Collaborating to develop a disease prevention program for a hard-to-reach population Amy B. Jessop , PhD, MPH 1,5 , Jerome Wells , MS 2 , Monika Burke , RN, MPH 1,4 , Kate Cushman , MPH 3 , John Muccitelli , RN,MPH 1
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Collaborating to develop a disease prevention program for a hard-to-reach population
Amy B. Jessop, PhD, MPH1,5,Jerome Wells, MS2,Monika Burke, RN,MPH1,4,Kate Cushman, MPH3,John Muccitelli, RN,MPH1
1HepTREC, 2The Consortium, Inc, 3Philadelphia Department of Public Health, 4Temple University, 5Univ. of the Sciences in Philadelphia, Philadelphia, PA
Hepatitis A (HAV) & B (HBV) viruses infect 90,000 in US annually and 1.25 million live with chronic HBV1.
CDC recommends HBV and HAV vaccination for high-risk adults (i.e.. multiple sexual partners, MSM, and injection drug users) and those with chronic liver disease (including hepatitis C (HCV))2. Now, 25 years later, high risk adults still account for 70% of new HBV cases3.
High-risk adults are labeled “hard-to-reach” and they are often poor, un or underinsured, and have histories of stigmatized behaviors. However, 60% to 70% of newly infected adults were recently seen in settings where vaccination is possible4.
In methadone maintenance programs (MMP), clients have/had high-risk drug use practices and many engage in unprotected sex, often with other drug users. HCV infection is common (40-80%)4. Most clients should be vaccinated.
This poster describes a collaborative partnership to vaccinate high-risk clients at a Philadelphia MMP.
Series completion: All ParticipantsSeries Completion: Eligible clients
(excludes 103 discharged before completion)
Sessions: 11 HAV only 17/28 = 61% HAV only 17/18 = 95%
Total Doses: 712 All HAV 186/331 = 56% All HAV 186/234 = 80%
Participants: 331 All HBV 158/303 = 52% All HBV 158/208 = 76%
* Additional 51 doses of flu vaccine were administered in November 2007
Hepatitis Vaccines Administered by Month
New Cases of Acute HBV Among Adults (2001-2004)
(High-risk practices labeled)
We successfully reached this “hard-to-reach” population. Each partner provided a critical element. Keys to success include education, the Vaccination Champion, volunteers, support of MMP administration, and availability of vaccine from PDPH.
MMPs are ideal settings for promotion and prevention. Clients are present, they are already taking action to improve their health status and, as demonstrated here, enthusiastically participate. Future plans include testing and vaccination for more of the 5,000 MMP clients in Philadelphia.
Heterosexual > 1 opposite sex partner
past 6 months (22.3%)
References:1CDC, MMWR 2008:57;( SS-2), 2CDC MMWR 1982: 31;317-318, CDC MMWR 1999 48(RR12);1-37 , 3 CDC, Sentinel County Surveillance, 2006. 4 Rich, J. AJM 114(4), 316 – 318, 5 communication Office of Addiction Services, City of Philadelphia, PA
Source: Sentinel Counties Study of Acute Viral Hepatitis, CDC