National HIV Prevention Conference Atlanta, Georgia, USA — July 27 - 30, 2003

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-C0201
Lally MA, Gaitanis MM, Khan B, Dispigno M, McNevin RJ, Stein MD;
Brown University, Providence, RI

BACKGROUND/OBJECTIVES:: We may soon have a preventative HIV vaccine. The effect of an HIV vaccine will depend on our ability to deliver it to high-risk individuals, such as intravenous drug users. Developing a model of successful hepatitis vaccination among substance users now may allow for the delivery of an HIV vaccine to the same population once one becomes available. We tested one model of HAV and HBV vaccination in a drug treatment center by providing on-site initial vaccines; comprehensive HIV, hepatitis, and STI testing; and incentives for follow-up vaccination.

METHODS: Participants were recruited from a state-funded, short-term drug treatment center in Fall River, Massachusetts. From January to March 2001, we enrolled male and female inpatients to receive comprehensive HIV, hepatitis, and STI testing. Participants were offered pre and posttest counseling, and those who tested negative for evidence of prior HAV or HBV infection were offered HAV and HBV vaccines. Follow up appointments were scheduled at six months for HAV vaccination and at one and six months for HBV vaccination. Research assistants attempted to contact and remind the participants of their appointments, and participants received $20 for each follow-up visit. Those who lived in the same town as the treatment center were able to receive transportation, but this service was not available to those who lived further away.

RESULTS: Fifty-two inpatients agreed to participate in the study and receive one or more biological tests. Among those who participated, 71% reported recent injection drug use. The average age of the participants was 32, and 79% of the subjects were Caucasian. Forty-five participants were eligible for either HAV or HBV vaccination, and 71% (32/45) received the initial vaccination. Sixty-nine percent (22/32) of these were HCV positive. Those who did not receive the initial vaccine either refused or had left the facility. None of the participants returned for a second HAV vaccine at six months. Only 5 out of 17 (29%) returned for a second HBV vaccination at one month and none returned for a third HBV vaccination at six months. Of those patients that lived in the same town as the study site, 80% (4/5) returned for the second HBV vaccine as opposed to 8% (1/12) of those that did not live in town (Fisher's exact test, p = 0.01).

CONCLUSIONS: In a drug-treatment facility setting, we were able to provide initial vaccinations against HAV and HBV to 71% (32/45) of eligible participants, but only 16%(5/32) returned for a follow-up vaccination. In addition to monetary incentives, providing transportation to a vaccine site may encourage better follow up among high-risk populations. Further work is currently needed to ensure high rates of hepatitis vaccine delivery among substance users in order to prepare for the delivery of the HIV vaccine to this population.

030727
M1-C0201

Copyright notice: The National HIV Prevention Conference is collaborative effort by the Centers for Disease Control and Prevention, a U.S. Government agency and other governmental and non-government organizations. All abstracts published in by the conference organizers are in the public domain and can be used without permission. Proper citation, however, is required.