Low completion rate of hepatitis B vaccination in female sex workers

Abstract

How to cite this article: Magalhães RLB, Teles SA, Reis RK, Galvão MTG, Gir E. Low completion rate of hepatitis B vaccination in female sex workers.Rev Bras Enferm [Internet]. 2017;70(3):489-94. DOI: http://dx.doi.org/10.1590/0034-7167-2016-0567Submission: 10-24-2016 Approval: 11-04-2016 ABSTRACT Objective: to assess predictive factors for noncompletion of the hepatitis B vaccination schedule in female sex workers in the city of Teresina, Northeastern Brazil. Method: 402 women were interviewed and, for those who did not wish to visit specialized sites, or did not know their hepatitis B vaccination status, the vaccine was offered at their workplaces. Bi-and multivariate analyses were performed to identify potential predictors for noncompletion of the vaccination schedule. Results: of the 284 women eligible for vaccination, 258 (90.8%) received the second dose, 157/258 (60.8%) and 68/258 (26.3%) received the second and third doses, respectively. Working at clubs and consuming illicit drugs were predictors for noncompletion of the vaccination schedule. Conclusion: the high acceptability of the vaccine's fi rst dose, associated with low completion rates of the vaccination schedule in sex workers, shows the need for more persuasive strategies that go beyond offering the vaccine at their workplaces. Descriptors: Sex workers; Immunization; Hepatitis B; Women; Vulnerable Populations. RESUMO Objetivo: avaliar fatores preditores de não completude do esquema vacinal contra hepatite B em mulheres que se prostituem em Teresina, Nordeste do Brasil. Método: Um total de 402 mulheres foi entrevistado e, para as que se negaram a irem a lugares especializados, ou desconheciam sua situação vacinal contra hepatite B, a vacina foi oferecida no local do trabalho. Análises bi e multivariadas foram realizadas para identifi car potenciais preditores de não completude do esquema vacinal. Resultados: Das 284 mulheres elegíveis para vacinação, 258 (90,8%) receberam a primeira dose, 157/258 (60,8%) e 68/258 (26,3%) receberam a segunda e terceira doses. Trabalhar em boates e consumir drogas ilícitas foram preditores de não completude do esquema vacinal (p<0,05). Conclusão: A elevada aceitabilidade da primeira dose da vacina, associada à baixa completude do esquema vacinal em profi ssionais do sexo, evidencia a necessidade de estratégia mais persuasiva que vá além da oferta da vacina no local de trabalho. Descritores: Profi ssionais do Sexo; Imunização; Hepatite B; Mulheres; População Vulnerável. RESUMEN Objetivo: Evaluar factores predictores del no completamiento del esquema de vacunación contra la hepatitis B en mujeres que se prostituyen en Teresina, noreste de Brasil. Método: Fueron entrevistadas 402 mujeres. Para las que se negaron a ir a lugares especializados o desconocían su situación de vacunación contra la hepatitis B, la vacuna fue ofrecida en lugar de trabajo. Fueron efectuados análisis multivariados para identifi car potenciales predictores del no completamiento del esquema de vacunación. Resultados: de las 284 mujeres elegibles p...

Barriers and facilitators to hepatitis B vaccination among sex workers in Vancouver, Canada: Implications for integrated HIV, STI, and viral hepatitis services

“…Sex workers also represent a priority occupation group for HBV vaccination (Government of Canada, 2016), yet unlike healthcare personnel who are also an identified priority (Government of Canada, 2014), the sex workers in the present study face suboptimal coverage. This is likely due to previously identified barriers to healthcare such as criminalization, stigma, mobility, and unsafe working conditions (Baars et al, 2009;BC Ministry of Health, 2012;Deering et al, 2015;Magalhães et al, 2017), which make sex workers less likely to disclose their occupation or report potential risk factors to healthcare providers, and thus not meet the criteria for vaccination. In addition, there is an absence of targeted provincial/national HBV vaccination programmes to address HBV risks faced by sex workers in Canada.…”

“…In addition, there is an absence of targeted provincial/national HBV vaccination programmes to address HBV risks faced by sex workers in Canada. Although very few settings have explicitly rolled out HBV programmes for sex workers, in the Netherlands where such a campaign exists (Baars et al, 2009), sex workers still face barriers to care through stigma, mobility, and place of work, all of which affect access to care and vaccinations (Baars et al, 2009;Magalhães et al, 2017). This emphasizes the need to address broader OR, odds ratio; CI, confidence interval; IQR, interquartile range; HBV, hepatitis B virus; SRH, sexual and reproductive health; HCV, hepatitis C virus; STI, sexually transmitted infection.…”

“…Additionally, integrated services delivered through non-traditional methods (e.g., community outreach) allow for low barrier, voluntary engagement (Des Jarlais et al, 2001;Ompad et al, 2004). Integrated community-based outreach has also proven useful for the uptake and completion of the full HBV vaccination schedule (three doses over 6 months) among 'hard-to-reach' populations of sex workers when approached within their workplaces (Baars et al, 2009;Carneiro et al, 2014;Magalhães et al, 2017). Current provincial HIV guidelines recommend that HBV vaccination be given to people living with HIV who are susceptible to HBV infection (BC Centre for Excellence in HIV/AIDS, 2015), indicating the critical importance of integrating HBV programmes within harm reduction, sexual health, and HIV initiatives to improve coverage amongst marginalized populations.…”

“…Based on our adapted structural determinants framework (Shannon et al, 2014), the main analysis looked at independent variables of interest exploring individual-, healthcare access-, and structural-level factors. Variable selection was based on the literature and previously published AESHA data, and included factors hypothesized to be linked to HBV vaccination and health and/or safety for sex workers (Mak et al, 2003;Baars et al, 2009;Carneiro et al, 2014;Anderson et al, 2015;Deering et al, 2015;Goldenberg et al, 2017b;Magalhães et al, 2017). Individual-level characteristics included age, HIV seropositivity (assessed through voluntary bioLytical INSTI rapid tests for HIV screening), identifying as a gender and/or sexual minority (defined as 'yes' to any of gay, lesbian, bisexual, queer, two spirit, asexual, transgender, intersex, transsexual, genderqueer, other), ethnicity (categorized as white, indigenous, or other minority), and injection and noninjection illicit drug use (e.g., crack cocaine, crystal meth, heroin, diversion of prescription opiates).…”

“…Given the multiple potential routes of HBV transmission (sexual transmission, needle sharing) (Franco et al, 2012;World Health Organisation, 2013), HBV has been identified as an important potential health risk for several groups of marginalized women, including homeless women (Beech et al, 2002), women who use drugs (Nielsen et al, 2016;Haussig et al, 2018), and women living with HIV (CDC, 2014). However, few studies on STBBIs within the context of sex work have included assessments of the burden of HBV or the uptake of vaccination or other HBV-related services amongst sex workers (Mak et al, 2003;Baars et al, 2009;Carneiro et al, 2014;Magalhães et al, 2017). In Canada, many sex workers face the potential for elevated HBV exposure through both sexual and drug-related pathways (Goldenberg et al, 2017c).…”