Identifying Missed Opportunities for Routine Vaccination among People Who Use Drugs

• Type of Material: Article
• Authors: Paula Frew, Emory University; Jay T. Schamel, University of Nevada; Laura A. Randall, University of Nevada; Adrian R. King, University of Nevada; Ian W. Holloway, University of California Los Angeles; Katherine Burris, University of Nevada; Anne Spaulding, Emory University
• Language: English
• Date: 2021-02-01
• Publisher: MDPI AG
• Publication Version: Final Published Version
• Copyright Statement: © 2021 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph18041447
• Title of Journal or Parent Work: International Journal of Environmental Research and Public Health
• Volume: 18
• Issue: 4
• Grant/Funding Information: Project findings reported in this publication were supported UNLV faculty development funds. Ian W. Holloway acknowledges support from the National Institute of Mental Health (P30 MH58107) and the California HIV/AIDS Research Program (RP15-LA-007). Anne C. Spaulding has funding from industry.
• Keywords: hidden populations; opioid crisis; vaccine missed opportunities; vaccine uptake; health equity; substance use; immunization; adult vaccination; vaccine coverage; social determinants
• Research Categories: Health Sciences, Immunology; Health Sciences, Public Health; Biology, Virology

Abstract

In the US, adult immunization coverage remains low, especially among vulnerable populations, as recent hepatitis A outbreaks have demonstrated. We studied the vaccination history variation among the US adults who use drugs by implementing a community-engaged research survey to identify reported immunization coverage, missed opportunities (MO), and places where immunizations might be delivered. Our analysis of a sample of 1127 participants recruited at community syringe exchanges in three cities identified higher overall vaccination receipt in Los Angeles compared to Atlanta or Las Vegas (e.g., HAV receipt 52.2% LA, 42.1% LV, 41.4% Atlanta). Overall, fewer participants reported having received HAV (45.9%), HBV (47.5%), or influenza (47.6%) vaccines than MMR (57.1%) or Td/Tdap (61.1%). Across sites, HAV receipt was higher for participants incarcerated ≥ 5 years (54.2% vs. 43.6% for those incarcerated < 5 years, 49.4% no incarceration history, p = 0.02). HBV receipt was higher among participants who were not intravenous drug users (56.1% vs. 46.0%, p = 0.03). Additionally, income >$20k predicted higher rates of MMR receipt (67.0% vs. 56.5%, p = 0.009), as did stable housing (62.8% vs. 54.3%, p = 0.01). To address the need to expand vaccine coverage among vulnerable adults, delivering vaccine at sites where persons who use drugs access services, or in correctional facilities, may be warranted.