Prevalence of hepatitis B and C in medically assisted treatment programs

Introduction Injecting drugs is a leading risk for Hepatitis B (HBV) and C (HCV) infection. CDC recommends HBV vaccination for injection drug users (IDUs but coverage is low. Identifying infected IDUs and potentially modifiable risk behaviors may help to reduce HBV-related transmission and morbidity. Methods This study identified factors associated with HBV in Philadelphia's medically-assisted treatment programs (MAT). Program charts for 674 (90%) of clients at two MATs were reviewed to determine client demographics, hepatitis status, and history of drug use, physical and mental health, and incarceration. Associations between these factors and infection status were examined through bivariate and multivariate methods. Results HBV infection rate (4.4%) is 10 times the national prevalence estimate. Seven clients became infected while enrolled in MAT. Anti-HCV antibodies were noted in 64% of clients (23 times the national estimate). Of HBV-infected, 65% were co-infected with HCV. Clients were not tested for anti-HBV antibodies therefore resolved HBV infection, vaccination status, and susceptibility were indeterminable. Drug history, injection status, age, institutionalization, and other demographic characteristics were associated with hepatitis infection status. Conclusion HCV and HBV pose significant health risks to IDUs and MAT clients. HBV infection during MAT enrollment illustrates the need for vaccination and education. Vaccinating susceptible MAT clients and the contacts of those with HBV may reduce the incidence and prevalence of HBV in the community. Those with HCV should be vaccinated against HBV and hepatitis A. MAT clients are accessible and generally have health insurance, mitigating the usual barriers to vaccination of high-risk adults.