KEYWORDS:

BACKGROUND:
A well-coordinated approach to prevention of hepatitis B virus (HBV) infection among young adults has not yet been developed in the U.S.

OBJECTIVE(S):
To evaluate HBV acceptance and completion of free immunization in an STD clinic.

METHOD(S):
Clinicians were asked to complete screening form regarding past experience with and current interest in HBV immunization. Patients eligible for free immunization (gay/bisexual men, injection drug users, and high risk heterosexuals) were referred to the adjacent Immunization Clinic. From 8/99-7/00, clients were reminded to return for subsequent doses via letter or telephone. Subsequently, there was no active reminder system.

RESULT(S):
From 8/99-4/01, of 12,694 eligible persons visiting the STD clinic, 5519 (43%) were screened; of these, 1517 (27%) had been previously vaccinated. Of remaining 4002, 1545 (39%) declined, 1294 (32%) agreed but never presented for vaccine, and 1163 (29%) received first dose. Overall, 446/1163 (38%) clients received second dose within 60 days of first dose. Through 11/01, of 937 receiving their first dose < 12 months earlier (e.g. before 11/00), 257 (27%) clients completed the 3-dose immunization series. In bivariate analysis, factors associated with return for second doses included older age (<25: 28%, &#61619;25: 44%, p< .001), ethnicity (non-Hispanic white: 42%, non-white: 34%, p <.01), and reminders (present 45%, absent 30%). In a multivariate model, reminder system (OR=2.0, 95% CI: 1.5-2.6, p<.001), white race (OR=1.5; 95% CI: 1.1-2.1, p<.05) and age (OR=1.04 for each year of age; 95% CI: 1.02-1.06, p,.0001) were each independently associated with higher return rates.

CONCLUSIONS(S):
Approximately 30% of persons offered free HBV vaccine will present to an adjacent clinic for first dose. Follow up with subsequent doses varies by demographic factors and can be influenced by simple reminder systems.

LEARNING OBJECTIVES:
The participant will understand how Denver Public Health STD clinic began screening for interest in HBV vaccination and implemented a vaccination program.