Margolis Harold S, Handsfield H Hunter, Jacobs R Jake et al for the Hepatitis B-WARE Study Group.
Evaluation of office-based intervention to improve prevention counseling for patients at risk for sexually acquired hepatitis B virus infection.
Am J Obst. Gynec. 182, Jan 2000,1-6
Hepatitis B virus infection remains a major public health problem in the United States, with an estimated 250,000 new infections annually during the past decade. Most infections occur among young adults, and most of these result from exposures during high-risk activities.
Sexual transmission accounts for >50% of hepatitis B virus infections, and although the proportion of infections attributable to men who have sex with men has declined the proportion of infections among persons with multiple heterosexual partners has increased.
Although hepatitis B vaccine has been available for almost 2 decades, vaccination of adults at high risk has been problematic. Until routine infant and adolescent vaccination has produced cohorts of adults protected against hepatitis B virus infection, however, large number of adults will continue to face the health and economic consequence of hepatitis B virus-related liver disease.
Except for those at occupational risk of hepatitis B virus infection, adults at risk have not been vaccinated for a number of reasons. These include lack of awareness by health care professionals and the public of risk factors for infection; lack of counseling concerning the disease, its consequences, and means of prevention; and lack of programs to vaccinate adults at risk for infection. Surveillance data indicate that between 30% and 40% of patients with acute hepatitis B had a previously diagnosed sexually transmitted disease as quoted in Unpublished observation by S Goldstein, et al for the Centers for Disease Control and Prevention.
These healthcare encounters for treatment of sexually transmitted diseases should be considered missed opportunities for hepatitis B vaccination. However, there have been few attempts to evaluate the feasibility of identifying persons at risk for sexually transmitted hepatitis B virus infection and providing counseling and vaccination.
The aim of this study was to determine the effectiveness of tools to identify and counsel patients at risk for sexually transmitted hepatitis B virus infection. Physicians were randomly assigned to either an intervention group or a control group. The intervention group was provided with materials intended to encourage patients to return for counseling and to guide counseling concerning prevention of hepatitis B virus infection. Baseline data on 457 patients at risk for hepatitis B virus infection showed that 7% had received prevention counseling and 2% had begun hepatitis B vaccination. Counseling was least likely to occur in obstetric-gynecologic practices, among uninsured patients, and among patients whose only risk factor was a diagnosis of a sexually transmitted disease. After a 6-month intervention period 25% of the intervention group patients and 7% of the control group patients had been counseled (P <. 01). Vaccination was more likely among intervention group patients (8% vs <1%; P<.001). The use of tools to identify and counsel patients at risk for sexually transmitted hepatitis B virus infection resulted in increased office-based prevention activities.