# Presentation: 100422

## Hepatitis B Screening and Vaccine Referral Program in an STD ClinicDenver, Colorado

- Julie Subiadur RN
- Jennifer Landrigan MHS
- Franklin Judson MD
- Mona Bedell RN
- John Douglas MD

## Facts About Denver Metro Health Clinic

- A free, walk-in clinic open to the public regardless of residency in Denver
- Open Monday through Friday, with evening clinics on Mondays and Wednesdays
- Average of 12,500 visits per year
- Daily clinic visits average 70 clients per day

## Referral Process

- Client seen per usual STD clinic visit
- Paper screening form clipped to chart to remind clinician to screen for eligibility
- Screening forms collected by clerical staff and entered into database
- Eligible, consenting clients escorted/directed  to Denver Public Health Immunization Clinic with paper referral form (same floor, 50 feet away)
- Immunization Clinic doses client and enters information into Adios database

## HBV Screening Form 8/99-1/14/01

- Patient’s risk: MSM, IDU, sex partner of MSM or IDU,   2 sex partners in past 4 months, history of STD including today, known HCV+ (77% of clients fit eligibility criteria)
- Is patient interested in getting vaccine today? Or later?
- If no, why not?
- Already had vaccine?
- Already had disease?
- No perceived need/ not interested?
- Other________

## Screening Results 8/99-11/01

## Screening Results 8/99-11/01

## Percentages Already Received Vaccine By Age Group

## Screening Results 8/99-11/01

## Calculation of Completion Rates

- First dose:
- 	 # received dose 1 / # eligible
- Second dose:
- 	_# received dose 2 within 60 days of dose 1_
- 	 # received dose 1 and had 60 days of follow-up
- Third dose:
- _# received dose 3 within 1 year of dose 1_
- # received dose 2 and had 1 year of follow-up since first dose

## Dosing Results 8/99-11/01

## Return Rates for Second Dose 

- 					_n__	__ %__	_   _OR (95% CI)_
- Total			      1347	37%
- Male 		      931      39%   1.48 (1.15-1.90)
- Female		      416      31%   Reference
- White		      609      42%   Reference
- African-American    354      31%   0.59 (0.44-0.78)
- Hispanic		      384      32%   0.75 (0.57-0.99)
- *data available on 1347 of 1488 of patients who received a first dose

## Return Rates for Second Dose  

- 				 	_n__	__ %__	_   _OR (95% CI)_
- <25			      424      27%     Reference
- 25-34 		      451      36%     1.52 (1.14-2.04)
- 35+			      472      45%     2.26 (1.69-3.01)
- Client-based     	      541      44%     1.97 (1.52-2.56)
- None		      	      510      30%     Reference
- Post-card 	               296      33%     1.16 (0.85-1.59)
- *data available on 1347 of 1488 of patients who received a first dose

## Conclusions

- The proportion of clients claiming prior history of Hep B or who have previously been vaccinated has significantly increased over the study period, among all age groups
- About 30% of eligible clients received first dose of Hep B vaccine
- Return rates were higher for male, white, and older clients; these variables remained significant in the multivariate model
- Return rates for second doses were higher with a client-based reminder system, than with a postcard based system or none at all

## Implications

- It is questionable as to whether post-card reminders increase return rates; client-based reminder system are preferable
- Extra efforts necessary to encourage clients to complete vaccine series
- Even with free HBV vaccine, only 60% of eligible clients screened express interest
- about 30% actually receive 1st vaccine
- about 38% of those receiving 1st dose get 2nd dose, (11% of total eligible)
- about 27% of those receiving 2nd dose get 3rd dose (3% of total eligible)

## Other Approaches To Enhance Program Success

- Enhanced literature encouraging vaccination (may increase acceptance)
- On-site immunization versus referral to Immunization Clinic (to reduce initial no-shows)
- Enhanced reminders (to reduce loss to follow up)

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