Targeting Settings That Serve At-Risk Populations

Integrating viral hepatitis services in a broad array of settings creates more opportunities to identify at-risk clients and to get them other services that they need (Hoffman et al., 2004). STD/HIV clinics, shelter-based programs, and mobile health units are settings that serve populations that are at risk for hepatitis B and hepatitis C.

STD–HIV Clinics

Clinical venues that provide screening, identification, and care for people at risk for or infected with STDs and HIV present critical opportunities to provide similar viral hepatitis services. CDC has estimated that almost 30% of people who have received a diagnosis of acute hepatitis B have previously been treated for an STD (Goldstein et al., 2002). Among HIV-infected people, rates of chronic hepatitis B are about 6–14%, and rates of chronic hepatitis C about 33% (Alter, 2006; Sherman et al., 2002; Sulkowski, 2008; Thio et al., 2002). In 2001, the National Alliance of State and Territorial AIDS Directors recommended that state health programs integrate HIV, STD, and viral hepatitis prevention services and that programs offer hepatitis A and hepatitis B vaccination; counseling and testing for HIV, STDs, hepatitis B, and hepatitis C; and partner services and referrals to additional prevention and health-care services (NASTAD, 2001). CDC’s 2006 STD Treatment Guidelines recommend that all unvaccinated persons attending STD clinics receive the hepatitis B vaccine (Workowski and Berman, 2006). The concept of integrating hepatitis B vaccination into STD clinics has been accepted and needs to be expanded to all STD clinic venues.

Some progress has been made in the integration of viral hepatitis services into health-care settings, such as STD or HIV clinics, that serve high-risk populations. A study by Gilbert et al. (2005) showed that many STD clinics have effectively introduced a policy and a plan for hepatitis B prevention; 55% of STD clinics had come to consider hepatitis B vaccination a program responsibility, and 78% had established a vaccination program. From 1997 to 2001, there was a marked increase in the proportion of clinics that offered hepatitis B vaccine (from 61% to 82%), provided hepatitis B educational materials (from 49% to 84%), and accessed federal vaccination programs (from 48% to 84%). In areas where a state STD program had distributed a hepatitis B prevention plan, 88% of STD clinics offered hepatitis B vaccination compared with 50% in areas where a prevention plan had not been developed. The main obstacles cited were the lack of resources for services and low patient compliance. The need for and effect of hepatitis B vaccination was underscored in a study of an urban STD clinic

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