1. 2003 National Hepatitis Coordinator’s Conference
Maintaining Momentum: Stimulating Hep B Vaccine Acceptance Among High-risk Adolescents and Young Adults
Amy Slonim, Christi Downing, Nancy Fasano, Mark Miller and Loretta Davis-Satterla
2003 National Hepatitis Coordinator’s Conference
San Antonio, TX
February 28, 2003

2. Presentation Overview
60% acceptance rate in the target population
75% of eligible clinics participating
80% receive 2nd dose that start series
70% receive 3rd dose that start series

3. Results to Date
Acceptance rate in the target population—Intake forms show 30-40%
81% of eligible clinics participating
Adolescent Health (20 0f 22) 91%
Family Planning (129 of 158) 82%
STD Clinics (50 of 65) 77%
55% receive 2nd dose that start series
26% receive 3rd dose that start series

4. Intake Conversion Rates (%) by Clinic Type*
* Excluding No Date on Intake Form, Already Documented Series Completion, or Previously Diagnosed with Hepatitis
N=5,629
N=3,570
N=2,653

5. Second and Third Dose Acceptance Rates (%)
Series Started in 1999
Series Started in 2000

6. STD Client Acceptance Based on Caseload Information
Data from 5 Clinics
Caseload of year olds in the year 2000
First dose of hepatitis B vaccination acceptance 3%-22% of clients in 2000

7. What are the Barriers to Higher Acceptance of the First Dose?

8. Findings From Buffalo Integration Client Rapport
Knowing Clients Rely on Staff to Be Experts
Staff Commitment
Leadership Commitment
Education

9. What are Your Approaches to Encourage Hepatitis B Vaccine Acceptance and Return for Doses 2 and 3?

10. One-Liners to Encourage Acceptance
Compare HBV to HIV—HBV is more contagious and if there was a vaccine for HIV wouldn’t you get it?
Do you know how easy it is to get hepatitis B?
The shot is no worse than piercing/not as bad as tattooing.
Why put yourself at risk when you don’t have to?
It’s a self-love thing—you need to take care of yourself and protect your health
Highlight the severity of hepatitis B and their risk factors for acquiring the disease; make it real in their life.

11. Incentives Didn’t Seem to Have an Impact
Literature review conducted and found:
Studies found that education about hepatitis increased immunization
Individual incentives did not increase acceptance or completion
Factors that were related to client acceptance:
Provider acceptance
Economic cost
Patient follow-through

12. Our Plans for the Next Year
Site visits to clinics that serve large at-risk populations
Develop areas for potential action to improve vaccine acceptance and series completion
Assist clinics in implementing plans and documenting impact
Conduct other in-services or trainings, as needed
Work to secure future funding for the project

13. What is unique about the MI High-risk Program?
No other program similar nationally, serving as a model for the nation
High-risk adolescents that do not fall under mandatory immunization
Includes family planning, STD and adolescent health clinics Statewide
State-funded
Reimburses clinics for vaccines administered

14. What Attributes of the Program Have Made It Easy to Implement Hepatitis B Immunization in Your Clinic?

15. What Barriers Have You Encountered in Implementing Project in Your Clinic?

16. Lessons Learned: What We Heard From Clinic Staff
Education
Persistence
Parental involvement
Develop rapport
Cost savings
Directly address fears

17. Getting Clients to Say, “Yes”
Images must be potent
Scare tactics
Reminders
Be accommodating
You’re the expert
Communicate effectively
Foster word-of-mouth communication

18. Lessons learned: What We Heard from Clinic Clients
When you hear the word “vaccine,” what do you think of?
“a shot and preventive” (20%)
“cure” or “medicine” (9%)
“a shot” (33%)
“don’t know what it means” (35%)

19. What Clients Told Us…
Can you think of reasons why someone would refuse the vaccine?
Lack of sufficient knowledge (primary reason)…50% indicated they knew nothing about the virus
Fear (of needles, shots, vaccine, discovering they already had the disease)

20. What Clients Told Us…
Can you think of reasons why someone wouldn’t return for doses 2 and 3?
Forgetfulness
Time
Inconvenience
Laziness

21. How to Make Susceptibility Real for Clients
Hepatitis B is sexually transmitted
Body pierces and tattoos place you at risk
Hepatitis B is 100 times more contagious than HIV
Hepatitis B can live on a surface for 7 days
Hepatitis B can be spread by contact with blood from infected person on toothbrushes or razors

22. New Brochure Developed
Captures lessons learned from the clinic staff and clients
Provides information on project
Will be distributed to clinics soon

23. In the Next Few Months, What Changes Can You Make that May Improve Acceptance and Completion in Your Clinic?

24. What Can We Do to Help You?