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McCosker LK, Ware RS, Seale H, Hooshmand D, O'Leary R, Downes MJ. The effect of a financial incentive on COVID-19 vaccination uptake, and predictors of uptake, in people experiencing homelessness: A randomized controlled trial. Vaccine 2024; 42:2578-2584. [PMID: 38485641 DOI: 10.1016/j.vaccine.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024]
Abstract
People who are homeless are at increased risk of COVID-19 infection, and of poorer associated outcomes. Delivering vaccinations to, and ensuring uptake of multiple doses in, people who are homeless is complex. Financial incentives may improve vaccination uptake, particularly in people who have not received routine vaccinations previously, though evidence about the effect of incentives is limited and variable. This randomized controlled trial (ANZCTR 383156) assessed the effect of a financial incentive (an A$10 grocery voucher) on uptake of the second COVID-19 vaccination in Australian adults who were homeless, and who had received their first dose. Participants were recruited through a vaccination program for people experiencing homelessness between September 2021 and January 2022. They were followed-up for a minimum of 6.5 months. Uptake was measured 'on-time' at 6 weeks, and at any time during the trial period. Vaccination status was checked on the Australian Immunisation Register. Demographic and vaccination program characteristics associated with uptake were also investigated. Eighty-six people consented to participate, and 43 were randomly allocated to each of the 'incentive' and 'no incentive' groups. The incentive slightly increased the likelihood of a participant receiving a second vaccination on-time (risk difference (RD), 11.6 % [95 %CI, -9.0, 32.2 %]; p = 0.27), and at any time during the trial (RD, 14.0 % [95 %CI, -2.2, 30.1 %], p = 0.09). The incentive had a significant positive effect on uptake in people with no previous vaccination history, increasing their likelihood of receiving a second vaccination on-time (RD, 42.3 % [95 %CI, 15.7, 68.8 %]; p = 0.002) and at any time during the trial (RD, 38.7 % [95 %CI, 16.1, 61.3 %], p < 0.001). Financial incentives may increase COVID-19 vaccination uptake in people who are homeless, and particularly those who have no previous vaccination history. Future research should consider alternative incentive values, types, and cost-effectiveness.
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Affiliation(s)
- Laura K McCosker
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Robert S Ware
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Dona Hooshmand
- Ashben Medical Centre, Gold Coast, Queensland, Australia.
| | - Ryan O'Leary
- Queensland Council of Social Service, Brisbane, Queensland, Australia; Gold Coast Homelessness Network, Australia.
| | - Martin J Downes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
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Li C, Zhang M, Karthijekan K, Fu X. How nurses contribute to the elimination of hepatitis B? A systematic review and meta-analysis. Int J Nurs Stud 2024; 149:104622. [PMID: 37944357 DOI: 10.1016/j.ijnurstu.2023.104622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND With approximately one-third of the global population exhibiting serological evidence of exposure, the hepatitis B virus remains a serious public health threat. Elimination of hepatitis B faces enormous challenges, from prevention to diagnosis, treatment, and long-term monitoring. Nurses are pivotal in optimising the hepatitis B care continuum; however, their contributions have been neglected. OBJECTIVE To identify the role of nurses in the elimination of hepatitis B and to synthesise the effectiveness of interventions with nursing roles in approaching the elimination target. DESIGN A systematic review and meta-analysis. SETTING(S) Thirteen databases (EMBASE, MEDLINE via OvidSP, Ovid Emcare, Ovid Nursing Database, British Nursing Index, APA PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, Web of Science Core Collection, China National Knowledge Internet, SinoMed, and Wanfang Data) were searched from their inception to 6 December 2022. METHODS Interventional studies examining the contribution of nursing roles towards elimination targets were included. Content analysis was used to extract and map the nursing roles based on the nursing interventions classification system. Random-effects meta-analyses were conducted to examine the effectiveness of the intervention in improving hepatitis B screening, detection, and vaccination rates. RESULTS The synthesis from 16 studies identified 13 nursing roles that primarily involved (1) health education and counselling for informed patient decision-making regarding hepatitis B prevention, vaccination, screening, and disease monitoring; (2) case management and health promotion to advocate elimination services at multiple levels and enable equitable access among marginalised communities; and (3) running specialist clinics to lead advanced practices in prescribing and carrying diagnostic tests, formulating evidence-based individualised care plans, and coordinating care throughout the disease process. Interventions with these roles achieved pooled hepatitis B screening and detection rates of 64 % (95 % confidence interval [CI] = 0.44, 0.84) and 2 % (95 % CI = 0.00, 0.05), respectively, increased the odds of hepatitis B virus vaccination by 2.61 times (95 % CI = 1.60, 4.28), improved immunity rate, and enhanced patient adherence to antiviral treatment and monitoring of liver comorbidities. However, their effects on hepatitis B virus DNA-negative conversion rates and hepatocellular carcinoma incidence were not significant. CONCLUSIONS Nurses play multifaceted roles in advocating hepatitis B screening and vaccination, initiating outreach efforts in marginalised communities, and leading advanced practices that effectively contribute to the elimination of hepatitis B. Policymakers should consider how nurses may help the achievement of the elimination target. REGISTRATION PROSPERO (CRD42022380719) registered on December 12, 2022. TWEETABLE ABSTRACT Nurses raised awareness, initiated outreach efforts, addressed inequalities, and led advanced practices-effectively contributing to eliminating hepatitis B.
