1. Hepatitis A Immunization Among Men Who Have Sex With Men (MSM) James Sweeney RN, BSN, James Dean MD, Robert Levenson MBA, James Lutz MPA, Toni Resnick BS, Aramide Ayorinde BS, Claire Newbern PhD.

2. Outline Hepatitis A incidence in Philadelphia Collaborative Agencies & Plan Results Conclusions

3. Hepatitis A, Philadelphia 1991-2002 Cases and Rates * 2003 Us incidence rate based on provisional data

4. Between 1997-2002 7354 children were immunized No shelter outbreaks of vaccine preventable diseases since 1998 Savings estimate $2 million when incorporating loss of work days, hospitalization, medical personnel, and post exposure prophylaxis of contacts Shelter Immunization Results

5. Hepatitis A Rates Philadelphia, 2001-03 N=179N=66N=98 0.00 2001 2002 2003 0.01 to 4.995.00 to 9.99 10.00 to 19.9920.00 to 39.9940.00 to 58.89 Rate per 100,000 persons

6. Hepatitis A Cases in Phila. Residents 2001-2002 27.8% 34.2%

7. Philadelphia: Needs Assessment Episodic nature of outbreaks Concentrations in areas of high MSM population and IVDU/ Street drug use Low MSM/Gay utilization of PDPH STD clinic Extremely low utilization of Hep Vaccines in PDPH STD clinic

8. Number of Visits to HC#1 Made by HBV Naïve Clients – 2001 - 2003 All ClientsNon-MSM MalesMSM N(%)N(%)*N 14,345(86) 2,835(65)165(4) 2396(8)257(65)10(3) 3168(3)108(64)5(3) 4+125(2)76(61)4(3) Total5,034(100) * Percentage of all clients visits. Female client visits not shown.

9. Hepatitis B Vaccine Received by Vaccine Naïve Clients in HC#1 – 2001 - 2003 All HC1 Clients (N=5,034) Non-MSM Males (N = 3,276) MSM Males (N=184) N(%)N N No information3,271(65)2,018(62)133(72) Refused301(6)207(6)14(8) 11,453(29)1,044(32)37(20) 29(0.2)7 0(0) 30 0 0

10. Collaborative Partners Mazzoni Center – LGBT Health & Well- Being ( Formerly; Philadelphia Community Health Alternatives, PCHA): –To identify, advocate and support the well being and physical and mental health needs of sexual minorities and other high risk groups inadequately served by mainstream healthcare – regardless of a person’s ability to pay.

11. Mazzoni Center MSM Pilot Program Summer 1999 –Immunize 100 MSM –Required scheduling of appointments during regular business hours –Frequently did not have a provider to immunize –Only had 100 doses of vaccine –Request to PDPH for assistance

12. PDPH/Mazzoni Center ( Formerly PCHA ) Enhanced MSM Program January 2000 Increase Outreach to community Include Hep B Vaccine Institutionalize Store Front immunizations – on last Friday of every month. –Center of “gayborhood” –No waiting –9pm – midnight –Increase number “volunteer” providers

14. Collaborative Partners Triangle Medical: –Primary care practice with an almost exclusive patient population of MSM. –Uninsured/Underinsured Patients Jonathan Lax Treatment Center: –Founded in 1997 as a treatment center that would treat people living with HIV regardless of their ability to pay. Over 2/3’s of the patient population of 1,400 have no insurance.

15. Collaborative Partner Prevention Point Needle Exchange Program: –Provide needle exchange and medical treatment –3 locations weekly –Volunteer Medical Providers/Med Students –Nurse Practitioner

16. Hepatitis A Cases in Phila. Residents 2002-2003 34.2% 3.3%

17. Hepatitis A Rates Philadelphia, 2001-03 N=179N=66N=98 0.00 2001 2002 2003 0.01 to 4.995.00 to 9.99 10.00 to 19.9920.00 to 39.9940.00 to 58.89 Rate per 100,000 persons

18. MSM Patient Demographics 2000-2003 xxxx17%xxxx Missing 1.6%9.2%1%Other 2.4%47%29%A/A 96%36%70%White TriangleLaxMazzoniMSM

19. Mazzoni Completion Rates 2000-2003 DOSEHep AHep BA&B 1505337206 2328192135 3xxxx192101 Completion 65%56.9%49%

20. Lax Treatment Center Completion Rates 2002-2003 15%37.5%47.7% Completion 1533xxxx3 7835432 10088901 A&BHep BHep ADOSE

21. Triangle Medical Completion Rates 2000-2003 87.6%56.9%86.7% Completion 5711xxxx3 6012462 6515531 A&BHep BHep ADOSE

22. Prevention Point Completion Rates 2002-2003 11.2%xxxx Completion 22xxxx 3 66xxxx 2 196xxxx 1 A&BHep BHep ADOSE

23. Public Health Message For Hepatitis A  Increase awareness of HAV as a serious disease  Hepatitis A is a vaccine preventable disease  Increase awareness of Hep. A vaccine’s safety and efficacy  Routine immunization = most effective strategy  mass vaccination programs in endemic communities have demonstrated reduction in HAV  increase utilization of vaccine in STD centers  Once initiated, sustain efforts in public/private  Influence policy makers to support HAV pediatric immunization mandates

24. Acknowledgements Mizzoni Clinic:Nurit Shein, Toni Resnick, Sophear Phat Lax Treatment Center: Joseph Ondercin PA Triangle Medical: Mark Watkins, DO Prevention Point: Casey Cook