Opportunities to Prevent Hepatitis B Infection Among People Who Use or Inject Drugs

Author: Ryan Clary Michaela Jackson Kate Moraras Rhea Racho Richard Andrews Rita Kuwahara Richard So Dan-Tam Phan-Hoang Catherine Freeland Adam Carbullido Amy Trang Jeff Caballero Catherine Chari Cohen

Theme: Social Science & Policy Research Year: 2022

Globally, nearly 300 million people are living with hepatitis B (HBV), the world’s most common
serious liver infection. Despite the availability of highly effective vaccines, HBV remains a significant
public health problem. In recent years, HBV infections in the U.S. are rising, with approximately 36%
of new infections occurring among people who inject drugs. Acute HBV infections have risen 50% –
450% in areas heavily impacted by the opioid crisis. Increasing rates of HBV infections reveal gaps in
HBV adult vaccination coverage. In 2021, the U.S. Centers for Disease Control and Prevention (CDC)
recommended the HBV vaccine for all adults in the U.S. aged 19-59. The CDC is also working towards
a recommendation for a universal one-time HBV screening for adults.
A survey of health department (HD) vaccine program staff representing 26 states documented
barriers to distribution of HBV vaccines in high impact settings like syringe service programs (SSPs).
Nearly 70% of HDs stated policies do not support universal adult HBV vaccine recommendations.
Identified barriers to distributing HBV vaccination include inability to identify and reach vulnerable
populations, lack of staff and proper equipment to provide immunizations, and difficulty enrolling
nontraditional immunization sites to provide vaccination. Less than half of SSPs are eligible to
receive and distribute adult HBV vaccines through current funding mechanisms. For eligible SSPs,
HDs face barriers in receiving and distributing HBV vaccines due to factors including lack of
participation from SSPs, certifying providers at the SSPs, and staff education and training.
HBV is often neglected in harm reduction programs and within drug user health advocacy. There are
missed opportunities to address HBV alongside prevention of hepatitis C and HIV infections.
Updated HBV recommendations provide an opportunity for stakeholders to expand access to HBV
prevention among those at risk for infection, including people who use or inject drugs.
Disclosure of Interest Statement:

The authors recognize the considerable contribution that industry
partners make to professional and research activities. We also recognize the need for transparency of
disclosure of potential conflicts of interest by acknowledging these relationships in publications and

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