Financial Incentives Improve Hepatitis B Vaccination Among Injection Drug Users

Cases of hepatitis B have risen along with increases in injection drug use (IDU), driving a need to improve vaccination rates among people who inject drugs (PWID).

A recent study, published in Open Forum Infectious Diseases, found that using financial incentives and accelerated vaccine schedules are moderately effective at improving vaccination rates.

The study, conducted at the West Virginia University School of Public Health Department of Epidemiology, involved meta-analysis of 11 studies, representing more than 4000 participants in the United States, Iran, Denmark, Australia, and the United Kingdom.

“Since 2009, the increase in IDU in the US has highlighted the importance of providing harm reduction services to PWID, including access to HBV vaccine,” the study noted. “However, making the vaccine available does not always translate to increased HBV vaccination rates in PWID. Strategies are needed to increase the vaccine uptake among this high-risk group.”

The opioid crisis in the United States has led to an increase in infections, including viral hepatitis, HIV, and bacterial infection, a recent study noted.

More than 240 million people worldwide are chronically infected with hepatitis B, which is associated with hepatocellular carcinoma, including 2.2 million in the United States. Among newly infected people in 2015, 30.3% reported injection drug use as a risk factor.

The WVU analysis comprised randomized studies that included interventions to increase vaccine adherence as an outcome and people who inject drugs as part of all of the study sample. The Inverse Heterogeneity Model was used to establish pooled odds ratios to determine likelihood of completing the 3-dose vaccine.

Intervention strategies were broken into 3 subgroups: 1) accelerated vaccine schedules, 2) financial incentives, and 3) case management, such as peer coaching and motivational interviewing. Overall, subgroups that included an intervention had a statistically significant increase in the likelihood of completing all 3 doses of the vaccine, with an odds ratio of 2.53.

Financial incentives, which included cash or vouchers, were the most effective intervention for increasing vaccine completion, with an odds ratio of 7.01. The odds ratio for the vaccine schedule intervention was 1.90. The case management intervention subgroup did not yield statistically significant improvements.

The study noted that the cost of providing financial incentives to increase vaccine adherence was estimated to be $220 per participant compared with a cost of $590 per participant for outreach methods.

“Combining financial incentives with an accelerated vaccine schedule represents a low cost and effective method for increasing compliance,” the study noted.

A new 2-dose vaccine approved by the US Food and Drug Administration in 2017 may help improve vaccine compliance. However, other interventions still may be necessary, according to the study, which noted that only 40.4% of high-risk people completed the second dose of the vaccine.

“Using accelerated vaccine schedules and financial incentives have been shown to increase compliance to the 3-dose vaccine schedule,” the study concluded. “As IDU continues, more research is needed to find strategies to improve health outcomes in this high-risk group.”

The study also touted administering the first dose of HBV in conjunction with testing for HBV as both cost-saving and effective.

The World Health Organization calls for the elimination of hepatitis by 2030. A commentary published in February in The Lancet Gastroenterology & Hepatology called the goal ambitious by achievable. That report noted that diagnosis is a key barrier, with only 10% of people living with chronic hepatitis B viral infection aware of their status in 2015.