BACKGROUND:
The Colorado Coalition for the Homeless, Stout Street Clinic has delivered health care to homeless clients in Denver since 1984. The Colorado Department of Public Health and Environment contracted with the clinic to provide hepatitis A and hepatitis B vaccine to high-risk adults. Barriers to vaccination included a lack of funding for vaccine, a perception that homeless individuals will not return for multiple doses of vaccine, and high staff turnover in the clinic.

OBJECTIVE:
1)Train staff to screen and immunize clients 2)Identify hepatitis risk factors among homeless clients; 3) Administer hepatitis vaccines to high-risk adults; and 4) Monitor hepatitis vaccine completion rates.

METHOD:
Adult clients are screened for behavioral risks at the first visit and hepatitis vaccine is administered to those at risk. The vaccinations are entered into an electronic database that is used to determine how many doses are administered to each client. Medical assistants conduct the screening and administer the vaccine under the supervision of a registered nurse.

RESULT:
The Stout Street Clinic had 18,169 medical encounters in 2003. Typically, 20%-40% of adults have used injectable drugs and/or had more than one sex partner in the past six months, 2%-4% are men who have sex with men, and 2%-5% have been recently diagnosed with a sexually transmitted disease. In 2003, 150 individuals began their hepatitis A vaccination series and 400 began their hepatitis B vaccination series. A final evaluation of completion rates for 2003 is in progress.

CONCLUSION:
Many homeless people are also at risk of hepatitis A and/or hepatitis B infections. Although they usually do not have a medical home, they do access health care and can be immunized.

LEARNING OBJECTIVES:
To describe the successes and challenges of a hepatitis immunization program that serves high-risk adults in a clinic for homeless clients.