ABSTRACT

Injection drug users (IDUs) are at high risk for hepatitis B virus (HBV); however, they often do not receive preventive vaccination. IDUs who use mobile health care services linked to a syringe exchange program in New Haven were routinely screened for HBV, hepatitis C virus, and syphilis. Individuals without prior exposure to HBV were offered three-part vaccination series. Of the 212 IDUs screened for HBV infection, 134 (63%) were eligible (negative for HBV surface and core anti-bodies) for vaccination and 10 (4.7%) had evidence of chronic HBV infection. Compared to those with previous exposure to HBV, vaccine-eligible patients were significantly more likely to be younger and use heroin and less likely to be black, home-less, daily injectors, and cocaine users. Of the 134 vaccine-eligible subjects, 103 (77%) and 89 (66%) completed two and three vaccinations, respectively. Correlates of completing all three vaccinations included older age (OR = 1.06, 95% CI = 1.04-1.07), injecting daily (OR = 2.12, 95% CI = 1.36-6.73), and being homeless (OR = 1.98, 95% CI = 1.14-12.27). These results suggest that IDUs remain at high risk for acquiring HBV infection. Programs that link health care to a syringe exchange program are effective ways to provide preventive health care services to IDUs, particularly HBV vaccination. Trust engendered by and mutual respect afforded by such programs result in repeated encounters by active IDUs over time.

We examined the influence of job category, source patient HIV status, and exposure type as predictors of whether health care workers initiated antiretroviral prophylaxis after potential blood-borne pathogen exposures. Of 639 exposures over an 18-month period, 82 individuals (13%) elected to receive prophylaxis, of whom 66% took medications for fewer than 96 hours and 12% completed a 4-week course. Reasons for early drug discontinuation included confirmation of source patient HIV-negative serological status (65%), gastrointestinal side effects (13%), headache (4%), and personal decision after counseling/other input (18%). Individuals exposed to HIV-positive source patients were more likely to initiate prophylaxis (odds ratio [OR], 5.1; 95% confidence interval [CI] 2.6 to 9.9). Licensed nurses were less likely than others to accept prophylaxis (OR, 0.5; 95% CI, 0.3 to 0.8), whereas physicians and medical students were more likely to accept prophylaxis (OR, 1.9; 95% CI, 1.1 to 3.3).