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Affiliation(s)
- Caixia Li
- Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong Province, China.
| | - Mengxing Zhang
- Department of Nursing, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
| | - Karthikesu Karthijekan
- Department of Supplementary Health Sciences, Faculty of Health-Care Sciences, Eastern University Sri Lanka, Vantharumoolai, Eastern Province, Sri Lanka.
| | - Xia Fu
- Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong Province, China.
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Weightman AL, Kelson MJ, Thomas I, Mann MK, Searchfield L, Willis S, Hannigan B, Smith RJ, Cordiner R. Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta-analysis and thematic synthesis. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1329. [PMID: 37206622 PMCID: PMC10189499 DOI: 10.1002/cl2.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Adequate housing is a basic human right. The many millions of people experiencing homelessness (PEH) have a lower life expectancy and more physical and mental health problems. Practical and effective interventions to provide appropriate housing are a public health priority. Objectives To summarise the best available evidence relating to the components of case-management interventions for PEH via a mixed methods review that explored both the effectiveness of interventions and factors that may influence its impact. Search Methods We searched 10 bibliographic databases from 1990 to March 2021. We also included studies from Campbell Collaboration Evidence and Gap Maps and searched 28 web sites. Reference lists of included papers and systematic reviews were examined and experts contacted for additional studies. Selection Criteria We included all randomised and non-randomised study designs exploring case management interventions where a comparison group was used. The primary outcome of interest was homelessness. Secondary outcomes included health, wellbeing, employment and costs. We also included all studies where data were collected on views and experiences that may impact on implementation. Data Collection and Analysis We assessed risk of bias using tools developed by the Campbell Collaboration. We conducted meta-analyses of the intervention studies where possible and carried out a framework synthesis of a set of implementation studies identified by purposive sampling to represent the most 'rich' and 'thick' data. Main Results We included 64 intervention studies and 41 implementation studies. The evidence base was dominated by studies from the USA and Canada. Participants were largely (though not exclusively) people who were literally homeless, that is, living on the streets or in shelters, and who had additional support needs. Many studies were assessed as having a medium or high risk of bias. However, there was some consistency in outcomes across studies that improved confidence in the main findings. Case Management and Housing Outcomes Case management of any description was superior to usual care for homelessness outcomes (standardised mean difference [SMD] = -0.51 [95% confidence interval [CI]: -0.71, -0.30]; p < 0.01). For studies included in the meta-analyses, Housing First had the largest observed impact, followed by Assertive Community Treatment, Critical Time Intervention and Intensive Case Management. The only statistically significant difference was between Housing First and Intensive Case Management (SMD = -0.6 [-1.1, -0.1]; p = 0.03) at ≥12 months. There was not enough evidence to compare the above approaches with standard case management within the meta-analyses. A narrative comparison across all studies was inconclusive, though suggestive of a trend in favour of more intensive approaches. Case Management and Mental Health Outcomes The overall evidence suggested that case management of any description was not more or less effective compared to usual care for an individual's mental health (SMD = 0.02 [-0.15, 0.18]; p = 0.817). Case Management and Other Outcomes Based on meta-analyses, case management was superior to usual care for capability and wellbeing outcomes up to 1 year (an improvement of around one-third of an SMD; p < 0.01) but was not statistically significantly different for substance use outcomes, physical health, and employment. Case Management Components For homelessness outcomes, there was a non-significant trend for benefits to be greater in the medium term (≤3 years) compared to long term (>3 years) (SMD = -0.64 [-1.04, -0.24] vs. -0.27 [-0.53, 0]; p = 0.16) and for in-person meetings in comparison to mixed (in-person and remote) approaches (SMD = -0.73 [-1.25,-0.21]) versus -0.26 [-0.5,-0.02]; p = 0.13). There was no evidence from meta-analyses to suggest that an individual case manager led to better outcomes then a team, and interventions with no dedicated case manager may have better outcomes than those with a named case manager (SMD = -0.36 [-0.55, -0.18] vs. -1.00 [-2.00, 0.00]; p = 0.02). There was not enough evidence from meta-analysis to assess whether the case manager should have a professional qualification, or if frequency of contact, case manager availability or conditionality (barriers due to conditions attached to service provision) influenced outcomes. However, the main theme from implementation studies concerned barriers where conditions were attached to services. Characteristics of Persons Experiencing Homelessness No conclusions could be drawn from meta-analysis other than a trend for greater reductions in homelessness for persons with high complexity of need (two or more support needs in addition to homelessness) as compared to those with medium complexity of need (one additional support need); effect sizes were SMD = -0.61 [-0.91, -0.31] versus -0.36 [-0.68, -0.05]; p = 0.3. The Broader Context of Delivery of Case Management Programmes Other major themes from the implementation studies included the importance of interagency partnership; provision for non-housing support and training needs of PEH (such as independent living skills), intensive community support following the move to new housing; emotional support and training needs of case managers; and an emphasis on housing safety, security and choice. Cost Effectiveness The 12 studies with cost data provided contrasting results and no clear conclusions. Some case management costs may be largely off-set by reductions in the use of other services. Cost estimates from three North American studies were $45-52 for each additional day housed. Authors' Conclusions Case management interventions improve housing outcomes for PEH with one or more additional support needs, with more intense interventions leading to greater benefits. Those with greater support needs may gain greater benefit. There is also evidence for improvements to capabilities and wellbeing. Current approaches do not appear to lead to mental health benefits. In terms of case management components, there is evidence in support of a team approach and in-person meetings and, from the implementation evidence, that conditions associated with service provision should be minimised. The approach within Housing First could explain the finding that overall benefits may be greater than for other types of case management. Four of its principles were identified as key themes within the implementation studies: No conditionality, offer choice, provide an individualised approach and support community building. Recommendations for further research include an expansion of the research base outside North America and further exploration of case management components and intervention cost-effectiveness.
