Cost-effectiveness analysis of behavioral interventions to improve vaccination compliance in homeless adults

University of California, Los Angeles, School of Nursing, Box 956917, Los Angeles, CA 90095-6917, USA.
Vaccine (Impact Factor: 3.62). 12/2008; 27(5):718-25. DOI: 10.1016/j.vaccine.2008.11.031
Source: PubMed


To estimate the cost-effectiveness of three behavioral interventions provided to enhance hepatitis A virus (HAV) and hepatitis B virus (HBV) joint vaccination (HAV/HBV) compliance among homeless persons living in Los Angeles County.
A cost-effectiveness analysis (CEA) based on data from a randomized trial where the costs and compliance data from the trial are incorporated into two Markov models, simulating the natural history of acute and chronic hepatitis infection, following HAV/HBV vaccination.
Reductions in HBV-related disease is cost-effective to society and is associated with substantial improvements in quality of life.

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    ABSTRACT: Hepatitis B virus (HBV) infection constitutes a major health problem for homeless persons. Ability to complete an HBV vaccination series is complicated by the need to prioritize competing needs, such as addiction issues, safe places to sleep, and food, over health concerns. The objectives of this study were to evaluate the effectiveness of a nurse-case-managed intervention compared with that of two standard programs on completion of the combined hepatitis A virus (HAV) and HBV vaccine series among homeless adults and to assess sociodemographic factors and risk behaviors related to the vaccine completion. A randomized, three-group, prospective, quasi-experimental design was conducted with 865 homeless adults residing in homeless shelters, drug rehabilitation sites, and outdoor areas in the Skid Row area of Los Angeles. The programs included (a) nurse-case-managed sessions plus targeted hepatitis education, incentives, and tracking (NCMIT); (b) standard targeted hepatitis education plus incentives and tracking (SIT); and (c) standard targeted hepatitis education and incentives only (SI). Sixty-eight percent of the NCMIT participants completed the three-series vaccine at 6 months, compared with 61% of SIT participants and 54% of SI participants. NCMIT participants had almost 2 times greater odds of completing vaccination than those of participants in the SI program. Completers were more likely to be older, to be female, to report fair or poor health, and not to have participated in a self-help drug treatment program. Newly homeless White adults were significantly less likely than were African Americans to complete the vaccine series. The use of vaccination programs incorporating nurse case management and tracking is critical in supporting adherence to completion of a 6-month HAV/HBV vaccine. The finding that White homeless persons were the least likely to complete the vaccine series suggests that programs tailored to address their unique cultural issues are needed.
    Preview · Article · Dec 2008 · Nursing research
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    ABSTRACT: The study was undertaken, first, to determine the coverage rate of hepatitis B (HB) vaccine and second to evaluate the immune response to HB vaccine among children under 10 years old by measuring the level of circulating anti-HB surface antigen (anti-HBs) antibodies after immunisation with three doses. First, 840 children were randomly selected from 4 randomly selected sites in Sana'a city to study the coverage rate of the vaccine; of these, 504 children vaccinated against HBV prior to the study, were tested (56% males and 44% females). Sera were tested for anti-HBs antibodies by ELISA quantitative technique. Each individual's data was collected in a pre-designed questionnaire including: vaccination date, sex, and age at the time of the study. The coverage rate of HBV vaccine was only 69.9%, being slightly higher among male children (72.1%) than female children (66.8%). A total of 276 (54.8%) of the 504 children responded to the vaccine with anti-HBs antibody level ≥ 10 mIU/ml, while 228 (45.2%) of the 504 children had non-protective anti-HBs antibodies levels (<10IU/ml). Children of ages 3-5 years had the highest protective rate (63.6%), and the lowest protective rate was in the 9-10 years age group. This study revealed a low coverage rate of HBV vaccine and a low protective rate against HBV infection. A considerable proportion of vaccinated children should be considered for either revaccination or booster doses. There is also the need to complete HBV vaccine coverage among the child population in San'a, Yemen.
    Preview · Article · Feb 2011 · Sultan Qaboos University medical journal
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