Collaborating to develop a disease prevention program for a hard-to-reach population

Background- Hepatitis A (HAV) and B (HBV) vaccination is recommended for high-risk adults including substance users and those with chronic liver diseases such as hepatitis C (HCV). In Philadelphia, clients of methadone programs receive physicals including HBV and HCV screening. Despite the 80% HCV infection rate, few clients have been vaccinated against HAV or HBV. Methadone clients visit clinics daily for years. With the long-term contact, methadone programs are excellent sites for vaccinating this at-risk group.

Program description: HepTREC, a community-based organization, the Philadelphia Department of Public Health, and The Consortium Inc.'s methadone program collaborated to implement a hepatitis immunization program that successfully vaccinates high-risk adults. The City provides vaccine and some supplies. The Consortium provides space and makes clients aware of and available for vaccination. HepTREC orders, stores, and transports the vaccine and supplies, and administers vaccine and reports activity according to City requirements. Clients receive educational materials and links to support services. Participation is voluntary.

Results: At ten 5-hour sessions, we administered 751 doses of hepatitis vaccine to 332 individuals. The 2 or 3 dose series completion rate for all clients is 62%. The completion rate for active clients (non-discharged) is 84%. We also delivered 100 doses of influenza vaccine. Many clients report follow up with healthcare providers. Factors influencing participation and the collaboration will be discussed.

Conclusion: Each partner provided components essential to the success of this low-cost program. Without the collaboration, more than 750 Consortium methadone clients would be at-risk for life threatening, but preventable infections.