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Affiliation(s)
| | - Mark J. Kelson
- Department of Mathematics and Statistics, Faculty of Environment, Science and EconomyUniversity of ExeterExeterUK
| | - Ian Thomas
- Wales Institute of Social and Economic Research and Data (WISERD)Cardiff UniversityCardiffUK
| | - Mala K. Mann
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Lydia Searchfield
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Simone Willis
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
| | - Ben Hannigan
- Mental Health Nursing, School of Healthcare SciencesCardiff UniversityCardiffUK
| | | | - Rhiannon Cordiner
- Specialist Unit for Review Evidence (SURE)Cardiff UniversityCardiffUK
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Langat B, Muge EK, Night D, Okoth F, Ochwedo KO, Songok EM. Sero-prevalence of hepatitis B virus and compliance with hepatitis B vaccination schedules among outpatient clinic attendees in Nairobi. PLoS One 2023; 18:e0281256. [PMID: 36730277 PMCID: PMC9894478 DOI: 10.1371/journal.pone.0281256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/18/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hepatitis B is becoming a growing public health problem in Kenya. To combat the threat, HBV vaccination should be recommended, particularly for individuals who are not covered by the national immunization program. Vaccination provides sero-protection rates approaching 95% among healthy adults after completing the three-dose vaccination course, but decreases to 87% among those who receive only two doses, emphasizing the importance of completing the three-dose vaccination course. However, data on adult adherence to HBV multi-dose vaccines in Sub-Saharan Africa are limited, despite the fact that this information is critical for prevention. As a result, more research on HBV vaccine dose completion is required. The purpose of this study is to estimate the prevalence of hepatitis B virus infection among out-patient clinic attendees in Nairobi, Kenya, as well as to identify beneficiaries of free vaccination and barriers to completing the recommended vaccine doses. METHODS Between July 30th and September 30th, 2015, 2644 outpatient clinic attendees aged ≥ 4 were recruited from three hospitals in Nairobi County, Kenya: Mama Lucy, Riruta, and Loco. Self-administered questionnaires were used to collect socio-demographic information, and blood samples were tested for hepatitis B surface antigen (HBsAg) using the KEMRI HEPCELL Rapid® (Hepatitis B Detection kit) test kit. Individuals who tested negative for HBsAg were given a free course of three doses of HBV vaccine. The vaccination register provided information on the number of doses administered. RESULTS The average age of the study population was 31.4 years (range: 4-66), with females accounting for 59.2%. 1.82% (48/2644) of the participants tested positive for HBsAg. Among the 2596 individuals eligible for vaccination, 66% (1720/2596) received at least one dose, and 51.8% (1345/2596) received all three doses. Vaccination acceptance increased with age, with older patients more likely to return for subsequent dose (OR>1 for second and third dose). Unavailability and failure to contact client were cited as significant (p<0.0001) barrier to vaccination completion by 53.7% (666/1226, 95% CI 0.5-0.6) and 37% (454/1226, 95% CI 0.3-0.4) of respondents respectively. CONCLUSION The prevalence of HBV infection among outpatient clinic attendees highlights the importance of expanding HBV immunization programs in Kenya. However, given the low vaccination completion rate, there is a need for public awareness of the vaccine's importance in preventing HBV and HBV-related complications.
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Affiliation(s)
- Benard Langat
- Department of Medical Biochemistry, University of Nairobi, Nairobi, Kenya
- * E-mail:
| | - Edward K. Muge
- Department of Medical Biochemistry, University of Nairobi, Nairobi, Kenya
| | - Doris Night
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Fredrick Okoth
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kevin O. Ochwedo
- Faculty of Science and Technology, Department of Biology, University of Nairobi, Nairobi, Kenya
| | - Elijah M. Songok
- Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
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McCosker LK, El-Heneidy A, Seale H, Ware RS, Downes MJ. Strategies to improve vaccination rates in people who are homeless: A systematic review. Vaccine 2022; 40:3109-3126. [PMID: 35484042 PMCID: PMC9040475 DOI: 10.1016/j.vaccine.2022.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 10/28/2022]
Abstract
People who are homeless experience higher rates of vaccine-preventable disease, including COVID-19, than the general population, and poorer associated health outcomes. However, delivering vaccinations to people who are homeless is complex, and there is a lack of evidence to inform practice in this area. The aim of this systematic review is to: (a) identify, (b) analyse the characteristics of, and (c) evaluate the outcomes of, strategies to improve vaccination rates in people who are homeless. Literature was retrieved from eight electronic databases. Studies undertaken in high-income countries, published in English, in a peer-reviewed journal, and in full-text were considered. No limits were placed on study design or date. A total of 1,508 articles were retrieved and, after the removal of duplicates, 637 were screened. Twenty-three articles, reporting on nineteen separate vaccination strategies for hepatitis A/B, influenza, herpes zoster, invasive pneumococcal disease, and diphtheria in people who are homeless, were selected for inclusion. All the strategies were effective at improving vaccination rates in, people who are homeless. Most strategies involved vaccination clinics and most were delivered, at least in part, by nurses. Other characteristics of successful strategies included: delivering vaccinations at convenient locations; using accelerated vaccination schedules (if available); vaccinating at the first appointment, regardless of whether a person's vaccination history or serological status were known (if clinically safe); operating for a longer duration; offering training to staff about working with people who are homeless; widely promoting clinics; considering education, reminders, incentives, and co-interventions; ensuring no out-of-pocket costs; and working collaboratively with stakeholders, including people who are homeless themselves. These findings will inform evidence-based vaccination strategies, including for COVID-19, in people who are homeless, and improve associated health outcomes in this at-risk, hard-to-reach group.
