title: Outreach hepatitis B vaccination of female sex workers in central-west Brazil: immunization status, compliance, and immune response.
abstract: OBJECTIVE
  To evaluate the hepatitis B immunization status of female sex workers (FSWs) in Central-West Brazil and to evaluate their compliance with and immune response to hepatitis B vaccination delivered using outreach strategies.
  
  
  METHODS
  A total of 721 FSWs recruited in 2 large cities in Central-West Brazil were interviewed and screened for the presence of hepatitis B virus (HBV) markers. Hepatitis B vaccine was offered to all women susceptible to HBV, using outreach strategies. The immune response of FSWs who received a full course of vaccine was assessed following the final vaccine dose.
  
  
  RESULTS
  We found that 27.6% of FSWs, the majority of whom were aged 18 to 25 years, had serological evidence of previous hepatitis B vaccination. A total of 434 FSWs were eligible for vaccination, 389 (89.6%) of whom accepted the first hepatitis B vaccine dose. Of those, 64% received a second dose and 37.5% received all three doses. Through the outreach strategy, there was a 52.2% increase in the number of women who received the second dose and a 67% increase in the number who received the third dose. Of the 146 women who received a full course of vaccine, 105 accepted testing for quantitative anti-HBs (hepatitis B surface antibody) following the final vaccine dose, and 92.4% of those tested had developed protective levels of anti-HBs. Lower education level, workplace, and length of prostitution were predictors of full-vaccine acceptance.
  
  
  CONCLUSIONS
  The present findings illustrate the benefits of using outreach strategies to overcome the difficulties of vaccinating hard-to-reach populations such as FSWs.
authors.affiliation: Municipal Secretary of Health, Jataí, GO, Brazil (Ms L. M. Carneiro); Center of Biological Sciences and Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil (Mss Mousquer, L. Castro, and Rezende and Dr A.R.C.M. Castro); Faculty of Nursing (Ms Pinheiro, Mr de Matos, and Dr Teles), Hospital of Clinics (Ms Caetano), and Institute of Tropical Pathology and Public Health (Drs M. A. dos Santos Carneiro and Martins), Federal University of Goiás, Goiânia, GO, Brazil; and Municipal Secretary of Health, Goiânia, GO, Brazil (Ms Da Silva França).
authors.forename: Luciene Moraes
authors.initials: LM
authors.lastname: Carneiro
authors.forename: Gina Jonasson
authors.initials: GJ
authors.lastname: Mousquer
authors.forename: Raquel Silva
authors.initials: RS
authors.lastname: Pinheiro
authors.forename: Ana Rita Coimbra Motta
authors.initials: AR
authors.lastname: Castro
authors.forename: Divânia Dias Da Silva
authors.initials: DD
authors.lastname: França
authors.forename: Karlla Antonieta Amorim
authors.initials: KA
authors.lastname: Caetano
authors.forename: Megmar Aparecida dos Santos
authors.initials: MA
authors.lastname: Carneiro
authors.forename: Regina Maria Bringel
authors.initials: RM
authors.lastname: Martins
authors.forename: Marcos André de
authors.initials: MA
authors.lastname: Matos
authors.forename: Lisie
authors.initials: L
authors.lastname: Castro
authors.forename: Grazielli
authors.initials: G
authors.lastname: Rezende
authors.forename: Sheila Araujo
authors.initials: SA
authors.lastname: Teles
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D005260:Female; D006509:Hepatitis B / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000097:blood*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000517:prevention & control*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data*; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines