Perspectives on hepatitis A and B screening and immunization at a syringe services program: a mixed-methods study

Area of Science:

• Public Health
• Infectious Diseases
• Health Services Research

Background:

• People who inject drugs (PWID) have high risks for viral hepatitis, yet hepatitis A virus (HAV) and hepatitis B virus (HBV) prevention services are underutilized.
• Syringe services programs (SSPs) are effective settings for delivering these services, but few currently offer them.
• Qualitative insights into optimizing HAV and HBV services within SSPs are limited.

Purpose of the Study:

• To explore barriers and facilitators for providing HAV and HBV prevention and care services to PWID.
• To understand perspectives of PWID and SSP staff on optimizing these services within SSPs.
• To identify opportunities for improving service delivery at SSPs.

Main Methods:

• A mixed-methods study was conducted at an SSP in Miami, Florida.
• Quantitative data on vaccine administration (August 2023-May 2025) were extracted from the SSP database.
• Qualitative data were collected through in-depth interviews with 15 PWID and 11 SSP staff in May 2022, analyzed using thematic analysis.

Main Results:

• The SSP administered 114 HAV and 176 HBV vaccine doses between August 2023 and May 2025.
• Key barriers identified by PWID and staff included limited knowledge, stigma, resource/transportation challenges, and navigation difficulties.
• Facilitators for SSP-based services were co-located, on-demand care, and a non-stigmatizing environment; opportunities included incentives and expanded outreach.

Conclusions:

• PWID encounter substantial barriers to viral hepatitis services in traditional healthcare settings.
• Integrating HAV and HBV services into SSPs improves accessibility and uptake by utilizing trust, convenience, and harm reduction principles.