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Affiliation(s)
- Laura K McCosker
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia; School of Population Health, University of New South Wales, Australia.
| | - Asmaa El-Heneidy
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Australia
| | - Robert S Ware
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Martin J Downes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia
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Tressler S, Bhandari R. Interventions to Increase Completion of Hepatitis B Vaccination in People who Inject Drugs: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2019; 6:ofz521. [PMID: 31890724 PMCID: PMC6929254 DOI: 10.1093/ofid/ofz521] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/04/2019] [Indexed: 12/05/2022] Open
Abstract
Increases in opioid misuse and injection drug use have resulted in a rise in acute cases of hepatitis B. We conducted a systematic review and meta-analysis of randomized studies to determine the effect (pooled odds ratio) of interventions to increase hepatitis B vaccination completion in people who inject drugs (PWID). Odds ratios from the included studies were combined to create a pooled odds ratio (OR) using the Inverse Heterogeneity Model. Eleven studies met the eligibility criterion of having a randomized intervention to increase hepatitis B virus vaccination completion among PWID. The odds of vaccine completion in the intervention group were greater than in the control/comparison group (pooled OR, 2.53; 95% confidence interval [CI], 1.07–5.99). Subgroup analysis indicated that financial incentives were most effective (OR, 7.01; 95% CI, 2.88–17.06), followed by accelerated vaccine schedules (OR, 1.90; 95% CI, 1.14–3.14). Interventions using financial incentives and accelerated vaccine schedules are moderately effective at increasing hepatitis B vaccination completion in PWID.
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Affiliation(s)
- Stacy Tressler
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
- Correspondence: Stacy Tressler, MPH, Department of Epidemiology, West Virginia University, P.O. Box 9190, Morgantown, WV 26506 ()
| | - Ruchi Bhandari
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
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Taylor JEB, Surey J, MacLellan J, Francis M, Abubakar I, Stagg HR. Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study. BMC Infect Dis 2019; 19:372. [PMID: 31046683 PMCID: PMC6498651 DOI: 10.1186/s12879-019-3926-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background In the UK, hepatitis B virus (HBV) incidence is associated with migrants from particular high-burden countries and population groups deemed ‘hard-to-reach’ by standard healthcare services: the homeless, people who inject drugs and ex-prisoners. Currently, there is a national targeted HBV vaccine policy for such at-risk groups, but there is limited recent evidence about 1) the levels of vaccine uptake, 2) the factors associated with incomplete vaccination, and 3) reasons for incomplete vaccination. Methods A questionnaire capturing social and medical history, demographic factors and information about HBV vaccination status was completed by individuals deemed hard-to-reach due to socio-structural factors that criminalise, isolate and stigmatise who consented to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. The questionnaire also captured the reasons for incomplete vaccination. Descriptive, univariable and multivariable regression analyses were undertaken. Results Three hundred fourty six participants completed the questionnaire. 1) 52.3% (n = 181) reported full HBV vaccination. 2) Within a multivariable model adjusting for sociodemographic variables, the presence of one or two or more socio-structural factors that are included in the national targeted vaccination policy was associated with protection against incomplete HBV vaccination (51.7% vaccine coverage in those with one factor, odds ratio 0.43 [95% confidence interval 0.20–0.92]); 70.1% coverage with two or more factors, 0.19 [0.09–0.39]; overall p-value < 0.001). Being female was also associated with lower vaccine uptake (2.37 [1.24–4.57], 0.01). Examining the socio-structural factors individually, intravenous drug use was associated with protection against incomplete HBV vaccination. 3) The most common reasons declared for incomplete vaccination were never being offered the vaccine or not returning for further doses. Conclusion Within this study of HBV vaccination uptake among hard-to-reach population groups in London, UK, we document 52.3% coverage of the full vaccine course. Critically, although participants recommended for immunisation within national guidelines had an increased likelihood of receiving a complete vaccine course, we note surprisingly low coverage in the presence of the risk factors that are national indicators for vaccination. Public health bodies should make additional efforts to improve coverage in the hard-to-reach through improved vaccine delivery systems. Trial registration ISRCTN24707359, Registered 19th October 2012. Electronic supplementary material The online version of this article (10.1186/s12879-019-3926-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Josephine E B Taylor
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Julian Surey
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Jennifer MacLellan
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Marie Francis
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK.
