Testing for hepatitis B virus alone does not increase vaccine coverage in non-immunized persons

Table 1 Description of the study population n (%)

	Total (n = 1215)	Follow-up contact		P value
		Reply (n = 902)	No reply (n = 313)
Male	702 (57.8)	511 (56.7)	191 (61.0)	0.18
Age (yr), mean ± SD	36 ± 15	37 ± 15	34 ± 14	0.02
HBV prevalence of birth country				< 0.001
Low (< 2.0%)	670 (55.1)	527 (58.4)	143 (45.7)
Intermediate (2.0%-8.0%)	331 (27.2)	222 (24.6)	109 (34.8)
High (> 8.0%)	214 (17.6)	153 (17.0)	61 (19.5)
Parents from high endemic region	276 (22.7)	205 (22.7)	71 (22.7)	0.9
Traveled to high endemic region1	284 (23.4)	204 (22.6)	80 (25.6)	0.3
Healthcare in high endemic region	177 (14.6)	124 (13.8)	53 (16.9)	0.17
Health insurance plan				< 0.001
Social security/CMU2	913 (75.2)	719 (79.7)	194 (62.0)
CMUc3	61 (5.0)	47 (5.2)	14 (4.5)
AME4/Other/ None	241 (19.8)	136 (15.1)	105 (33.6)
Received transfusion	48 (4.0)	33 (3.7)	15 (4.8)	0.4
Received tattoos	151 (12.4)	100 (11.1)	51 (16.3)	0.02
Received piercing	510 (42.0)	387 (42.9)	123 (39.3)	0.3
Close contact with HBV+ individual	75 (6.2)	57 (6.4)	18 (5.8)	0.7
Number of life-time sexual partners				0.001
0-1	181 (14.9)	118 (13.1)	63 (20.1)
2-9	560 (46.1)	409 (45.3)	151 (48.2)
≥ 10	474 (39.0)	375 (41.6)	99 (31.6)
> 1 sexual partner within 12 mo	593 (48.8)	447 (49.6)	146 (46.7)	0.4
Men who have sex with men	93 (8.9)	73 (8.1)	20 (6.4)	0.3
Nasal drug-use	145 (11.9)	108 (12.0)	37 (11.8)	0.9
Intravenous drug-use	5 (0.4)	5 (0.6)	0	0.3
Long-term stay at a medical center	50 (4.1)	38 (4.2)	12 (3.8)	0.8
Previously incarcerated	87 (7.2)	63 (7.0)	24 (7.7)	0.7

Participants with reply and no reply were compared using Kruskal-Wallis test for continuous variables and Pearson χ² test or Fisher's exact test for categorical variables.

¹Period of stay was longer than 3 mo;

²Couverture médicale universelle, minimum health insurance coverage that is given to persons living in precarious situations (i.e. unemployed, poverty, etc.);

³Couverture médicale universelle complémentaire, additional health insurance coverage that is given to stable residents in France living with limited financial resources;

⁴Aide médicale d’état, health insurace generally given to immigrants without proper documentation.

Table 2 Hepatitis B virus vaccination and no reply rates across study centers

	n	No reply n (%)	Immunization coverage
			Vaccinatedn3	Per protocol1(%)	ITT2(%)
Total	1215	313 (25.8)	99	11	8.2
General practitioner	418	85 (20.3)	21	6.3	5
Policlinique Saint Antoine	165	47 (28.5)	10	8.6	6.1
Travel clinic Saint Antoine	31	5 (16.1)	3	11.5	10
CPAM	222	33 (14.9)	8	4.2	3.6
STD clinics	635	166 (26.1)	35	7.5	5.5
CDAG Saint Antoine	51	10 (19.6)	0	0	0
CDAG Figuier	275	78 (28.4)	22	11.2	8
CDAG Belleville	309	78 (25.2)	13	5.6	4.2
Immigrant-health clinics	140	61 (43.6)	37	46.8	26.4
Croix-Rouge Moulin Joly	9	0 (0)	5	55.6	55.6
CRAMIF	18	0 (0)	9	50	50
Médecin du Monde	113	61 (54.0)	23	44.2	20.4
Prison (UCSA Paris)	22	0 (0)	6	27.3	27.3

