Post on 01-Apr-2015
Regional Epi Meeting –Hepatitis B Vaccine Pilot
Colandra Holiday,
Vic Landa, Whitney Griffith
TN Dept. Health – Regional Epi Meeting
April 29, 2014
Overview Purpose:
Reduce the incidence of adults that become infected with hepatitis B virus (HBV)
Goal: Achieved through vaccination of high-risk
adults… …seeking STD services in 38 county health
department clinics …incarcerated in select county jails
2
Participating Sites STD services in public health clinics
Memphis/Shelby Packer STI ClinicUpper Cumberland Region (UCR)East TN Region (ETR)Northeast Region (NER)
County jailsEast TN Region (ETR)Northeast Region (NER)
3
East TN Region (ETR) – Jails 4 initial sites recruited, clinics established
(Claiborne, Hamblen, Campbell, Blount) 2 additional sites identified for future clinics
(Sevier & Anderson)
4
East TN Region (ETR) – Jails
Claiborne Hamblen Campbell Blount
Average Cen-sus
222 283 129 502
Average Up-take
97 100 75 226
% Uptake 0.43 0.35 0.58 0.45
50
250
450
Vaccine Uptake in ETR Jails
Ce
ns
us
5Timeframe Oct 2013 – April 2014
East TN Region (ETR) – Jails
Census Uptake Series Completed0
500
1000
1500
2000
2500
3000
2471
1109
234
Totals
Totals
6Timeframe Oct 2013 – April 2014
Northeast Region (NER) – Jails 5 initial sites recruited, clinics established
(Washington, Greene, Johnson City, Hancock, Johnson)
3 sites recruited, 1st clinic pending (Carter, Unicoi, Hawkins)
7
Northeast Region (NER) – Jails
Wash-ington
John-son City
Greene Han-cock
John-son
Hawkins
Av-er-age Census
420 87 348 92 130 241
Av-er-age Up-take
173 37 122 10 60 143
% Up-take
0.41 0.42 0.35 0.11 0.46 0.59
25
175
325
Vaccine Uptake in NER Jails
Ce
ns
us
8Timeframe Oct 2013 – March 2014
Northeast Region (NER) – Jails
Census Uptake Series Completed0
1000
2000
3000
4000
5000
6000
7000
5926
2219
569
Totals
Totals
9Timeframe Oct 2013 – March 2014
Vaccination* – Jails (ETR/NER)
10
Overall County Jail
1st Dose 2406 1401
2nd Dose 774 403
3rd Dose 129 66
250750
1250175022502750
Completion Rates**
# o
f D
ose
s
* Doses of monovalent hep B vaccine; for timeframe Sept 2012 – Dec 2013**Completion rates underrepresented
Accomplishments – Eastern TN Additional staff dedicated to project Data collection tools
Risk factor questionnaires, REDCap Vaccination efforts implemented in…
…most public health clinics across region…10 county jails across 2 regions, with 4
additional sites pending Tracking of evaluation metrics required
by CDC11
Pilot Support – Eastern TN Public health clinics & county jails
Vaccine inventoryRisk assessment questionnairesAssisting staff with administrative clinic
supportProviding & sending reminder cards
County JailsData entry (PTBMIS, REDCap)
12
Pilot Challenges – Eastern TN Tracking of Doses Administered
Having access to PTBMIS to view all supported regions from one access point
Not all records are loaded into TWIS from PTBMIS
PTBMIS does not retrieve all data from TWIS
13
Vaccination – Packer STI Clinic Experience gained from previous
hepatitis B vaccine effortsOffer of vaccine made part of nurse chart
auditRecognition of nurses with most doses
given
14
Vaccination – Packer STI Clinic Addition of Fast Track STI services – a
unique opportunityPatients without symptoms or exposure
seen by M.A. onlyPatients offered urine GC/chlamydia and
HIV/RPRCall back in 7 business days for results from
hotline
15
Vaccination – Packer STI Clinic Introduction of new program
Designated RN hired to recruit and educate patients
Fast Track patients referred from the M.A. to the hepatitis B nurse
Patients for standard services referred from nurse after exam completed
Hepatitis B nurse enters information into REDCap and provides follow-up calls for subsequent doses.
16
Vaccination – Packer STI Clinic Lessons learned
Designated nurse integral to program success
Month prior to program introduction – 8 doses given. Month after inception – 137 doses given.
Compliance with completion of series more than doubled with designated nurse making reminder calls.
Patients seen by the designated nurse rarely refuse vaccination once educated
17
Vaccination – Packer STI Clinic Lessons learned (cont.)
Special education efforts help Vaccine education posters in waiting room and
exam rooms Vaccine information video created and shown in
waiting room
18
Vaccination* – STD Services
19
Overall STD Services
1st Dose 2406 1005
2nd Dose 774 371
3rd Dose 129 63
250750
1250175022502750
Completion Rates**
# o
f D
ose
s
* Doses of monovalent hep B vaccine; for timeframe Sept 2012 – Dec 2013**Completion rates underrepresented
20
ARE WE REACHING OUR HIGH-RISK POPULATION?
Population Characteristics*
14.38%
66.49%
18.93%0.20%
Age
18-2425-4445-6465+
* For timeframe Sept 2012 – Dec 2013
Population Characteristics*
82.0%
17.0%0.1% 1.0%
Race
White
Black or African Amer-ican
Asian
American Indian/Alaska Native
Native Hawaiian/Other Pacific Islander
Other Race
* For timeframe Sept 2012 – Dec 2013
Population Characteristics*
3.6%
96.4%
Ethnicity
Hispanic or Latino
NOT Hispanic or Latino
* For timeframe Sept 2012 – Dec 2013
Population Characteristics*
54.1%
45.9%
Sex
MaleFemale
* For timeframe Sept 2012 – Dec 2013
Population Characteristics*
55.9%
44.1%
Setting
Public Health Clinic (STD Services)County Jail
* For timeframe Sept 2012 – Dec 2013
Reported Risk Factors*
12.1%
87.4%
0.5%
History of IV Drug Use
YesNoUnkown
*As of April 11, 2014
Reported Risk Factors*
52.1%46.1%
1.9%
History of Treatment for STDs
YesNoUnkown
*As of April 11, 2014
Reported Risk Factors*
39.1%
60.5%
0.4%
History of >1 sexual partners in last 6 months
YesNoUnkown
*As of April 16, 2014
Questions
29
Contact Information – Central Office: Jennifer Ward, MS
Epidemiologist, Viral Hepatitis Team Lead jennifer.ward@tn.gov615-253-8662
Dana Jackson, BSNRN, Viral Hepatitis Prevention CoordinatorDana.jackson@tn.gov 615-253-1361
30
Contact Information – Satellite Office: Whitney Griffith,
RN, Hepatitis B Coordinatorwhitney.griffith@tn.gov 865-549-5277
Henning “Vic” Landa, MBAAdministrative Service Assistantvic.landa@tn.gov 865-549-5282
31
Contact Information – Memphis: Colandra Holliday, xxx
RN, Hepatitis B Coordinatorcolandra.holiday@shelbycountytn.gov 901-222-9356
Donna Freeman, FNP-BCRN, Nurse SupervisorDonna.freeman@shelbycountytn.gov 901-222-9417
32