regional epi meeting – hepatitis b vaccine pilot colandra holiday, vic landa, whitney griffith tn...

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

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Participating Sites STD services in public health clinics

Memphis/Shelby Packer STI ClinicUpper Cumberland Region (UCR)East TN Region (ETR)Northeast Region (NER)

County jailsEast TN Region (ETR)Northeast Region (NER)

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East TN Region (ETR) – Jails 4 initial sites recruited, clinics established

(Claiborne, Hamblen, Campbell, Blount) 2 additional sites identified for future clinics

(Sevier & Anderson)

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East TN Region (ETR) – Jails

Claiborne Hamblen Campbell Blount

Average Cen-sus

222 283 129 502

Average Up-take

97 100 75 226

% Uptake 0.43 0.35 0.58 0.45

50

250

450

Vaccine Uptake in ETR Jails

Ce

ns

us

5Timeframe Oct 2013 – April 2014

East TN Region (ETR) – Jails

Census Uptake Series Completed0

500

1000

1500

2000

2500

3000

2471

1109

234

Totals

Totals

6Timeframe Oct 2013 – April 2014

Northeast Region (NER) – Jails 5 initial sites recruited, clinics established

(Washington, Greene, Johnson City, Hancock, Johnson)

3 sites recruited, 1st clinic pending (Carter, Unicoi, Hawkins)

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Northeast Region (NER) – Jails

Wash-ington

John-son City

Greene Han-cock

John-son

Hawkins

Av-er-age Census

420 87 348 92 130 241

Av-er-age Up-take

173 37 122 10 60 143

% Up-take

0.41 0.42 0.35 0.11 0.46 0.59

25

175

325

Vaccine Uptake in NER Jails

Ce

ns

us

8Timeframe Oct 2013 – March 2014

Northeast Region (NER) – Jails

Census Uptake Series Completed0

1000

2000

3000

4000

5000

6000

7000

5926

2219

569

Totals

Totals

9Timeframe Oct 2013 – March 2014

Vaccination* – Jails (ETR/NER)

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Overall County Jail

1st Dose 2406 1401

2nd Dose 774 403

3rd Dose 129 66

250750

1250175022502750

Completion Rates**

# o

f D

ose

s

* 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 CDC11

Pilot Support – Eastern TN Public health clinics & county jails

Vaccine inventoryRisk assessment questionnairesAssisting staff with administrative clinic

supportProviding & sending reminder cards

County JailsData entry (PTBMIS, REDCap)

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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

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Vaccination – Packer STI Clinic Experience gained from previous

hepatitis B vaccine effortsOffer of vaccine made part of nurse chart

auditRecognition of nurses with most doses

given

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Vaccination – Packer STI Clinic Addition of Fast Track STI services – a

unique opportunityPatients without symptoms or exposure

seen by M.A. onlyPatients offered urine GC/chlamydia and

HIV/RPRCall back in 7 business days for results from

hotline

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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.

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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

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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

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Vaccination* – STD Services

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Overall STD Services

1st Dose 2406 1005

2nd Dose 774 371

3rd Dose 129 63

250750

1250175022502750

Completion Rates**

# o

f D

ose

s

* Doses of monovalent hep B vaccine; for timeframe Sept 2012 – Dec 2013**Completion rates underrepresented

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ARE WE REACHING OUR HIGH-RISK POPULATION?

Population Characteristics*

14.38%

66.49%

18.93%0.20%

Age

18-2425-4445-6465+

* For timeframe Sept 2012 – Dec 2013

Population Characteristics*

82.0%

17.0%0.1% 1.0%

Race

White

Black or African Amer-ican

Asian

American Indian/Alaska Native

Native Hawaiian/Other Pacific Islander

Other Race

* For timeframe Sept 2012 – Dec 2013

Population Characteristics*

3.6%

96.4%

Ethnicity

Hispanic or Latino

NOT Hispanic or Latino

* For timeframe Sept 2012 – Dec 2013

Population Characteristics*

54.1%

45.9%

Sex

MaleFemale

* For timeframe Sept 2012 – Dec 2013

Population Characteristics*

55.9%

44.1%

Setting

Public Health Clinic (STD Services)County Jail

* For timeframe Sept 2012 – Dec 2013

Reported Risk Factors*

12.1%

87.4%

0.5%

History of IV Drug Use

YesNoUnkown

*As of April 11, 2014

Reported Risk Factors*

52.1%46.1%

1.9%

History of Treatment for STDs

YesNoUnkown

*As of April 11, 2014

Reported Risk Factors*

39.1%

60.5%

0.4%

History of >1 sexual partners in last 6 months

YesNoUnkown

*As of April 16, 2014

Questions

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Contact Information – Central Office: Jennifer Ward, MS

Epidemiologist, Viral Hepatitis Team Lead jennifer.ward@tn.gov615-253-8662

Dana Jackson, BSNRN, Viral Hepatitis Prevention CoordinatorDana.jackson@tn.gov 615-253-1361

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Contact Information – Satellite Office: Whitney Griffith,

RN, Hepatitis B Coordinatorwhitney.griffith@tn.gov 865-549-5277

Henning “Vic” Landa, MBAAdministrative Service Assistantvic.landa@tn.gov 865-549-5282

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Contact Information – Memphis: Colandra Holliday, xxx

RN, Hepatitis B Coordinatorcolandra.holiday@shelbycountytn.gov 901-222-9356

Donna Freeman, FNP-BCRN, Nurse SupervisorDonna.freeman@shelbycountytn.gov 901-222-9417

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