Integrating hepatitis, STD, and HIV services into a drug rehabilitation program.
BACKGROUND
Considering the difficulties in providing screening and vaccination services for inmates in short-stay incarceration facilities, an evaluation was conducted of the integration of prevention services in an alternative sentencing drug rehabilitation program (alternative to incarceration) in San Diego CA.


METHODS
During the period April 1999 to December 2002, clients were asked to complete a brief risk-assessment questionnaire, and were offered hepatitis B virus (HBV) vaccination, HBV and hepatitis C virus (HCV) serologic testing, STD screening, and HIV counseling and testing.


RESULTS
Of the estimated 1125 rehabilitation program enrollees, 930 (83%) participated in the integration program services. Most clients were male (64%), were aged >30 years (64%), and few (7%) reported previous HBV vaccination. Of the 854 clients eligible for hepatitis B vaccination, 98% received the first dose, 69% the second dose, and 42% completed the series. Eleven percent of clients had prior HBV infection, and 14.7% had HCV infection, with positivity rates being highest among those with a history of injection drug use-HBV, 19%, and HCV, 36%. HIV infection was rare (prevalence, 0.3%), and STDs were uncommon (chlamydia prevalence, 2%, and gonorrhea prevalence, 0.6%). Total annual cost of integration services (excluding HIV testing) was dollar 31,994 equating to dollar 122 per client served.


CONCLUSIONS
Alternative sentencing drug rehabilitation programs provide a venue to efficiently deliver integrated hepatitis and other prevention services. Considering the vast number of high-risk persons in drug rehabilitation, probation, parole, and inmate release programs, an opportunity exists to greatly expand hepatitis services.
Gunn
Robert A
RA
Division of STD Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. Robert.gunn@sdcounty.ca.gov
Lee
Marjorie A
MA
Callahan
David B
DB
Gonzales
Patricia
P
Murray
Paula J
PJ
Margolis
Harold S
HS
D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D003376:Counseling; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D011795:Surveys and Questionnaires