| | - Helen R Stagg
- Institute for Global Health, University College London, 4th floor, Mortimer Market Centre, off Capper Street, London, WC1E 6JB, UK.,Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, 30 West Richmond Street, Edinburgh, EH8 9DX, UK
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Jacobson Vann JC, Jacobson RM, Coyne‐Beasley T, Asafu‐Adjei JK, Szilagyi PG. Patient reminder and recall interventions to improve immunization rates. Cochrane Database Syst Rev 2018; 1:CD003941. [PMID: 29342498 PMCID: PMC6491344 DOI: 10.1002/14651858.cd003941.pub3] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Immunization rates for children and adults are rising, but coverage levels have not reached optimal goals. As a result, vaccine-preventable diseases still occur. In an era of increasing complexity of immunization schedules, rising expectations about the performance of primary care, and large demands on primary care providers, it is important to understand and promote interventions that work in primary care settings to increase immunization coverage. One common theme across immunization programs in many nations involves the challenge of implementing a population-based approach and identifying all eligible recipients, for example the children who should receive the measles vaccine. However, this issue is gradually being addressed through the availability of immunization registries and electronic health records. A second common theme is identifying the best strategies to promote high vaccination rates. Three types of strategies have been studied: (1) patient-oriented interventions, such as patient reminder or recall, (2) provider interventions, and (3) system interventions, such as school laws. One of the most prominent intervention strategies, and perhaps best studied, involves patient reminder or recall systems. This is an update of a previously published review. OBJECTIVES To evaluate and compare the effectiveness of various types of patient reminder and recall interventions to improve receipt of immunizations. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL to January 2017. We also searched grey literature and trial registers to January 2017. SELECTION CRITERIA We included randomized trials, controlled before and after studies, and interrupted time series evaluating immunization-focused patient reminder or recall interventions in children, adolescents, and adults who receive immunizations in any setting. We included no-intervention control groups, standard practice activities that did not include immunization patient reminder or recall, media-based activities aimed at promoting immunizations, or simple practice-based awareness campaigns. We included receipt of any immunizations as eligible outcome measures, excluding special travel immunizations. We excluded patients who were hospitalized for the duration of the study period. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane and the Cochrane Effective Practice and Organisation of Care (EPOC) Group. We present results for individual studies as relative rates using risk ratios, and risk differences for randomized trials, and as absolute changes in percentage points for controlled before-after studies. We present pooled results for randomized trials using the random-effects model. MAIN RESULTS The 75 included studies involved child, adolescent, and adult participants in outpatient, community-based, primary care, and other settings in 10 countries.Patient reminder or recall interventions, including telephone and autodialer calls, letters, postcards, text messages, combination of mail or telephone, or a combination of patient reminder or recall with outreach, probably improve the proportion of participants who receive immunization (risk ratio (RR) of 1.28, 95% confidence interval (CI) 1.23 to 1.35; risk difference of 8%) based on moderate certainty evidence from 55 studies with 138,625 participants.Three types of single-method reminders improve receipt of immunizations based on high certainty evidence: the use of postcards (RR 1.18, 95% CI 1.08 to 1.30; eight studies; 27,734 participants), text messages (RR 1.29, 95% CI 1.15 to 1.44; six studies; 7772 participants), and autodialer (RR 1.17, 95% CI 1.03 to 1.32; five studies; 11,947 participants). Two types of single-method reminders probably improve receipt of immunizations based on moderate certainty evidence: the use of telephone calls (RR 1.75, 95% CI 1.20 to 2.54; seven studies; 9120 participants) and letters to patients (RR 1.29, 95% CI 1.21 to 1.38; 27 studies; 81,100 participants).Based on high certainty evidence, reminders improve receipt of immunizations for childhood (RR 1.22, 95% CI 1.15 to 1.29; risk difference of 8%; 23 studies; 31,099 participants) and adolescent vaccinations (RR 1.29, 95% CI 1.17 to 1.42; risk difference of 7%; 10 studies; 30,868 participants). Reminders probably improve receipt of vaccinations for childhood influenza (RR 1.51, 95% CI 1.14 to 1.99; risk difference of 22%; five studies; 9265 participants) and adult influenza (RR 1.29, 95% CI 1.17 to 1.43; risk difference of 9%; 15 studies; 59,328 participants) based on moderate certainty evidence. They may improve receipt of vaccinations for adult pneumococcus, tetanus, hepatitis B, and other non-influenza vaccinations based on low certainty evidence although the confidence interval includes no effect of these interventions (RR 2.08, 95% CI 0.91 to 4.78; four studies; 8065 participants). AUTHORS' CONCLUSIONS Patient reminder and recall systems, in primary care settings, are likely to be effective at improving the proportion of the target population who receive immunizations.
