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 Clinic  Upper Cumberland Region (UCR)  East TN Region (ETR)  Northeast Region (NER) County jails  East 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 5 Timeframe Oct 2013 – April 2014

East TN Region (ETR) – Jails 6 Timeframe Oct 2013 – April 2014

Northeast Region (NER) – Jails 5 initial sites recruited, clinics established (Washington, Greene, Johnson City, Hancock, Johnson) 3 sites recruited, 1 st clinic pending (Carter, Unicoi, Hawkins) 7

Northeast Region (NER) – Jails 8 Timeframe Oct 2013 – March 2014

Northeast Region (NER) – Jails 9 Timeframe Oct 2013 – March 2014

Vaccination* – Jails (ETR/NER) 10 * 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 CDC 11

Pilot Support – Eastern TN Public health clinics & county jails  Vaccine inventory  Risk assessment questionnaires  Assisting staff with administrative clinic support  Providing & sending reminder cards County Jails  Data 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 efforts  Offer of vaccine made part of nurse chart audit  Recognition of nurses with most doses given 14

Vaccination – Packer STI Clinic Addition of Fast Track STI services – a unique opportunity  Patients without symptoms or exposure seen by M.A. only  Patients offered urine GC/chlamydia and HIV/RPR  Call 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 * Doses of monovalent hep B vaccine; for timeframe Sept 2012 – Dec 2013 **Completion rates underrepresented

ARE WE REACHING OUR HIGH-RISK POPULATION? 20

Population Characteristics*

Reported Risk Factors*

Questions 29

Contact Information – Central Office: Jennifer Ward, MS  Epidemiologist, Viral Hepatitis Team Lead   Dana Jackson, BSN  RN, Viral Hepatitis Prevention Coordinator  

Contact Information – Satellite Office: Whitney Griffith,  RN, Hepatitis B Coordinator   Henning “Vic” Landa, MBA  Administrative Service Assistant  

Contact Information – Memphis: Colandra Holliday, xxx  RN, Hepatitis B Coordinator   Donna Freeman, FNP-BC  RN, Nurse Supervisor  