources for the group. Ideally, these individuals should have experience in the area of liver disease or in treating serious illness.

Many hepatitis C patients have indicated particular interest in certain topics. You can find a list of these topics in Appendix G. Support group planners may seek out guest speakers with specialized knowledge or expertise in these areas. (The Support Group Guide Planning Committee plans to develop the suggested topics listed in Appendix G as educational modules and include supplemental materials, such as lecture notes and PowerPoint slide presentations, in future versions of this Guide.)

The American Liver Foundation (ALF) is another resource for starting support groups, particularly if your group is to be based in the community rather than at a VA medical facility. ALF has an expert speakers' bureau and provides many helpful suggestions for structuring and conducting your support group. You may wish to contact ALF and work together once you have an idea as to the purpose and target population of your group. ALF is also able to list your support group on its local Web site. You may find out how to speak with the ALF representative for your area by contacting ALF via the resource information provided in Appendix H.

Corporations that develop health care products and services sometimes offer resources that can benefit your group, such as informational materials on hepatitis C and patient care consultants who can serve as speakers. VA rules prohibit soliciting support from industry representatives, but donated support, such as unrestricted educational grants, may often be used to augment the resources available from your facility. Many VA medical centers have specific policies or procedures pertaining to acceptance of support from outside sources, and you should make sure that you understand and abide by these. Representatives of outside organizations that provide support should not be permitted to attend patient support groups.

One mission of this manual is to help group facilitators empower veterans with knowledge and resources that promote optimal self care. To increase information access, we suggest you provide veterans with a resource list addressing their varied concerns. This list could include the following:

	Contact information on agencies and Web sites that promote liver health, education, and advocacy
	Relevant case management and social service resources (e.g., legal aid, Social Security, housing, Americans with Disabilities Act, and disability rights contacts)
	Recommended readings on liver health, hepatitis C, and related issues
	Information on current liver research
	Public health clinics and other locations that test for hepatitis (especially for significant others)
	Advocacy organizations
	Other hepatitis C support groups in the community
	Contact information on alcohol and drug recovery resources (such as treatment centers, local 12-step and Self Management and Recovery Training (SMART) recovery meetings, directories and/or contact numbers or Web sites)

This manual provides a directory of national resources (see Appendix H). You are encouraged to add any local resources to this listing, which should be updated periodically. Hard copies of the resource list could be made available at each group meeting along with educational brochures about the liver and hepatitis C.

The following planning points are important to address early on:

	When are most participants available?
	When is the facility available?
	How frequently will people be able to meet (weekly, monthly)?
	Is there adequate parking?
	Is there access to audiovisual equipment?
	Is the room arrangement and number of chairs sufficient for the group?
	Who will be responsible for opening and closing the facility?

Once you have an idea of when and how often your group will meet (at least for the first couple of meetings) you need to secure a location for the group. Ideally, you will have meeting space at your VA facility. The space should be large enough to seat everyone comfortably, but if the space is too large it may feel cold and impersonal for the purpose of the support group.

If you have to hold your support group offsite:

	Some locations may require payment for use of the facility.
	Contact community resources (e.g., library, town hall) or community organizations (American Red Cross, Rotary Club, Lions Club, YMCA/YWCA, Salvation Army).
	Most organizations have community relations offices as a contact point.
	Also consider local hospitals, health centers, a doctor's office, or the local Visiting Nurses Association.
	Have an idea of the total number of meetings and/or the number of months you plan to meet prior to making the initial contact call (most meetings last approximately 11/2 hours, plus time for questions).
	Don't forget time for setup (refreshments, video, etc.) and cleanup.
	Let your point of contact know projected dates and times, that the meetings are free of charge, and that the group is voluntary and nonprofit.

Wherever you hold your group, be sure to consider safety issues (adequate lighting, in a safe area), especially for night groups, to minimize the possibility of harm to or harassment of participants. Also consider confidentiality issues when creating your signs for the support group. For example, `Liver Support Group` would likely be preferable to `Hepatitis C Support Group` when posting signage.

One important step in developing your hepatitis C group is to set up one or more clinics in the Computerized Patient Record System (CPRS), in order to capture accurately the workload data associated with the group. This should be done before the groups begin but near the end of the planning process.

