Addressing Hepatitis A and Hepatitis B Risks: Screening and Preventative Care for People Who Inject Drugs

People who inject drugs (PWID) often present to hospital with complicated infections, providing an opportunity to screen and vaccinate for hepatitis A virus (HAV) and hepatitis B virus (HBV). This study evaluated HAV and HBV screening and vaccination among PWID over 3 years.

A single-centre retrospective study of all infectious diseases inpatient admissions for current PWID with a length of stay ≥ 48 h, Drug and Alcohol team referral and/or opioid substitution therapy was performed (January 2020-December 2022). Serological screening for HAV (immunoglobulin G [IgG]) and HBV (complete screening: surface antigen, core and surface antibodies), and vaccinations were collected per encounter. The prevalence of serological screening and vaccinations against HAV and HBV and differences in characteristics by screening status were explored with descriptive statistics.

Overall, 115 patients from 159 encounters were included (mean age: 41.8 ± 8.4 years; male: n = 73, 64%; median length of stay: 7 (IQR 4-16) days). Anti-HAV screening was performed for 47 patients across 57 (35.8%) encounters, with 12 patients who screened negative vaccinated (n = 12/21, 57.1%). Complete HBV screening was performed for 75 patients across 85 (53.5%) encounters, with 7 patients who screened negative vaccinated (n = 7/12, 58.3%). Males were more likely to receive HAV screening than females (77% vs. 23%, p = 0.015). HBV screening was less likely in encounters requiring intensive care unit admission (12% vs. 88%, p = 0.038).

While more than half of eligible patients received vaccination, complete screening for both HAV and HBV was low. Initiatives including electronic serology order sets should be considered to improve screening.