Short reportThe reach of a free hepatitis B vaccination programme: Results of a Dutch study among drug users
Introduction
Hepatitis B is a major public health problem among drug users (DUs). In 2004–2005 prevalence rates of previous infection of over 40% were reported among injecting drug users in six different European countries (Vincente & Wiessing, 2007). Immunisation of this group is very important. The Netherlands does not have a universal hepatitis B vaccination programme, but a policy of targeting certain ‘high risk’ groups. After a successful pilot (Van Steenbergen, 2002) a nationwide vaccination programme started in 2002 to increase the number of DUs with immunity against hepatitis B virus (Waldhober & Heijnen, 2003).
As part of this programme, Public Health Services (PHS) have been collaborating with drug services, needle exchanges, methadone programmes, homeless shelters, and prisons (enhanced outreach) (Heijnen et al., 2004). Participants are tested for markers of current or past infection with the hepatitis B virus when receiving the first dose of the 3-dose hepatitis B vaccination. Those susceptible for hepatitis B are encouraged to adhere to the 6-month vaccination schedule; and are given an incentive (pocket radio) to finish the programme.
In order to examine if the target group was adequately reached by the hepatitis B vaccination programme, we investigated the proportion and characteristics of DUs who were aware of the free hepatitis B vaccination, of those who were vaccinated by the programme, and who complied with the vaccination schedule. In addition, reasons for refusing the vaccine were assessed.
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Procedure
Interviews were conducted between February and December 2005 in three intervention regions: Rotterdam, Utrecht and South Limburg. These areas were chosen on the basis of ethnographic mapping (Baars, Boon, Garretsen, & Van de Mheen, 2009; Watters & Biernacki, 1989). The mapping included conducting interviews with key figures and undertaking observation to map all locations where DUs gathered (for example street locations, drug services, methadone outlets, and homeless shelters). The interviewers
Awareness of free hepatitis B vaccination
Approximately two-thirds of DUs (62.8%, n = 194) were aware of the free hepatitis B vaccination. Of those, 58% had been informed by drug service staff, 16% by staff of PHSs, 12% had seen a flyer, 9% had seen a poster, and 10% were informed by friends (multiple answers possible).
Table 1 shows that region, homelessness, age at onset of drug use, and visiting night shelters and/or drug consumption rooms in the past 6 months were associated with awareness. In addition, those DUs who had most
Discussion
Our results reveal that almost two-thirds of DUs (62.8%) have been reached by the hepatitis B vaccination programme: they were aware that they could opt for free vaccination. Visiting drug consumption rooms was the most important predictor of awareness. Moreover, 41.8% of DUs in our study obtained a vaccination through the programme. DUs who started drug use at a younger age were more likely to be vaccinated, as well as those who had been informed about the free vaccine by drug service staff
Conflict of interest statement
None declared.
Acknowledgements
This study was funded by the Netherlands Organization for Health Research and Development (grant number 2500.0011) and the Netherlands Association for Community Health Services.
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