To set up a clinic in CPRS you will need the following information:

1. The length of each group session

2. The primary provider(s) associated with the group sessions

3. Other providers who will be routinely speaking to the group

You will need to work with your station's Decision Support Service (DSS) program manager or analyst, or other staff responsible for creating clinics in CPRS. Find appropriate staff to help you identify and set up the primary and secondary stop codes within that clinic as well as local codes to capture every element of the workload associated with the group. You may need only one clinic to capture the workload or you may need several, depending on the providers associated with the group. Please advise the person assisting with the clinic setup that veterans attending these clinics must not be charged for the visit.

There may be other considerations for setting up a clinic at your facility. Some facilities may require a review of patient education materials. Others may have a system for reimbursement of travel costs for attending the meeting. Any requirements for individual facilities should be addressed ahead of time, and the process should be in place prior to the first meeting.

How you select and bring people into the support group will vary depending on its format and objectives. Each method has advantages and disadvantages, as indicated below.

Providers can be the best referral source for potential group participants. They often know the patients' needs as well as their current health status. Discuss who might benefit from group participation with physicians (especially gastroenterologists, hepatologists, and infectious disease specialists), nurses (especially those who treat liver disease), social workers, psychologists, and other mental health professionals (especially those who work with patients with a history of substance abuse and/or chronic disease).

If you send invitations to patients by mail, our early experience with this method resulted in a 10 to 20 percent attendance rate among those we invited. If you call selected patients by phone, your response rate likely will be higher, and you will also have a greater sense of who will attend by what they tell you.

Many newspapers have a community bulletin board you can access without charge. Some States have monthly newsletters that list dates, times, and activities for public service groups in the State. Take advantage of bulletin boards and public service announcements from local media, making sure to clear information in accordance with local policy.

Some institutions may require a group to be registered or approved by a patient education coordinator or hospital education committee. Be sure to check your local policies to see if this is the case at your site.

A flyer, either to post or to mail to potential participants, is a good visual aid to promote your group.

A meeting planning tool is enclosed (see Appendix B) to help keep track of what has been done and what needs to be done for each meeting, once your meetings are under way. Here are some considerations for your first group and beyond:

	Audiovisual -- Do you have the equipment that you or your guest speaker needs for a presentation (e.g., VCR, PowerPoint, overhead projector)?
	Food/Refreshments -- Food helps to attract and maintain group participation. If possible, provide food that is healthy for patients with liver disease (i.e., avoid high-sugar sodas and caffeinated beverages). If you serve food, remember the little things everyone needs (napkins, utensils, serving spoons).
	Directions/Signs -- Patients will easily get frustrated if they have to walk the length of the hospital to find the meeting room.
	Announcements -- Groups are great forums for disseminating information, especially information about upcoming meetings and speakers.
	Handouts -- Do you have enough copies?
	Brochures/Flyers -- See "Community Resources" section above.
	Room Environment -- Check temperature, lighting, and seat arrangement in advance. You may need to obtain a key beforehand to gain access to the room.
	Name Tags -- Do you want people to wear them or not?

General Practice Note: START AND END ON TIME!

Having some general guidelines and expectations regarding group conduct established from the beginning can make the group more comfortable for the members. This will help to resolve difficult situations without appearing dictatorial. Appendix C is a list of patient rights and responsibilities you may wish to incorporate.

At the first meeting it is a good idea to establish and emphasize that every member should respect the confidentiality and anonymity of individual group members. Your group may also decide if it is to be open or closed to spouses, family members, or friends. Group members should feel free to express themselves without fear that their private lives will become a matter of public knowledge outside the group.

To begin, prepare a mission statement for the first meeting (see sample in Appendix A). Ask members to suggest changes or additions. With their input and feedback, you will be able to ensure that the interests and needs of the group will be met. You should review this mission statement periodically to help the group stay focused on its purpose and goals.

Facilitating a group, large or small, can be tricky. The following table lists common problem areas that often arise in groups, along with some suggested remedies.

We suggest you read Appendix D to learn more about group facilitation. Many of these tools may come in handy once the group starts.