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Affiliation(s)
- Julie C Jacobson Vann
- The University of North Carolina at Chapel HillSchool of NursingCarrington HallChapel HillNorth CarolinaUSA27599‐7460
| | - Robert M Jacobson
- Mayo ClinicPediatric and Adolescent Medicine200 First Street, SWRochesterMinnesotaUSA55905‐0001
| | - Tamera Coyne‐Beasley
- University of North CarolinaGeneral Pediatrics and Adolescent MedicineChapel HillNorth CarolinaUSA
| | - Josephine K Asafu‐Adjei
- University of North Carolina at Chapel HillDepartment of Biostatistics, School of Nursing120 North Medical Drive, 2005 Carrington HallChapel HillNorth CarolinaUSA27599
| | - Peter G Szilagyi
- University of California Los AngelesDepartment of Pediatrics90024Los AngelesCaliforniaUSA90024
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Nyamathi A, Reback CJ, Shoptaw S, Salem BE, Zhang S, Yadav K. Impact of Tailored Interventions to Reduce Drug Use and Sexual Risk Behaviors Among Homeless Gay and Bisexual Men. Am J Mens Health 2017; 11:208-220. [PMID: 26130725 PMCID: PMC5675281 DOI: 10.1177/1557988315590837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A randomized controlled trial was conducted with homeless gay and bisexual men to assess the impact of two culturally sensitive intervention programs on reduction of drug use and risky sexual behavior. In this study, gay and bisexual men between 18 and 46 years of age were randomly assigned to one of two culturally sensitive behavioral intervention programs: a Nurse Case Management Plus Contingency Management (NCM + CM; n = 204) or a Standard Education Plus Contingency Management (SE + CM; n = 210) program. Regardless of group assignment, significant and clinically relevant reductions were observed in stimulant use over time. Multivariable predictors of stimulant use at 4- and 8-month follow-up evaluations were recent injection drug use, tested positive for HIV, or for use of amphetamine. Data revealed a significant linear decline over time for those who had sex with multiple partners. Furthermore, being HIV positive was associated with reporting multiple partners, while higher homophobia scores and having children were inversely related to reports of having sex with multiple partners at follow-up. Culturally sensitive approaches are needed to successfully reduce drug use and risky sexual activities among gay and bisexual populations.
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10
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Jin H, Tan Z, Zhang X, Wang B, Zhao Y, Liu P. Comparison of Accelerated and Standard Hepatitis B Vaccination Schedules in High-Risk Healthy Adults: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10:e0133464. [PMID: 26196903 PMCID: PMC4510064 DOI: 10.1371/journal.pone.0133464] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Selecting the most efficient vaccination schedule is an important issue. OBJECTIVE To assess the beneficial and harmful effects of accelerated hepatitis B vaccination schedules in high-risk healthy adults. METHODS We searched controlled trial registers of The Cochrane Library as well as MEDLINE, EMBASE, VIP Database for Chinese Technical Periodicals, and the Chinese National Knowledge Infrastructure databases for randomized controlled trials published up to December 2013 that compared accelerated hepatitis B vaccine schedules to the standard schedule in adults. The results were presented as relative risk with 95% confidence intervals. Fixed or random effect models were used for analysis. RESULTS We identified 10 randomized trials, all with one or more methodological weaknesses. Compared to the standard schedule, most accelerated schedules resulted in higher proportions of healthy vaccines more rapidly reaching anti-hepatitis B antibody levels >10 IU/L (P<0.05) initially and maintaining similar seroprotection rates after 6 months (P>0.05). Although accelerated schedules produced anti-hepatitis B levels higher than the standard schedule for the first month after the initial vaccine dose, they were significantly lower than the standard schedule after 6 months, except for an accelerated schedule that called for a fourth booster injection 12 months after the initial dose. Subjects administered accelerated vaccine schedules had similar compliance rate as those administered the standard schedule over the first 6 months of vaccination (relative risk = 1.00, 95% confidence interval: 0.84-1.21). CONCLUSION For rapid seroconversion and almost immediate short-term protection, accelerated vaccination schedules could be useful for at-risk groups. However, additional studies on the long-term protection and effectiveness of the primary doses of accelerated schedules are necessary.
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Affiliation(s)
- Hui Jin
- Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Zhaoying Tan
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Xuefeng Zhang
- Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, China
| | - Bei Wang
- Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Yueyuan Zhao
- Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Pei Liu
- Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
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11
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Tyler D, Nyamathi A, Stein JA, Koniak-Griffin D, Hodge F, Gelberg L. Increasing hepatitis C knowledge among homeless adults: results of a community-based, interdisciplinary intervention. J Behav Health Serv Res 2014; 41:37-49. [PMID: 23616250 DOI: 10.1007/s11414-013-9333-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Homeless adults have high rates of hepatitis C virus infection (HCV) and low levels of HCV knowledge. This study reports results of an interdisciplinary, community-based intervention using stakeholder cooperation, case management, risk factor identification, and modification of dysfunctional psychosocial factors to increase HCV knowledge among homeless adults (N = 747). Data are from a randomized quasi-experimental study, with the major goal of evaluating the effectiveness of a Nurse Case Managed Intervention compared to a Standard Intervention, encouraging completion of a three-series hepatitis A/hepatitis B vaccination program. Increased HCV knowledge was measured with an 18-item questionnaire discerning risk factors for HCV and common misconceptions about individuals with HCV. A significant increase in HCV knowledge resulted regardless of intervention format. Receiving the Nurse Case Managed Intervention predicted greatest gain in HCV knowledge (p < 0.000). Successfully engaging key stakeholders, outreach workers, community organizations, and homeless people themselves proved most efficacious in increasing HCV knowledge.
