title: Hepatitis B testing and vaccination among adults with sexually transmitted infections in a large managed care organization.
abstract: Data on viral hepatitis B (HBV) testing and vaccination in primary care settings among persons at sexual risk for HBV infection have been sparse. We examined rates and factors associated with HBV serologic testing and vaccination rates in adults infected with sexually transmitted infections. We conducted a retrospective cohort study of adults diagnosed with chlamydia, gonorrhea, or syphilis in Kaiser Permanente Southern California in 2008-2011. The vaccine series initiation was examined in subjects who were tested susceptible. The 90-day hepatitis B surface antigen (HBsAg) testing rate was 28.1% in 15 357 adults. Testing rates increased through the study period. Only 8.8% of patients received both HBsAg and hepatitis B surface antibody tests to determine prior exposure and susceptibility to HBV. Among those who were tested susceptible, 116 (10.6%) subjects initiated the vaccine series. In multivariable logistic regression analysis, the odds of receiving testing was inversely associated with female sex, black race, other/unknown race, or having prespecified chronic comorbidities. In survival analysis, adults aged 25-34 years and ≥55 years were more likely to initiate hepatitis B vaccine series compared with those aged 18-24 years. There are missed opportunities in HBV testing and vaccination in primary care. Implementation of provider decision-making support tools in the electronic medical record system may potentially improve hepatitis B testing and vaccination rates.
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Rulin C
authors.initials: RC
authors.lastname: Hechter
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Yi
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Division of Infectious Disease, Southern California Permanente Medical Group, Los Angeles.
authors.forename: Jim H
authors.initials: JH
authors.lastname: Nomura
authors.affiliation: Division of Infectious Disease, Southern California Permanente Medical Group, Los Angeles.
authors.forename: William J
authors.initials: WJ
authors.lastname: Towner
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Sara Y
authors.initials: SY
authors.lastname: Tartof
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Hung Fu
authors.initials: HF
authors.lastname: Tseng
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D002140:California / Q000453:epidemiology; D002690:Chlamydia Infections / Q000453:epidemiology; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology; D006509:Hepatitis B / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012698:Serologic Tests / Q000706:statistics & numerical data; D012737:Sex Factors; D013587:Syphilis / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines
keywords: primary care setting; testing; vaccination; viral hepatitis B