¹Per-protocol end-point defined as the proportion of non-immunized participants initiating vaccination who were contacted;

²Intent-to-treat (ITT) end-point defined as the proportion of non-immunized participants initiating vaccination assuming that those who were unable to be contacted did not initiate or complete vaccination;

³Participants initiating HBV vaccination sequence after HBV testing in the OPTISCREEN-B study. CDAG: Centre de dépistage anonyme et gratuit; CPAM: Caisse primaire d’assurance maladie; CRAMIF: Caisse régionale d'assurance maladie d'Ile-de-France; UCSA: Unité de consultations et de soins ambulatoire; STD: transmitted disease.

Table 3 Determinants for initiating hepatitis B virus vaccination sequence

Risk-factor	Univariate		Multivariable5
	OR (95%CI)	P value	OR (95%CI)	P value
Female vs male	0.61 (0.37-0.99)	0.04
Age (per yr)	1.00 (0.98-1.02)	0.8
Parents from high endemic region	1.52 (0.89-2.58)	0.12
Traveled to high endemic region1	1.43 (0.83-2.45)	0.19
Care in high endemic region	1.45 (0.79-2.67)	0.2
Transfusion	0.28 (0.03-2.28)	0.2
Tattoos	1.26 (0.63-2.55)	0.5
Piercing	1.05 (0.66-1.67)	0.8
Close contact with HBV+ individual	1.14 (0.48-2.70)	0.8
Men who have sex with men	2.05 (0.97-4.34)	0.06	2.53 (1.14-5.60)	0.02
Nasal drug-use	0.37 (0.13-1.07)	0.07	0.41 (0.14-1.21)	0.1
Intravenous drug-use	3.42 (0.41-28.40)	0.3
Long-term stay at a medical center	1.02 (0.33-3.14)	0.9
Previously incarcerated	0.71 (0.24-2.06)	0.5
HBV-prevalence of birth region
Low (< 2.0%)	1		1
Intermediate (2.0%-8.0%)	4.39 (2.35-8.19)	< 0.001	3.58 (1.85-6.95)	< 0.001
High (> 8.0%)	4.43 (2.24-8.75)	< 0.001	3.44 (1.65-7.15)	0.001
Health insurance plan
Social security or CMU2	1		1
CMUc3	1.13 (0.35-3.62)	0.8	0.76 (0.23-2.58)	0.7
AME4, Other, or none	4.54 (2.21-9.30)	< 0.001	2.60 (1.23-5.52)	0.01
Number of life-time sexual partners
0-1	1
2-9	0.93 (0.47-1.87)	0.8
≥ 10	0.75 (0.35-1.60)	0.5

Per-protocol analysis on the 902 non-immunized participants who were able to be contacted.

¹Period of stay was longer than 3 mo;

²Couverture médicale universelle, health insurance coverage that is given to persons living in precarious situations (i.e. unemployed, poverty, etc;

³Couverture médicale universelle complémentaire, additional health insurance coverage that is given to stable residents in France living with limited financial resources;

⁴Aide médicale d’état, health insurace generally given to immigrants without proper documentation;

⁵When constructing the multivariable model, gender was not included due to collinearity with men who have sex with men.

Table 4 Reasons for not initiating hepatitis B virus vaccination

Reason	n (%)
Serology results were never obtained	112 (14.0)
Vaccination was not proposed by physician	173 (21.5)
Vaccination was not indicated (according to physician)	26 (3.2)
Not at risk	14 (1.7)
Vaccination was already done1	12 (1.5)
Participant did not want to be vaccinated	239 (29.8)
Not perceived to be at risk	95 (11.8)
Vaccination was already done	21 (2.6)
Not receptive to vaccinations in general	44 (5.5)
Not receptive to HBV vaccination	89 (11.1)
Will be vaccinated later	268 (33.4)

Among the 803 contacted individuals who did not initiate HBV vaccination. More than one response was possible (only applies to 15 participants).

¹No indication for revaccination despite undetectable anti-HBs antibodies.