BACKGROUND:
Most individuals with hepatitis B have high-risk behaviors and contact hepatitis B in adolescence or early adulthood. Many high-risk adolescents seek medical care in alternative settings, are incarcerated or are in the foster care system.

OBJECTIVE:
To evaluate the availability of hepatitis B vaccine for adolescents who receive care in alternative health care settings; to assess how financing influences provision of the vaccine; and to identify barriers hindering immunization.

METHOD:
Six expert focus groups representing alternative health care facilities (teen clinics (TCs), school-based health centers (SBHCs), youth correctional facilities (YCFs), STD clinics (STDCs), family planning clinics (FPCs) and Planned Parenthood facilities (PPs)) were convened to identify setting-specific issues impacting immunization. Facility-specific surveys were then developed and sent out to a random sample of several hundred of each of these types of facilities nationwide, as well as to each state’s youth authority medical director and foster care program. Following the surveys, recommendations were developed with additional focus groups.

RESULT:
There was widespread agreement that offering immunizations was important. Facilities that solely provided services to adolescents (TCs-98%, SBHCs-88%, YCFs-92%) were more likely to routinely offer them hepatitis B vaccine than were facilities that provided services to both adolescents and adults (STDCs-75%, FPCs-71%, PPs-35%). At the latter facilities, adolescents were more likely than adults to routinely be offered the vaccine. Facilities participating in the Vaccines for Children Program were most likely to offer the vaccine to unvaccinated adolescents. Several barriers hindering immunization were identified including vaccine financing, access to immunization records, consent, and completion of the vaccine series. Based on this information, several recommendations were developed.

CONCLUSION:
Barriers hindering the provision of hepatitis B vaccine in alternative health care settings are readily identifiable, allowing for the development of strategies to overcome them.

LEARNING OBJECTIVES:
Describe barriers hindering vaccination efforts in alternative health care settings.