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12
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Factors associated with hepatitis B vaccine series completion in a randomized trial for injection drug users reached through syringe exchange programs in three US cities. BMC Public Health 2014; 14:820. [PMID: 25107530 PMCID: PMC4138371 DOI: 10.1186/1471-2458-14-820] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Hepatitis B virus (HBV) is a vaccine preventable infection yet vaccination rates are low among injection drug users (IDUs) despite the high risk of infection and longstanding recommendations to promote vaccination. We sought to improve vaccination rates by reaching IDUs through syringe exchange programs (SEPs) in three U.S. cities. Methods IDUs were randomized in a trial comparing the standard HBV vaccination schedule (0, 1, and 6 months) to an accelerated schedule (0, 1, and 2 months) and participation data were analyzed to identify determinants of completion of the three-dose vaccine series. Independent variables explored included sociodemographics, injection and syringe access behaviors, assessment of health beliefs, HBV-associated knowledge, and personal health status. Results Covariates associated with completion of the three-dose vaccine series were accelerated vaccine schedule (aOR 1.92, 95% CI 1.34, 2.58, p = <0.001), older age (aOR 1.05, 95% CI 1.03, 1.07, p = <0.001), and poorer self-rated health score (aOR 1.26, 95% CI 1.05, 1.5, p = 0.02). Completion was less likely for those getting syringes from SEP customers than for SEP customers (OR 0.33, 95% CI 0.19, 0.58, p = <0.001). Conclusions SEPs should offer hepatitis vaccination in a manner that minimizes time between first and last visits by accelerating the dosing schedule. Public health interventions should target younger, less healthy, and non-SEP customer participants. Other health interventions at SEPs may benefit from similar approaches that reach out beyond regular SEP customers.
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13
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Holman DM, Grossman M, Henley SJ, Peipins LA, Tison L, White MC. Opportunities for cancer prevention during midlife: highlights from a meeting of experts. Am J Prev Med 2014; 46:S73-80. [PMID: 24512934 PMCID: PMC4535330 DOI: 10.1016/j.amepre.2013.10.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 10/29/2013] [Accepted: 10/29/2013] [Indexed: 12/19/2022]
Abstract
This paper provides highlights from a CDC-hosted meeting on opportunities for cancer prevention during midlife (roughly ages 45-64 years). Positive changes during this phase of life have the potential to prevent cancer incidence later in life, making this phase an opportune time for targeted prevention efforts to facilitate healthy aging and increased longevity. Risk and protective factors discussed during the meeting included exposure to radiation from medical imaging procedures, circadian disruption, chemical exposures, dietary factors, alcohol consumption, obesity, physical activity, diabetes, and the human microbiome. Although many of these factors are well recognized as being related to cancer incidence, others are not as widely recognized or have emerged as growing areas of research. Meeting participants discussed promising strategies for cancer prevention targeting this age group. Just as there are multiple determinants of cancer risk, there are likely multiple solutions. Changes to social and physical environments may facilitate healthy behaviors and minimize harmful exposures. Information shared during the meeting about health disparities in the U.S. highlighted the need to go beyond traditional approaches to cancer prevention to truly reach vulnerable populations. Partnerships are also a key component to prevention efforts; community-based and nonprofit organizations, the healthcare system, research institutions, state health departments, and federal agencies were all noted as important partners in prevention efforts. Coordinated, multi-disciplinary efforts across multiple chronic diseases may provide opportunities for synergistic effects. Further, leveraging key partnerships and existing communication channels can maximize success and facilitate timely translation of research findings into public health practice.
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Affiliation(s)
- Dawn M Holman
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia.
| | - Melissa Grossman
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - S Jane Henley
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Lucy A Peipins
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Laura Tison
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Mary C White
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
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Ghadiri K, Vaziri S, Afsharian M, Jahanbaksh A, Mansouri F, Sayad M, Najafi F, Souri B. Comparison of the accelerated and standard vaccination schedules against hepatitis B in healthcare workers. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2012; 17:934-7. [PMID: 23825992 PMCID: PMC3698651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 07/01/2012] [Accepted: 07/13/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND For healthcare workers, sometimes the conventional hepatitis-B virus (HBV) vaccination schedule might not provide seroconversion rapidly enough. The aim of this study was to compare the efficacy of conventional HBV vaccination with an accelerated schedule (days 0-1-21). MATERIALS AND METHODS In this randomized clinical trial, 161 healthcare workers were divided into two vaccination groups; group A underwent the conventional schedule (0-1-6 months) and group B received the accelerated program (0-10-21 days) of hepatitis B virus vaccine. The anti-HBs antibody was determined 30 days after completion of the third vaccine injection in both groups by enzyme immunoassay (EIA) (Abbot, Aux SYMsys). By using the Fisher's exact and Wilcoxon tests, the results were analyzed. The protective level of anti-HBS was defined as titer ≥10 MIU/ml. RESULTS The seroprotection rate, 30 days after vaccination, were similar in both groups A and B; 96.3% of the participants in group A and 92.6% in group B had anti-HBS antibody ≥10 MIU/ml. CONCLUSION Our data indicated that compared to the classic HBS vaccination program an accelerated schedule could also be effective and achieve seroprotection more rapidly.
