Hepatitis B vaccination uptake in hard-to-reach populations in London: a cross-sectional study

• Published in: BMC infectious diseases Vol. 19; no. 1; p. 372
• Main Authors: Taylor, Josephine E B, Surey, Julian, MacLellan, Jennifer, Francis, Marie, Abubakar, Ibrahim, Stagg, Helen R
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02.05.2019; BioMed Central; BMC
• Subjects: Care and treatment; Confidence intervals; Cross-sectional studies; Demographics; Drug abuse; Drug delivery systems; Drug use; Hard-to-reach; Health care; Health care industry; Hepatitis; Hepatitis B; Hepatitis B vaccines; Hepatitis B virus; Hepatitis C; Homeless; Homeless people; Homeless persons; Homelessness; Immunization; Injecting drug users; Intravenous administration; Migrants; Outreach services; Prisoners; Prisons; Public health; Regression analysis; Risk analysis; Risk factors; Risk groups; Statistical analysis; Vaccination; Vaccines; Viruses; United Kingdom; United Kingdom > UK; England; Wales; Homeless; Hepatitis B virus; Vaccination; Hard-to-reach; Injecting drug users; Prisoners
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-019-3926-2

In the UK, hepatitis B virus (HBV) incidence is associated with migrants from particular high-burden countries and population groups deemed 'hard-to-reach' by standard healthcare services: the homeless, people who inject drugs and ex-prisoners. Currently, there is a national targeted HBV vaccine policy for such at-risk groups, but there is limited recent evidence about 1) the levels of vaccine uptake, 2) the factors associated with incomplete vaccination, and 3) reasons for incomplete vaccination. A questionnaire capturing social and medical history, demographic factors and information about HBV vaccination status was completed by individuals deemed hard-to-reach due to socio-structural factors that criminalise, isolate and stigmatise who consented to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. The questionnaire also captured the reasons for incomplete vaccination. Descriptive, univariable and multivariable regression analyses were undertaken. Three hundred fourty six participants completed the questionnaire. 1) 52.3% (n = 181) reported full HBV vaccination. 2) Within a multivariable model adjusting for sociodemographic variables, the presence of one or two or more socio-structural factors that are included in the national targeted vaccination policy was associated with protection against incomplete HBV vaccination (51.7% vaccine coverage in those with one factor, odds ratio 0.43 [95% confidence interval 0.20-0.92]); 70.1% coverage with two or more factors, 0.19 [0.09-0.39]; overall p-value < 0.001). Being female was also associated with lower vaccine uptake (2.37 [1.24-4.57], 0.01). Examining the socio-structural factors individually, intravenous drug use was associated with protection against incomplete HBV vaccination. 3) The most common reasons declared for incomplete vaccination were never being offered the vaccine or not returning for further doses. Within this study of HBV vaccination uptake among hard-to-reach population groups in London, UK, we document 52.3% coverage of the full vaccine course. Critically, although participants recommended for immunisation within national guidelines had an increased likelihood of receiving a complete vaccine course, we note surprisingly low coverage in the presence of the risk factors that are national indicators for vaccination. Public health bodies should make additional efforts to improve coverage in the hard-to-reach through improved vaccine delivery systems. ISRCTN24707359 , Registered 19th October 2012.