Even if you have decided to go with an educational or lecture-style format for your group, it is important to allow ample time for members to ask questions or share their comments on an issue. Some educational presentations are informal and allow for questions during the lecture, but often it's best to hold questions until after the speaker has presented all of his or her planned material.

Much of the strength of support groups is found in the patient-to-patient interactions that occur before, during, and after the "official" meeting. This is when veterans share information, compare notes, and even exchange phone numbers for informal contact outside of the group. While starting and ending groups on time is a good suggestion from a group management perspective, encouraging this peer-to-peer networking is important to promote patient self-help and to let the group thrive. Perhaps you can identify a safe, accessible place where patients can continue to talk even if your meeting room has to be locked up or released to the next scheduled user. If this is a possibility, announce to group members at the beginning of the meeting when the group officially ends and when and where informal discussions may continue.

1. Confidentiality. Try to choose a space that allows for persons to enter unnoticed by the general population. Remember that hepatitis C is a disease that often carries a stigma. Domiciliary patients may choose not to attend rather than reveal their hepatitis C positive status.

2. Frustration. Many veterans in a substance-use domiciliary will be frustrated if they are attempting to establish some sober time or to decrease their alcohol intake before starting treatment. Encourage veterans to use the time to prepare their bodies and minds for the treatment.

3. Familiarity and Group Dynamics. Domiciliary patients often spend the majority of their time in each other's company. They may know each other well and have patterned ways of interacting throughout the many groups within the domiciliary program. This can affect the group dynamic in several ways you may not anticipate, especially if you are not domiciliary staff. You will need to establish the hepatitis C group as its own group, not just one of a number of domiciliary groups. Holding the group outside of the domiciliary (e.g., in an outpatient clinic) and including nondomiciliary patients can help establish this fact. Discourage participation of those who do not have hepatitis C by offering limited hepatitis C information in the other domiciliary health classes.

4. Origin of Hepatitis C. Those who are newly diagnosed often question the origin of the virus or the source of their infection. Be cautious not to let this discussion get too far within the support group. It can lead to divisiveness within the group between those who obtained the virus from high-risk behaviors (e.g., IV drug use) and those who did not (e.g., a blood transfusion). Mixed populations are particularly susceptible to this dynamic as persons in the domiciliary often are early in recovery from drug or alcohol abuse and readily disclose high-risk behaviors.

Although a group session ends for its members, facilitators still have many important tasks to continue the group's work.

Facilitators should meet immediately after the group, even if only for 10 minutes, to discuss what happened and develop plans for followup. Here are some topics you may want to cover during your debriefing:

	Clinical issues requiring followup (e.g., a participant discussed severe depression or suicidal ideation, seemed agitated, is likely to drop out prematurely)
	Process issues in the group (e.g., a participant who dominates the group or one who does not participate, scapegoating, deflection from emotional issues)
	Case formulations and intervention plans: developing therapeutic plans for individual participants and the group as a whole
	Followup list of unanswered participant questions or requests for more information (e.g., referrals)
	Process issues between facilitators: mutual feedback, examining countertransference (i.e., personal reactions to group members), reaching agreements on practices, handling particular situations, responding to particular requests

A support group serves to empower the patient through increased knowledge gained from speakers and other members as well as through the assurance that he/she is not going through his/her problem alone.

1. We agree to participate in this program in a group setting with other hepatitis C patients and their families.

2. We understand the need for complete confidentiality and trust within the group.

3. We accept an individual's choice to actively participate or simply listen.

4. We will begin and end meetings on time.

5. We encourage "I" statements to keep discussions in the first person.

6. We let one person speak at a time.

7. We don't let one person monopolize the discussion.

8. We recognize the importance of actively listening to the person who is speaking.

9. We emphasize each individual's role in the group's success.

10. We will not be judgmental toward other members; we are here to support, not criticize.

11. We accept all feelings, whether they are positive or negative.

12. We agree that each of us is responsible for our own comments and that we need to consider the group setting prior to disclosing personal information. We should keep in mind that some questions and comments may need to be presented in an individual session.

13. We recognize and authorize that a participant's personal medical information may be disclosed in the group setting in order to respond appropriately to that participant's questions.

By my signature below, I show that I understand the purpose of this document.

