Background:
Adults at high risk for hepatitis B infection are a difficult population to target for vaccination through traditional health care. Public health STD clinics offer an accessible setting for reaching high-risk adults. Prior to the pilot, it was unknown whether clients would be receptive to receiving the vaccine series and if clinics could effectively incorporate vaccination into their clinic services. Further, a major barrier to implementation has been the lack of funding for the vaccine.

Objective:
Describe integration of hepatitis B vaccination into STD clinics.

Method:
In December 2002, the Texas Department of State Health Services (DSHS) made a one-time purchase of 39,000 doses of adult hepatitis B vaccine. The immunization and STD programs collaborated to pilot a project to administer hepatitis B vaccine to adult clients in select public health STD clinics. Eighteen STD clinics across the state of Texas voluntarily agreed to participate in the project. Vaccine was allocated based on the average number of STD clients receiving services monthly over the past year and then multiplied by estimated vaccine uptake for dose 1 (45%), 2 (49%), and 3 (25%). Each month, the participating clinics submitted monthly reports detailing the number of doses administered by age group and by series dose number.

Result:
As of April 2005, over 31,000 doses of hepatitis B vaccine were administered to STD clients in the participating clinics. An estimated 38% of clients returned for the 2nd dose, 48% for the 3rd dose, and 18% completed the series. In order to calculate a true measure of vaccine acceptance, the number of STD clients offered hepatitis B vaccine each month should have been collected.

Conclusion:
It is feasible to incorporate adult hepatitis B vaccination in STD clinics.

Implications:
Identification of a constant funding stream for adult hepatitis B vaccine is needed.