1. Vaccinating Men Who Have Sex with Men Against Hepatitis A and Hepatitis B in Community-Based Clinics: Experiences from Howard Brown Health Center (Chicago) and Callen-Lorde Community Health Center (New York) Harold S. Levine, Levine & Partners, Inc. Susan Weigl, Callen-Lorde Beau Gratzer, Howard Brown

2. Callen-Lorde Community Health Center Heritage dates back to 1971: St. Mark’s Community Clinic and Gay Men’s Health Project Merged in 1983 as Community Health Project in the NYC LGBT Community Center Became Callen-Lorde in 1998 and moved to 27,000 square foot, 6-story freestanding facility A full range of services: HIV/AIDS, mental health, case management, health education resource center, health outreach to teens.

4. Howard Brown Founded in 1974 In the heart of the Halsted district Full range of services Freestanding building 7,500 patients per year

5. Vaccination Supply Howard Brown –Combination (Twinrix) provided by CDPH for “free” administration –Combination and Monovalents purchased by clinic for administration to patients covered by private insurance. Callen-Lorde –Combination and monovalents provided by NYCDHMH (off and on) –Some vaccine purchased by clinic

6. Vaccination Delivery Howard Brown –Standing orders –All patients screened –Special free vaccination days twice a month –Ad hoc offsite clinics Callen-Lorde –Standing orders –All patients screened –Special “health- promotion” visit to bypass primary care system

7. Pricing Howard Brown –Only charge administration fee ($15 per visit) –If bundled with other service, no administration fee –Two free days per month (no fee) –Primary-care patients with private insurance: billed to insurance co. Callen-Lorde –Currently $30 per dose for cash/insured patients –Uninsured patients get vaccine free as part of “flat fee” service –Pricing has varied from $0 to $48 per dose depending on supply from DPH

8. Outreach and Promotion Howard Brown –Ads and posters –Dedicated outreach worker –Use of transit advertising –Community Events: Pride Parade, Northalsted Market Days, International Mr. Leather Callen-Lorde –Ads, posters, postcards, brochures –Ties to community organization and private physicians –Multiple NYC area PrideFests: float in parade, booth at festivals

9. Promotional Materials: Callen-Lorde

19. Promotional Materials: Howard Brown

22. Howard Brown Vaccination Stats Continued upward trend Predominantly combination vaccine 75 - 150 doses per month

27. Callen-Lorde Vaccination Stats Peaked mid-2001 150-250 doses per month Very good compliance: –15% falloff between doses 1, 2 and 3 for B –38% falloff between doses 1 and 2 for A Majority of patients ages 25 - 44

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32. Key Success Factors Credibility/stature of agency Standing orders for vaccination Provider education and updates Affordable pricing Vaccine supply from Department of Public Health Expedited/simplified vaccination outside of primary care visit Continual outreach to community at large and providers serving MSM

33. Future Plans Howard Brown –Offsite vaccination –More promotion of free days –Outreach to private providers Callen-Lorde –Collaborations to reach/target new communities –Increased outreach –Expanded access: more appointments