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Low Rates of Hepatitis Screening and Vaccination of HIV-Infected MSM in HIV Clinics

Hoover, Karen W. MD, MPH*; Butler, Mary PhD; Workowski, Kimberly A. MD*,‡; Follansbee, Stephen MD§; Gratzer, Beau MPP¶,‖; Hare, C. Bradley MD**; Johnston, Barbara MD††; Theodore, John L. PhD††; Tao, Guoyu PhD*; Smith, Bryce D. PhD*; Chorba, Terence MD, MPA*; Kent, Charlotte K. PhD*the Evaluation Group for Adherence to STD and Hepatitis Screening

Sexually Transmitted Diseases: May 2012 - Volume 39 - Issue 5 - p 349–353
doi: 10.1097/OLQ.0b013e318244a923
Original Study

Background: HIV-infected men who have sex with men (MSM) are at increased risk of viral hepatitis because of similar behavioral risk factors for acquisition of these infections. Our objective was to estimate adherence to HIV management guidelines that recommend screening HIV-infected persons for hepatitis A, B, and C infection, and vaccinating for hepatitis A and B if susceptible.

Methods: We evaluated hepatitis prevention services received by a random sample of HIV-infected MSM in 8 HIV clinics in 6 US cities. We abstracted medical records of all visits made by the patients to the clinic during the period from 2004 to 2007, to estimate hepatitis screening and vaccination rates overall and by clinic site.

Results: Medical records of 1329 patients who had 14,831 visits from 2004 to 2006 were abstracted. Screening rates for hepatitis A, B, and C were 47%, 52%, and 54%, respectively. Among patients who were screened and found to be susceptible, 29% were vaccinated for hepatitis A and 25% for hepatitis B. The percentage of patients screened and vaccinated varied significantly by clinic.

Conclusions: Awareness of hepatitis susceptibility and hepatitis coinfection status in HIV-infected patients is essential for optimal clinical management. Despite recommendations for hepatitis screening and vaccination of HIV-infected MSM, rates were suboptimal at all clinic sites. These low rates highlight the importance of routine review of adherence to recommended clinical services. Such reviews can prompt the development and implementation of simple and sustainable interventions to improve the quality of care.

From the *Centers for Disease Control and Prevention, Atlanta, GA; Battelle Centers for Public Health Research and Evaluation, Seattle, WA; Emory University School of Medicine, Atlanta, GA; §Kaiser Permanente, San Francisco, CA; Howard Brown Health Center, Chicago, IL; University of Illinois at Chicago School of Public Health, Chicago, IL; **San Francisco General Hospital Medical Center, San Francisco, CA; and ††St. Vincent Catholic Medical Centers, New York, NY

Evaluation Group for Adherence to STD and Hepatitis Screening: Mary Butler, Felix Carpio, Terence Chorba, Lauren Christiansen-Lindquist, John Cummins, Stephen Follansbee, Beau Gratzer, Brad Hare, Brenda Hernandez, Karen Hoover, Nidhi Jain, Barbara Johnston, Charlotte Kent, Clarissa Ospina Norvell, Bryce Smith, Guoyu Tao, John Theodore, Michael Wohlfeiler, and Kim Workowski.

None of the authors has conflicts of interest, or received support from the National Institutes of Health, Wellcome Trust, Howard Hughes Medical Institute, or the pharmaceutical or other industry.

Correspondence: Karen Hoover, MD, MPH, Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE MS E-80, Atlanta, Georgia 30333. E-mail:

Received for publication, August 3, 2011 and accepted December 1, 2011.

© Copyright 2012 American Sexually Transmitted Diseases Association