title: Factors influencing hepatitis B vaccine uptake in injecting drug users.
abstract: BACKGROUND
  Hepatitis B infection in injecting drug users is an important public health problem. Active immunization against hepatitis B is immunogenic and safe, but uptake rates in targeted vaccination programmes are low. This study was undertaken to identify factors associated with the uptake of hepatitis B vaccination in injecting drug users attending a needle exchange service.
  
  
  METHODS
  A retrospective cross-sectional survey of case-note data of injecting drug users who had no markers of hepatitis B infection or immunity was undertaken within a drop-in needle exchange service for injecting drug users in a large urban area in England. A qualitative study using semi-structured interviews with needle exchange staff was also conducted.
  
  
  RESULTS
  Of 207 injecting drug users, 180 (87 per cent) had been offered vaccine, 123 (59 per cent) accepted at least one dose and 55 (27 per cent) received three or more doses. Vaccine was less likely to be offered to those sharing injecting equipment or known to have hepatitis C. Needle sharing was also associated with failure to accept vaccine, as was increasing age and the length of contact with the service.
  
  
  CONCLUSIONS
  Those who are most at risk are least likely to be offered vaccine and accept it. This calls into doubt the effectiveness of hepatitis B vaccination strategies targeted at high-risk groups and adds weight to arguments for universal vaccination.
authors.affiliation: School of Nursing, University of Nottingham, Medical School, Queens Medical Centre, Nottingham NG7 2UH.
authors.forename: J
authors.initials: J
authors.lastname: McGregor
authors.forename: P J
authors.initials: PJ
authors.lastname: Marks
authors.forename: A
authors.initials: A
authors.lastname: Hayward
authors.forename: Y
authors.initials: Y
authors.lastname: Bell
authors.forename: R C B
authors.initials: RC
authors.lastname: Slack
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D008297:Male; D016485:Needle Sharing / Q000009:adverse effects / Q000523:psychology; D018671:Needle-Exchange Programs; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D015819:Substance Abuse, Intravenous / Q000821:virology*
chemical_list: D017325:Hepatitis B Vaccines