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Affiliation(s)
- Keyghobad Ghadiri
- Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Siavash Vaziri
- Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mandana Afsharian
- Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,Address for correspondence: Dr. Mandana Afsharian, Nosocomial Infection Research Center., Kermanshah University of Medical Sciences, Kermanshah, Iran. E-mail:
| | - Alireza Jahanbaksh
- Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Faizolah Mansouri
- Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mansouri Sayad
- Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahram Souri
- Nosocomial Infection Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Nyamathi AM, Marlow E, Branson C, Marfisee M, Nandy K. Hepatitis A/B vaccine completion among homeless adults with history of incarceration. JOURNAL OF FORENSIC NURSING 2012; 8:13-22. [PMID: 22372394 PMCID: PMC3359373 DOI: 10.1111/j.1939-3938.2011.01123.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Hepatitis B virus (HBV) vaccination rates for incarcerated adults remain low despite their high risk for infection. This study determined predictors of vaccine completion in homeless adults (N= 297) who reported histories of incarceration and who participated in one of three nurse-led hepatitis programs of different intensity. Moreover time since release from incarceration was also considered. Just over half of the former prisoners completed the vaccine series. Older age (≥40), having a partner, and chronic homelessness were associated with vaccine completion. Recent research has documented the difficulty in providing vaccine services to younger homeless persons and homeless males at risk for HBV. Additional strategies are needed to achieve HBV vaccination completion rates greater than 50% for formerly incarcerated homeless men.
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Zucker DM, Choi J, Gallagher ER. Mobile outreach strategies for screening hepatitis and HIV in high-risk populations. Public Health Nurs 2011; 29:27-35. [PMID: 22211749 DOI: 10.1111/j.1525-1446.2011.00970.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To screen, counsel and offer hepatitis A and B vaccination for subjects at high risk for hepatitis C virus (HCV) and HIV, and determine any relationship between risk factors and HCV positivity. DESIGN AND SAMPLE A descriptive correlational design. We correlated risk factors and HCV positivity and measured vaccination completion rates. Two hundred and two unduplicated subjects in 4 locations in Western Massachusetts: a walk in substance abuse clinic, a homeless shelter, a county jail, and a community corrections facility. MEASURES Demographic data and a standard HCV risk- screening survey were used. RESULTS Significantly higher rates of HCV were found in subjects who were currently using injection drugs (83.3% HCV positive, χ2(1) = 20.85, p<.001), who had a history of sharing needles for drug use (75% HCV positive χ(2) (1)=83.20, p<.001), or a history of receiving treatment for drug abuse/alcoholism (38.4% HCV positive χ2(1) = 12.14, p<.001). Vaccination completion ranged by setting between 18% and 38%. CONCLUSIONS Targeted outreach to hard to reach groups is effective in providing access for those at high risk for HIV and HCV infection. A mobile outreach strategy can focus needed resources for a variety of groups in a community.
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Affiliation(s)
- Donna M Zucker
- School of Nursing, University of Massachusetts Amherst, Amherst 01003, USA.
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Vaccination against hepatitis B among prisoners in Iran: accelerated vs. classic vaccination. Health Policy 2011; 100:297-304. [PMID: 21269722 DOI: 10.1016/j.healthpol.2010.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 12/21/2010] [Accepted: 12/25/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND Prisoners and injecting drug users are at constant risk of hepatitis B virus (HBV) infection and the classic 6-months HBV vaccination might not provide immunization rapidly enough. In this randomized clinical trial we investigated the efficacy of an accelerated vaccination protocol vs. classic schedule among prisoners in Iran. METHODS 180 prisoners were randomized into 2 vaccination groups; group A underwent accelerated vaccination at 0, 1, 4 and 8 weeks and group C were vaccinated at 0, 1 and 6 months. Antibody against Hepatitis-B surface-antigen (anti-HBs) was assessed at baseline, one, two, six and eight months after the first vaccine dose using immunoenzymatic assays. Seroprotection was defined as anti-HBs titer of 10 IU/L or more. Anti-HBc and HBsAg were measured at baseline and 8th month to evaluate new HBV infection and failure of vaccination. RESULTS Overall compliance was 100% and 90.4% in groups A and C respectively. While seroprotection rate at one month was significantly higher in group A (22.4%) compared to group C (4.7%), in the 8th month 78.8% and 93.4% seroprotection was achieved in groups A and C respectively (P < 0.002). CONCLUSION Compared to classic HBV vaccination regimen, an accelerated 0, 1, 4 and 8 weeks vaccination schedule can achieve early seroprotection more rapidly, provides clinically sufficient seroprotection with higher compliance in prisoners and can be suggested in situations that rapid immunization against HBV infection is warranted.
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Nyamathi A, Sinha K, Greengold B, Cohen A, Marfisee M. Predictors of HAV/HBV vaccination completion among methadone maintenance clients. Res Nurs Health 2010; 33:120-32. [PMID: 20143328 DOI: 10.1002/nur.20371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This randomized, controlled study (N = 256) was conducted to compare three interventions designed to promote hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccination completion among clients undergoing methadone maintenance (MM) treatment. Participants were recruited from five MM treatment sites in Southern California and randomized into three groups: Motivational Interviewing-Single (MI-Single), Motivational Interviewing-Group (MI-Group); and Nurse-Led Hepatitis Health Promotion (HHP). All were offered the three-series HAV/HBV vaccine. A total of 148 participants completed the vaccine. Groups did not differ in rate of vaccination completion (73.6%, HHP group, vs. 65% and 69% for the MI-Single and MI-Group, respectively). The equivalence of findings across groups suggests the value of including nurses with a comprehensive health focus in promoting vaccination completion.
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Affiliation(s)
- Adeline Nyamathi
- School of Nursing, University of California-Los Angeles, Box 951702, Los Angeles, CA 90095-1702, USA
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