KEYWORDS:
Hepatitis, vaccination, program, homeless, strategies

BACKGROUND:
Hepatitis C is associated with liver failure and is the primary reason for liver transplantation in the U.S. Hepatitis C positive individuals co-infected with hepatitis A and B have a significantly increased risk for liver failure, which is among the top four causes of death in homeless individuals. This population is challenging to vaccinate because of the various barriers to compliance.

OBJECTIVE:
To develop strategies and solutions to the emergent problem of hepatitis infection in the homeless population in inner city Baltimore through the implementation of a hepatitis A and B vaccination program specifically tailored for homeless individuals.

METHOD:
At Health Care for the Homeless in Baltimore, we targeted clients co-infected with HIV and hepatitis C (N=52) as those in greatest need of vaccination. Participants were notified and reminded by staff contact and communication to contact persons and shelters. Staff was notified by mail and chart fliers.

RESULT:
Data collection is ongoing since December 2001. Presently, 44% received their first dose of vaccination, 21% received their second dose, and 2% copmleted the series. Of note, 48% of clients receiving their first dose returned for their second dose.

CONCLUSION:
It takes a lot of time, effort, and ingenuity to vaccinate the homeless. Compliance seems to improve if the first dose is given. The strategies employed can be utilized in other poorly compliant populations.

LEARNING OBJECTIVES:
1) Describe why homelessness, itself, is a risk factor for hepatitis.
2) Describe methods of acquiring funding for immunizations in a setting without state fundng.
3) List 3 barriers to vaccination completion in the homeless population.
4) Describe 3 strategies for improving immunization compliance in the homeless population.