1. Hepatitis B Vaccination in HIV and STD Clinic Settings Rita Espinoza, MPH Infectious Disease Surveillance and Epidemiology Branch Texas Department of State Health Services March 8, 2007

2. Purpose To determine whether providing hepatitis B vaccine was feasible in the STD setting To offer vaccine to high-risk adult population in Texas

3. Pilot December 2002, Immunization Division purchased 39,000 doses of adult hepatitis B vaccine Approached STD program about piloting usage in their clinics Sites were chosen on a voluntary basis 18 sites volunteered to participate Duration: July 2003 - May 2006

5. List of Pilot Sites Abilene Taylor County Health Dept City of Amarillo Public HD Austin-Travis county HHSD Brazos County HD Corpus Christi-Nueces County HD Dallas County HHS El Paso County HD McAllen Clinic – Hidalgo County HD City of Lubbock City of Houston –Medical Center –Lyons –West End Milam County HD San Antonio Metro HD Northeast Texas Public HD (Smith County) Texarkana Bowie Victoria City-County HD Wichita Falls-Wichita County Public HD

6. Inclusion Criteria Persons 19 and older seeking testing, treatment, or counseling services

7. Site Requirements Standing orders that include hepatitis B vaccine Adequate vaccine storage capability (i.e., refrigerator) Medical supplies necessary for administering vaccine (i.e., syringes), and An appropriate record keeping system

8. Methods Doses recorded by age and dose number Temperature log Inventory monitored on a monthly basis (reports due on 7 th of each month) Vaccine is replenished as needed

9. Methods Monthly Allotments Based on: –Number of STD clients seen each month –Estimated percentage of individuals that would accept vaccine by dose number 45% would receive dose 1 49% would receive dose 2 25% would receive dose 3 –Adjustments made as necessary First shipment sent July 2003

11. Doses Administered by Dose Number – Pilot 7/03-5/06

12. Age Distribution of Clients Pilot, 7/03-5/06

13. Hepatitis B Vaccine Uptake Pilot, 7/03-5/06

14. Conclusions of Pilot The STD clinic setting is an accessible location to reach individuals at high risk for hepatitis B infection Conducted one or more reminder and recall activities –appointment cards, reminder calls, reminder letters, and reminder postcards Without state funding – vaccination would cease Continuation of program in 2006

15. Continuation: April 06 to Present One-time funds available from CDC –Imm Branch, HIV/STD, and IDCU collaboration –Two-year project Expanded to include HIV prevention services clinics in addition to STD clinics Participation voluntary, solicited by e-mail –34 STD clinics (24 lhds) –10 HIV clinics (8 agencies)

17. List of Participating STD Sites City of Amarillo Public HD Angelina County & Cities Health District Austin-Travis county HHSD Beaumont Public Health District Brazos County HD Cherokee County Collin County Health Dept Corpus Christi-Nueces County HD Dallas County HHS El Paso County HD Grayson HD Gregg HD Hays County HD Hidalgo County HD – McAllen Clinic City of Houston Laredo HD City of Lubbock Milam County HD Northeast Texas Public HD San Antonio Metro HD Victoria City-County HD Wichita Falls-Wichita County Public HD Williamson County HD

19. List of Participating HIV Sites AIDS Arms Peabody Health Center AIDS services of North Texas –Denton –Plano AIDS Resources of Rural Texas –Weatherford –Abilene Permian Basin Community Centers- Basin Asst Services Health Horizons - Nacogdoches Clinic Legacy –Houston Nelson-Tebedo Health Resource Center Valley AIDS Council

20. Doses Administered by Dose Number, 7/06-1/07* * Data received as of 2/15/07

21. Age Distribution of Clients 7/06-1/07* * Data received as of 2/15/07

22. Uptake Estimates 7/06-11/06* STD sites –16 sites submitted data on number offered first dose –85% vaccinated with 1 st dose –31% received the 2 nd dose HIV sites –7 sites submitted data on number offered first dose –80% vaccinated with 1 st dose –47% received the 2 nd dose * Data received as of 12/8/06

23. Conclusions Hepatitis B vaccine administration can be effectively implemented in the public health STD and HIV clinic settings Monthly reports were an effective vaccine and program management tool Replenishing vaccine as needed minimized vaccine wastage Reminder/Recall effective tool Continuous funding

24. For More Information Rita Espinoza, MPH rita.espinoza@dshs.state.tx.us Ph. (512) 458-7111 ext. 6335 Fax (512) 458-7616