title: Factors associated with hepatitis B vaccine series completion in a randomized trial for injection drug users reached through syringe exchange programs in three US cities.
abstract: BACKGROUND
  Hepatitis B virus (HBV) is a vaccine preventable infection yet vaccination rates are low among injection drug users (IDUs) despite the high risk of infection and longstanding recommendations to promote vaccination. We sought to improve vaccination rates by reaching IDUs through syringe exchange programs (SEPs) in three U.S. cities.
  
  
  METHODS
  IDUs were randomized in a trial comparing the standard HBV vaccination schedule (0, 1, and 6 months) to an accelerated schedule (0, 1, and 2 months) and participation data were analyzed to identify determinants of completion of the three-dose vaccine series. Independent variables explored included sociodemographics, injection and syringe access behaviors, assessment of health beliefs, HBV-associated knowledge, and personal health status.
  
  
  RESULTS
  Covariates associated with completion of the three-dose vaccine series were accelerated vaccine schedule (aOR 1.92, 95% CI 1.34, 2.58, p = <0.001), older age (aOR 1.05, 95% CI 1.03, 1.07, p = <0.001), and poorer self-rated health score (aOR 1.26, 95% CI 1.05, 1.5, p = 0.02). Completion was less likely for those getting syringes from SEP customers than for SEP customers (OR 0.33, 95% CI 0.19, 0.58, p = <0.001).
  
  
  CONCLUSIONS
  SEPs should offer hepatitis vaccination in a manner that minimizes time between first and last visits by accelerating the dosing schedule. Public health interventions should target younger, less healthy, and non-SEP customer participants. Other health interventions at SEPs may benefit from similar approaches that reach out beyond regular SEP customers.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bowman
authors.forename: Lauretta E
authors.initials: LE
authors.lastname: Grau
authors.forename: Merrill
authors.initials: M
authors.lastname: Singer
authors.forename: Greg
authors.initials: G
authors.lastname: Scott
authors.affiliation: Department of Epidemiology of Microbial Diseases and the Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA. robert.heimer@yale.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Heimer
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002947:Cities; D055030:Drug Users; D005260:Female; D006304:Health Status; D006509:Hepatitis B / Q000209:etiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs; D016017:Odds Ratio; D015819:Substance Abuse, Intravenous / Q000150:complications; D013594:Syringes; D014481:United States; D014611:Vaccination; D055815:Young Adult
chemical_list: D017325:Hepatitis B Vaccines
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