Audit of Hepatitis B Vaccination in Men-Who-Have-Sex-with-Men at a UK Level 3 Sexual Health Service

Background:  Men-who-have-sex-with-men (MSM) are at increased risk of hepatitis B virus (HBV) infection, with a UK carriage rate of 1%. UK guidelines advise HBV screening for asymptomatic MSM, and vaccination in non-immune patients. Due to measures to ensure confidentiality, sexual health clinics do not have open access to results from other clinics. The aim of this audit was to ensure that MSM in a UK level 3 sexual health clinic were receiving hepatitis B screening, vaccination, and post vaccination monitoring in line with UK guidelines.

Methods:  The patient records of a random sample of 50 MSM attending a UK level 3 sexual health clinic between 18/04/11 and 22/09/11 were reviewed.

Results:  100% of patients were either offered hepatitis B vaccination at their first attendance, or were recorded as being previously vaccinated, with no patients declining vaccination if required. 14.00% of patients were known to be HIV positive with 85.71% having a decrease in HBV surface antibody (anti-Hbs) post vaccination after reaching antibody titres of >100i.u./l. All HIV patients were monitored in line with guidelines, with annual anti-Hbs testing. 46.51% of HIV negative patients had repeated anti-Hbs testing following a post vaccination result of >100i.u./l, with a total of 48 unnecessary tests for a sample of 43 patients being conducted (1.1 inappropriate tests per patient). One patient received 7 repeat antibody tests.

Conclusions:  MSM are being offered vaccination in line with current UK guidelines. However, repeated and unnecessary re-testing of anti-Hbs in fully vaccinated HIV-negative patients with demonstrated levels of HBV immunity carries financial costs to the UK National Health Service in laboratory expenses (estimated at over US$5000 annually for MSM in this clinic alone) and staff time for checking results. Clinics should ensure they are not needlessly retesting their HBV immune MSM at each attendance.