Patient Signature

Facilitator Signature

Corey, M.S., and G. Corey. Group Process and Practice. Pacific Grove, CA: Brooks/Cole, 1997.

Miller, W.R., and S. Rollnick. Motivational Interviewing: Preparing People for Change. New York: Pacific Press, 1991.

Rollnick, S., P. Mason, and C. Butler. Health Behavior Change: A Guide for Practitioners 11th Ed. Edinburgh: Churchill Livingstone, 1999.

Yalom, I. The Theory and Practice of Group Psychotherapy, 4th Ed. New York: Basic Books, 1995.

Thank you for your participation. Your answers will be used in further developing the hepatitis C group program.

Many hepatitis C patients have indicated the following topics as being of particular interest to them . Support group planners may seek out guest speakers with specialized knowledge or expertise in these areas.

1. Your Liver & Hepatitis C

2. Understanding Lab & Biopsy Results

3. Risk of Transmission & Intimate Relationships

4. Diet & Nutrition

5. Managing Sleep, Fatigue, and Exercise

6. Interferon-based Treatment for Hepatitis C

7. Alternative & Complementary Therapies for Hepatitis C

8. Symptom & Side-effect Management

9. Liver Transplant Issues

10. Emotional Self-Care

11. Anger Management

12. Benefits & Service Connection

The Support Group Guide Planning Committee to develop these 12 topics as educational modules and include educational materials (i.e., lecture notes, PowerPoint slide presentations) in future versions of this Guide.

The appearance of external hyperlinks does not constitute endorsement by the Department of Veterans Affairs of the linked Web sites, or the information, products or services contained therein.

Veterans and Providers

Veterans with Hepatitis C: www.hepatitis.va.gov/

Patient Support

Adverse Event Reporting Program: http://www.fda.gov/medwatch/index.html HCV Advocate: http://www.hcvadvocate.org Hep C Vets: http://www.hepcvets.com Hep Net (Canadian Hepatitis Network): http://www.hepnet.com Hepatitis Central: http://www.hepatitis-central.com HIV and Hepatitis: http://www.hivandhepatitis.com Medscape Resource Center: http://www.medscape.com Melissa Palmer, MD (Liver disease & Hepatitis): http://www.liverdisease.com Rx List: http://www.rxlist.com

Health Organization Links

American Association for the Study of Liver Disease: http://www.aasld.org American Autoimmune Related Diseases Association: http://www.aarda.org American Gastroenterology Association: http://www.gastro.org American Liver Foundation: http://www.liverfoundation.org Centers for Disease Control and Prevention: http://www.cdc.gov Hepatitis Branch: http://www.cdc.gov/ncidod/diseases/hepatitis/index.htm Food and Drug Administration: http://www.fda.gov Hepatitis C Society of Canada: http://www.hepatitiscsociety.com/index.htm Hepatitis Foundation International: http://www.hepfi.org Italian Liver Foundation: http://www.dfc.unifi.it/ilf/eng-home.htm National Business Coalition on Health: http://www.nbch.org National Council on Patient Information & Education: http://www.talkaboutrx.org/ National Foundation for Depressive Illness: http://www.depression.org National Institutes of Health: http://www.nih.gov National Center for Complementary and Alternative Medicine: http://nccam.nih.gov National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/index.htm National Library of Medicine: http://www.nlm.nih.gov National Network for Immunization Information: http://www.immunizationinfo.org United European Gastroenterology Federation: http://www.uegf.org Viral Hepatitis Prevention Board: http://www.vhpb.org World Health Organization: http://www.who.int/health_topics/hepatitis/en

General Health Information

Dr. C. Everett Koop's Web Site: http://www.drkoop.com Healing Well: http://www.healingwell.com Health Finder: http://www.healthfinder.gov Health Touch Online for Better Health: http://www.healthtouch.com/level1/menu.htm Life Saving Alternatives to Blood Transfusions: http://www.noblood.org United Network for Organ Sharing (UNOS): http://www.unos.org

Clinical Trials

Center Watch: http://www.centerwatch.com Clinical Trials Registry: http://www.veritasmedicine.com Veritas Medicine: http://www.veritasmedicine.com

Pharmaceutical/Pharmacy

CDC Healthy Travel Information: http://www.cdc.gov/travel/index.htm WORLD Traveler Hepatitis Information: http://www.travelsafely.com

