BACKGROUND
Individuals in custody face higher risks of vaccine-preventable diseases due to overcrowding, high turnover, high-risk behaviors, and inadequate healthcare access.1 Low immunization rates among individuals in custody are partly due to social marginalization and distrust in healthcare personnel, despite the opportunity for health interventions during incarceration.2 Organizations such as World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recommend vaccinating individuals in custody, but implementation varies by facility, especially in resource-limited settings.3 A 2001 survey found that only two states routinely vaccinate for hepatitis B virus (HBV), with cost and funding being major barriers to widespread vaccination in prisons.4 The prevalence of HBV among incarcerated individuals is significantly higher than in the general USA population, with 30% of acute HBV cases having a history of incarceration.5 Enhanced vaccination efforts, routine screenings, and close follow-up by multidisciplinary healthcare teams are needed to improve hepatitis A virus (HAV) and HBV immunity in incarcerated populations.6 The primary objective was to compare the rates of vaccination and immunity to HAV and/or HBV among individuals in custody living with HIV in 2022, to prior data in 2019, where standardized recommendations for serologic screening and vaccination were not routinely performed.
METHODS
The study was a retrospective cohort pre-post design that involved adults living with HIV who were followed in the Illinois Department of Corrections (IDOC) HIV Telemedicine Clinic during two distinct periods: from January 1 2019–December 31 2019, and from January 1 2022–December 31 2022. A follow-up period of 9 months was included to incorporate recommendations regarding screening and vaccinations. The statistical analysis for this study incorporated descriptive statistics, the Chi-squared test, and the Student’s t-test.
RESULTS
A total of 436 patients were included in the 2019 cohort, which served as historical control data. Of 341 patients screened for inclusion in the 2022 cohort, 300 were included. The majority of patients in either cohort were male (p=0.93) and Black (p=0.53). Overall, baseline demographics were similar between groups. In terms of baseline characteristics, the proportion of patients with an undetectable HIV-1 viral load was similar between groups, with 85% in 2019 and 84% in 2022 (p=0.80). Similarly, 95% of patients in 2019 and 94% in 2022 had a CD4 count above 200 cells/mm³ (p=0.96).In 2019, 79% of patients were immune to HAV compared to 70% in 2022 (p=0.02). For HBV, 65% of patients in 2019 were immune compared to 71% in 2022 (p=0.12). Overall, 52% of patients in 2019 and 53% in 2022 were immune to both HAV and HBV (p=0.89), while 8% in 2019 and 12% in 2022 had no immunity to either HAV or HBV (p=0.08).
A majority of patients were screened for both HAV (60%) and HBV (63%) during initial intake. Among individuals in custody who were not immune at initial intake, 23% received HAV screening and 28% received HBV screening during follow-up appointments. Thirty-six patients were released before follow-up. Of the 24 and 22 patients offered HAV and HBV vaccines, respectively, nine (38%) accepted the HAV vaccine, and 13 (59%) accepted the HBV vaccine.
CONCLUSION
The results indicated that there was no significant increase in overall immunity to both HAV and HBV in the post-intervention cohort. Among patients who initially lacked immunity to HAV and/or HBV, many did not undergo follow-up serologic screening after vaccination. The primary barrier to increasing vaccination rates among individuals in custody appears to be patient refusal.However, screening individuals in custody upon intake presents a valuable public health opportunity to recommend vaccination to those who are non-immune.
