Use the Internet to set up hepatitis B programs

Your facility offers sexually transmitted disease (STD) services, but does it include vaccinations for hepatitis B virus (HBV)?

If it does not, what will it take to integrate an immunization program into existing services? Take a tip from the Internet. Consult the online guide, Hepatitis B Immunization in a STD Clinic: Lessons Learned in San Diego County.1

Developed by the STD and Hepatitis Prevention Program of the San Diego County Health and Human Services Agency’s Office of Public Health, the guide covers specific information from the agency’s experience and includes educational materials, protocols, and data collection tools developed by the program.

The guide was written following the 1997 implementation of a hepatitis B vaccination demonstration project designed to reach high-risk adults and adolescents, funded by the Centers for Disease Control and Prevention (CDC). CDC funding for the demonstration program ended in 2003; however, the county-operated STD clinics continue to offer selective viral hepatitis services based on risk factors reported by clients, says Craig Sturak, health information specialist in the San Diego agency’s HIV, STD, and Hepatitis Branch. These services include hepatitis B and C screening, hepatitis B vaccination, educational materials, and medical referrals for clients who test positive for hepatitis B or C to seek follow-up care, he notes.

How has the guide been used by other programs? According to Sturak, the guide — or portions of it — is in wide circulation due to its availability on the Internet. From March 2002 to June 2003, the entire guide was downloaded 660 times from one site operated by the St. Paul, MN-based Immunization Action Coalition (IAC). Portions of the guide, such as specific chapters or training materials, were downloaded 5,251 times from the IAC site, says Sturak.

Take a basic approach

Integrating hepatitis B programs into STD clinic services can mean several things, says Lisa Gilbert, PhD, director of research at the American Social Health Association (ASHA) in Research Triangle Park. Programs can include such elements as vaccinating STD clients; educating clients and health care providers; developing and disseminating written hepatitis B prevention policies; collaborating with immunization programs to establish hepatitis B vaccination efforts; enrolling in the Vaccine for Children program (a federal program that provides free vaccine to eligible children); and identifying other sources of funding for vaccine through city, county, state, and federal programs, she explains.

What are some of the biggest challenges when it comes to implementing a HBV vaccination program in an existing STD program? Sturak lists three candidates: cost of vaccine; staff buy-in — fitting hepatitis services into the flow of a STD clinic; and determining the eligibility criteria for services, if a program chooses to do selective vaccination. Medicare covers HBV vaccine administration for those at intermediate or high risk for hepatitis B, but there is no federal policy for Medicaid reimbursement for vaccination. Each state determines coverage and services; private insurance plans and health maintenance organizations also determine reimbursable services.2

What are some ways to get started in HBV prevention? Consider the following options:

  • Offer viral hepatitis education and counseling for all patients accessing STD or HIV testing programs. Key information can be delivered in three to five minutes and can be integrated in current STD and HIV prevention messages. Use free handouts and posters to educate your clients.
  • Offer HBV vaccination to all those younger than 19 years of age who seek STD or HIV services. The vaccine is available under the Vaccines for Children federal program.
  • Use a self-administered health risk assessment form to identify persons at increased hepatitis risk. Use local or state vaccine funds to purchase HBV vaccine, which can be offered on a risk-based case.3

References

  1. San Diego County Health and Human Services Agency, Office of Public Health, STD and Hepatitis Prevention Program. Hepatitis B Immunization in a STD Clinic: Lessons Learned in San Diego County. San Diego; 2001.
  2. Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Viral Hepatitis. Consultation on Implementing Adult Hepatitis B Vaccination. Accessed at: www.cdc.gov/ncidod/diseases/hepatitis/partners/consultants_mtg_2005.htm.
  3. Gunn RA, Murray PJ, Sturak C. Integrating hepatitis, STD, and HIV services for high-risk clients: It’s easier than you think. NACCHO Exchange 2003; 2:19, 22.

Resources

For more information on hepatitis B vaccination programs, contact:

  • Immunization Action Coalition (IAC), 1573 Selby Ave., Suite 234, St. Paul, MN 55104. Telephone: (651) 647-9009.Fax: (651) 647-9131. E-mail: admin@immunize.org. Web: www.immunize.org. To see links to information on various HBV programs around the United States, go to the main web site, click on www.hepprograms.org under "IAC web sites," then click on "STD/HIV" under "Prevention Programs." Review the Hepatitis B Immunization in a STD Clinic: Lessons Learned in San Diego County at no cost by clicking on "San Diego County HIV, STD, and Hepatitis Branch," then the link at the bottom of the page. To review the IAC publication Adults Only Vaccination; A Step-By-Step Guide at no cost, go to the main web site, click on "Adults Only Vax Guide" under "Favorites from IAC." The guide is designed to help integrate immunization services into health care settings new to vaccination. It covers all aspects of a vaccination program, from assessing vaccine indications and contraindications to determining billing codes. The IAS site also offers free patient information sheets as well as links to abstracts of journal articles and provider resources. The IAC and its Hepatitis B Coalition program publish Hep Express, an on-line news publication. It can be reviewed on the IAC web site as well as through free e-mail subscription, which is available on the web site.

  • The Centers for Disease Control and Prevention’s Division of Viral Hepatitis in the National Center for Infectious Diseases offers many online resources at its web site, www.cdc.gov/ncidod/diseases/hepatitis. Click on "Hepatitis B" to review information on HBV. Click on "Integrating Hepatitis B Vaccination into STD and HIV/AIDS Programs" for specific information on vaccination programs. The publication, Hepatitis B Immunization in a STD Clinic: Lessons Learned in San Diego County is available at no cost at this site.