Free Anonymous HIV Testing Sites are an opportunity to offer hepatitis B virus vaccinationto high risk non immune patients

E. Bouvet1, P. Preziosi2, M. Branger3, M. Rotily2

1 Centre de dépistage anonyme et gratuit, Hôpital Bichat – Claude Bernard, Paris, France. 2 ClinSearch, Bagneux, France. 3 Laboratoire de virologie, Hôpital Bichat – Claude Bernard, Paris, France.

MethodsAbstract

Objectives

Results

Conclusions

References

1. Aggarwal R, Ranjan P. Preventing and treating hepatitis B infection. BMJ 2004;329:1080-6.

2. Antona D, Bussière E, Guignon N, Badeyan G, Levy-Bruhl D. La couverturevaccinale en France en 2001. Bull Epidemiol Hebdo 2003;2003:169-72.

3. Winstock AR. High risk groups are still not being vaccinated. BMJ 2005;330:198.4. Francois G, Hallauer J, Van Damme P. Hepatitis B vaccination: how to reach risk

groups. Vaccine 2002;21:1-4.

Prevention of hepatitis B infection relies mainly on vaccination; whose efficacy and cost effectiveness is well documented1. Vaccination of high risk groups is a widely recognised need and is critical in low endemicity areas—such as France—where neonatal hepatitis B vaccination coverage remains low2. However, evidence points to insufficient implementation of high risk groups immunisation in many high income countries3 4. Thus all opportunities to identify high risk subjects and offer them vaccination should be taken. Free anonymous HIV testing sites might be such an opportunity.

Objectives: Prevention of hepatitis B virus (HBV) transmission relies partly on vaccination of high risk subjects which are numerous among patients attending Free Anonymous HIV Testing Sites (FAHTS). Our purpose was to assess the risk profile, vaccination history and serologic status of a representative sample of high risk patients attending a FAHTS in Paris.

Methods: A sample of 1021 anonymous patient files was randomly selected among 5169 files from patients having attended a FAHTS in Hôpital Bichat – Claude Bernard, Paris, in the year 2004. Sociodemographic profile, risk factors, vaccine history and serologic profile of these patients were depicted using descriptive statistics.

Results: Among 1021 patients, 466 (45.6%) had one or more risk factors for HBV infection and were hence tested for HBV: 171 females (37%) and 295 males (63%). Mean age (SD) was 29.4 (8.9) years. Their birth countries were France (58%), sub-Saharan Africa (17%), north Africa (11%), other European country (6%) and others (8%). HBV risk factors were: multiple sexual partners (62%), originating from high (20%) or medium (18%) endemic area, history of sexually transmitted disease (15%), professional exposure (8%), history of transfusion (3%) or intravenous drug use (2%). Nearly a third (31%) of these patients had a history of complete HBV vaccination, 7% reported an incomplete or ongoing vaccination, the remaining 62% had no known history of vaccination. HBV serology showed that 52% of these patients had natural or vaccine-induced immunity and 1.8% were HBs antigen carriers. Thus more than 46% of these high risk patients had no HBV immunity.

Conclusion: Patients with a high risk of HBV infection are numerous among attendants of FAHTS in French large cities. Nearly two thirds of these patients have no HBV immunity. Thus FAHTS consultations appear to be a good opportunity to identify these patients and offer HBV vaccination. Patients with a high risk of HBV infection are numerous among

attendants of FAHTS in French large cities. Nearly two thirds of these patients have no HBV immunity. Thus FAHTS consultations appear to be a good opportunity to identify these patients and offer HBV vaccination.

A random sample of 1021 anonymous patient files was selected among 5169 patients having attended a FAHTS in Hôpital Bichat –Claude Bernard, Paris, in the year 2004. Sociodemographic profile, risk factors and vaccine history of these patients were drawn form patient files. Their serologic profile was obtained from the virology laboratory. These characteristics were depicted using descriptive statistics.

Among these 1021 patients, 466 (45.6%) had one or more risk factorsfor Hepatitis B infection and were hence tested: 171 (36.7%) femalesand 295 males (63.3%). Mean age (SD) was 29.4 (8.9) years. Theirbirth countries were France (55.8%), sub-Saharan Africa (19.0%), North Africa (10.5%), other European country (5.7%) and others(9.0%). Their HBV risk factors are detailed in figure 1.

59.0

22.3

17.1

14.1

7.8

3.4

2.1

0 10 20 30 40 50 60

%

Multiple sexual partners

From high endemic area

From medium endemic area

History of STD

Professionnal exposure

History of transfusion

History of i.v. drug use

Figure 1: HBV risk factors prevalence

Nearly a third (30.5%) of these patients had a history of complete vaccination, 7.3% re-ported an incomplete or ongoing vaccination, and the remaining 62% had no known his-tory of vaccination. Their serologic status is detailed on fig. 2.

Ag HBs+2%

Natural immunity

14%

Vaccinal immunity

38%Susceptible

46%

Figure 2: HBV serologic status