Interventions to Increase Completion of Hepatitis B Vaccination in People who Inject Drugs: A Systematic Review and Meta-analysis

Abstract

Increases in opioid misuse and injection drug use have resulted in a rise in acute cases of hepatitis B. We conducted a systematic review and meta-analysis of randomized studies to determine the effect (pooled odds ratio) of interventions to increase hepatitis B vaccination completion in people who inject drugs (PWID). Odds ratios from the included studies were combined to create a pooled odds ratio (OR) using the Inverse Heterogeneity Model. Eleven studies met the eligibility criterion of having a randomized intervention to increase hepatitis B virus vaccination completion among PWID. The odds of vaccine completion in the intervention group were greater than in the control/comparison group (pooled OR, 2.53; 95% confidence interval [CI], 1.07–5.99). Subgroup analysis indicated that financial incentives were most effective (OR, 7.01; 95% CI, 2.88–17.06), followed by accelerated vaccine schedules (OR, 1.90; 95% CI, 1.14–3.14). Interventions using financial incentives and accelerated vaccine schedules are moderately effective at increasing hepatitis B vaccination completion in PWID.

Cash incentives, ethics, and COVID-19 vaccination

“…The possibility that a high-pressure phase of CaSiO 3 might exist in the lower mantle was first suggested in 1967 in a study of CaSiO 3 -CaGeO 3 perovskite-type solid solution (2). In 1975, scientists successfully synthesized the CaSiO 3 -perovskite high-pressure phase with a cubic structure by using a laser-heated diamond anvil cell (3).…”

“…Do they work? Studies suggest that payments were successfully used to increase vaccination for human papillomavirus in England (1), hepatitis B in the United States and United Kingdom (2), and tetanus toxoid in Nigeria (3). However, little is known about the effect of direct payment or lotteries on COVID-19 vaccination rates.…”

Review article: current gaps and opportunities in HBV prevention, testing and linkage to care in the United States—a call for action

“…A prior meta‐analysis showed that financial incentives, followed by accelerated vaccine schedules had the highest efficacy in helping the PWID to complete the scheduled 3‐dose vaccination series 57 . The newly available and equally efficacious Heplisav‐B vaccine which requires only two doses over only 1 month (vs 3 doses over 6 months) should be considered in this population to improve compliance and adherence 58 …”

Prevention of COVID-19 among populations experiencing multiple social exclusions

“…People who are homeless are half as likely as other groups to receive the influenza vaccination and people who use drugs or who sell sex are less likely to receive hepatitis B vaccination (HBV) than healthcare workers. [3][4][5] The reduced uptake is attributable to mental health issues, drug use and reduced access to primary healthcare, compounded by stigma and general distrust in authorities. 6 Intersecting vulnerabilities can pose additional barriers, with migration status among sex workers, for example, restricting access to vaccination programmes in Canada.…”

“…Findings from a meta-analysis suggests that financial incentives and accelerated schedules were associated with 2.3 times the odds of completing HBV vaccination compared with standard care for people who use drugs. 5 Other review evidence shows that delivery of vaccinations via specialist services, such as OST clinics or needle syringe programmes, to hostels or shelters or outreach to places where drugs are used results in greater uptake of influenza and HBV vaccinations. 5 6 Emotional support and positive interactions in personal lives (defined as having someone to confide in or do something enjoyable with) has also been linked to increased completion of HBV vaccines among people experiencing homelessness.…”