Travel Information

Chiron Corporation: http://www.chiron.com Fujisawa Healthcare, Inc.: http://www.fujisawa.com Glaxo Smith Kline: http://www.gsk.com Home Access Health (home test kit for Hep C): http://www.homeaccess.com Idenix Pharmaceutical: http://www.novirio.com Intermune: http://www.intermune.com Merck: http://www.merck.com Rebetron Combination Therapy: http://www.rebetron.com Roche: http://www.rocheusa.com Roche-HIV: http://www.roche-hiv.com/portal/eipf/pb/hiv/Roche-HIV Schering: http://www.beincharge.com Walgreens Specialty Care: http://www.walgreens.com

Mental Health

Center for Mental Health Services: http://www.mentalhealth.org Mental Help Net: http://www.mentalhelp.net

Exercise and Fitness

Health and Fitness Tips: http://www.health-fitness-tips.com Hepatitis Neighborhood: http://www.hepatitisneighborhood.com Centers for Disease Control and Prevention: http://www.cdc.gov Hep C Connection 1-800-522-4372: http://www.hepc-connection.org American Liver Foundation: http://www.liverfoundation.org Nursing Center: http://www.nursingcenter.com Hepatitis Foundation International 1-800-891-0707: http://www.hepfi.org

Dolan, Matthew. The Hepatitis C Handbook. Catalyst Press, 1997.Hepatitis Management and Treatment, A Practical Guide for Patients, Family and Friends(magazine).

Everson, G. and H. Weinberg. Living with Hepatitis C: A Survivors' Guide. Hatherleigh Press, 1998.

Hepatitis Management & Treatment, A Practical Guide for Patients, Family and Friends (magazine).

Maddrey, Willis C., M.D., and Eugene R. Schiff, M.D. eds. The Hepatitis Workbook. A Guide to Living with Chronic Hepatitis B and C. Schering Corporation, 2001.

National Family Caregivers Association, The Resourceful Caregiver. Mosby Lifeline, 1996.

Pollin, Irene. Taking Charge: Overcoming the Challenges of Long-Term Illness. MSW, and Susan K. Golant, Times Books, 1994.

Stolman, Marc D. A Guide to Legal Rights for People with Disabilities. Demos Publications, 1994.

White, Barbara J. and Edward J. Madara. The Self-Help Source Book. Northwest Covenant Medical Center, 1995.

The Department of Veterans Affairs (VA) leads the country in hepatitis C screening, testing, treatment, research, and prevention. VA is the largest single provider of medical care to people with hepatitis C infection in the United States.

The National Hepatitis C Program works to ensure that veterans with or at risk for hepatitis C receive the highest quality health care services from the VA system. Led by the VA's Public Health Strategic Health Care Group (PHSHG) and carried out by VA medical facilities across the country, the hepatitis C program has a comprehensive approach to hepatitis C prevention and treatment that includes screening, testing and counseling, patient and provider education, optimal clinical care, and management of data to continuously improve program quality.

The Hepatitis C Resource Centers (HCRCs), a part of the National Hepatitis C Program, develop best practices in clinical care delivery, patient education, provider education, prevention, and program evaluation that can be used by the entire VA health care system and other medical care systems. They function as field-based clinical laboratories for the development, testing, evaluation, and dissemination of new and innovative products and services for improving the quality of hepatitis C clinical care and education in every VA medical facility.

VA provides extensive information on hepatitis C for health care providers, veterans and their families, and the public at http://www.hepatitisc.va.gov.

The Hepatitis C Resource Center would like to hear from you about this edition of Initiating and Maintaining a Hepatitis C Support Group: A "How-To" Program Guide. To share your opinions, please complete this tear-out tri-fold page, fold it, and drop it in the mail. Your answers will be used to inform development of future editions of this guide. Thank you!

Thank you for your time!

You may keep your responses anonymous, but if you would not mind being contacted by the HCRC for followup, would you please provide the following?

Name:

Phone:

Email:

Northwest Hepatitis C Resource Center
VA Puget Sound Health Care System
1660 S. Columbian Way (S-152-HCRC)
Seattle, WA 98018