A Strategy to Improve Hepatitis B Vaccine Uptake in Hesitant Adults: The Offer-Offer-Test-Vaccinate Approach

Area of Science:

• Public Health
• Immunization Practices
• Infectious Disease Prevention

Background:

• Adult hepatitis B vaccination coverage in the U.S. remains suboptimal despite recommendations for universal immunization.
• Many adults are unaware of their susceptibility to hepatitis B virus (HBV) infection.
• Vaccine hesitancy contributes to low uptake rates in the adult population.

Purpose of the Study:

• To evaluate a stepwise "Offer-Offer-Test-Vaccinate" workflow to improve hepatitis B vaccine uptake.
• To assess the impact of integrating serologic testing into the vaccination process for hesitant adults.
• To determine the feasibility and effectiveness of this quality improvement strategy in a primary care setting.

Main Methods:

• A retrospective quality improvement study was conducted in a primary care clinic.
• An "Offer-Offer-Test-Vaccinate" workflow was implemented for adult patients (≥19 years).
• Patients declining initial vaccination were offered serologic screening; seronegative patients were reoffered vaccination.

Main Results:

• Initial vaccination uptake was 20.8%.
• Integrating serologic testing increased overall uptake to 28.9% (8.2 percentage point absolute increase).
• Approximately 2.6 serologic tests yielded one additional first-dose vaccination; series completion was high (74.0%-87.8%).

Conclusions:

• Incorporating serologic testing modestly improved hepatitis B vaccination uptake among vaccine-hesitant adults.
• Personalized immunity information from serologic results can re-engage patients.
• The "Offer-Offer-Test-Vaccinate" strategy is a feasible and scalable approach for HBV prevention in adult primary care.