title: Adherence to hepatitis B virus vaccination at syringe exchange sites.
abstract: Injection drug users (IDUs) are at high risk for hepatitis B virus (HBV); however, they often do not receive preventive vaccination. IDUs who use mobile health care services linked to a syringe exchange program in New Haven were routinely screened for HBV, hepatitis C virus, and syphilis. Individuals without prior exposure to HBV were offered three-part vaccination series. Of the 212 IDUs screened for HBV infection, 134 (63%) were eligible (negative for HBV surface and core anti-bodies) for vaccination and 10 (4.7%) had evidence of chronic HBV infection. Compared to those with previous exposure to HBV, vaccine-eligible patients were significantly more likely to be younger and use heroin and less likely to be black, home-less, daily injectors, and cocaine users. Of the 134 vaccine-eligible subjects, 103 (77%) and 89 (66%) completed two and three vaccinations, respectively. Correlates of completing all three vaccinations included older age (OR = 1.06, 95% CI = 1.04-1.07), injecting daily (OR = 2.12, 95% CI = 1.36-6.73), and being homeless (OR = 1.98, 95% CI = 1.14-12.27). These results suggest that IDUs remain at high risk for acquiring HBV infection. Programs that link health care to a syringe exchange program are effective ways to provide preventive health care services to IDUs, particularly HBV vaccination. Trust engendered by and mutual respect afforded by such programs result in repeated encounters by active IDUs over time.
authors.affiliation: Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283, USA. raltice@aol.com
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
authors.forename: Robert D
authors.initials: RD
authors.lastname: Bruce
authors.forename: Mary R
authors.initials: MR
authors.lastname: Walton
authors.forename: Marta I
authors.initials: MI
authors.lastname: Buitrago
mesh_terms: D000328:Adult; D017677:Age Distribution; D003237:Connecticut / Q000453:epidemiology; D003955:Diagnostic Tests, Routine; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000302:isolation & purification; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units; D018671:Needle-Exchange Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000821:virology*; D019037:Urban Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines