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P240 What is the Hepatitis B vaccination coverage in MSM in South West London? An audit of Hepatitis B vaccination coverage in ‘first attendee’ MSM in a busy Teaching Hospital GUM clinic
  1. Rachel Hill-Tout1,2,
  2. Holly Mitchell2,
  3. Gwenda Hughes2
  1. 1St George’s NHS Foundation Trust, London, UK
  2. 2Public Health England, London, UK

Abstract

Background The 2001 National Strategy for Sexual Health and HIV recommended 90% uptake of Hepatitis B (HBV) vaccine in non-immune MSM at first GUM clinic attendance. The HepB3 Survey reported 95% uptake in 2008 but recent surveillance using GUM Clinic Activity Dataset-v2 (GUMCADv2) coding shows <20% uptake. A detailed regional audit was designed to investigate this apparent drop in coverage.

Aim To determine HBV vaccination coverage in ‘first-attendee’ MSMs.

Methods All MSM ‘first-attendees’ at our service between January-March 2014 were identified. Patient records were reviewed for HBV screening, vaccine-offer, vaccine-uptake, HIV testing and coding accuracy up to 18 months from first-attendance. MSM were deemed ‘immune’ if surface antibody (sAb) >10 mIU/ml, core antibody positive, or self-reported vaccination-status was ‘Fully-vaccinated’ and no serology was done; and eligible for vaccination if sAb ≤10 mIU/ml, or if they reported ‘Partially-vaccinated’, ‘Never-vaccinated’, or ‘Don’t know’ and no serology was done.

Results We identified 115 MSM ‘first-attendees’ (13 HIV+). 41% only attended once. Regarding vaccination-status: 41/95 (43%) reported ‘Fully-vaccinated’, 29/95 (30%) ‘Partially-vaccinated’, 12/95 (13%)’Never-vaccinated’, 11/95 (12%) ‘Don’t-know’, 1/95 (1%) ‘Chronic-HBV’ and 1/95 (1%) ‘Cleared-HBV’. 48/103 (47%) were deemed immune and 46/103 (45%) eligible. 36/46 (76%) of eligibles were offered vaccination; 2/36 (6%) declined, reporting ‘not at risk’. 3/32 (9%) who accepted vaccination pending sAb levels did not return for it. 31/46 (67%) of eligibles received ≥1 dose of vaccine, 28/46 (61%) within 42 days of first-attendance. Reasons for non-offer were not recorded. 75% of first-doses were coded. Only 15% of ‘immune’ patients were coded as such (P2I). HIV-test uptake was 99% and coding accuracy was 97%.

Discussion We found below-target levels of HBV vaccination-coverage and incomplete coding of immunity/vaccination. Failure to code P2I for ‘immunes’ will increase the apparent ‘eligibles’ denominator in GUMCADv2 algorithms, generating incorrectly low vaccination-coverage figures. Reduced offer-rate may contribute to low vaccination-coverage and should be reviewed locally. Further regional audits may be required. Significant improvements in coding are essential for accurate surveillance of HBV vaccination-coverage using GUMCADv2.

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