Hepatitis B vaccination uptake in hard-to-reach populations in London: A cross-sectional study

Josephine E.B. Taylor, Julian Surey, Jennifer MacLellan, Marie Francis, Ibrahim Abubakar*, Helen R. Stagg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Background: In the UK, hepatitis B virus (HBV) incidence is associated with migrants from particular high-burden countries and population groups deemed 'hard-to-reach' by standard healthcare services: the homeless, people who inject drugs and ex-prisoners. Currently, there is a national targeted HBV vaccine policy for such at-risk groups, but there is limited recent evidence about 1) the levels of vaccine uptake, 2) the factors associated with incomplete vaccination, and 3) reasons for incomplete vaccination. Methods: A questionnaire capturing social and medical history, demographic factors and information about HBV vaccination status was completed by individuals deemed hard-to-reach due to socio-structural factors that criminalise, isolate and stigmatise who consented to participate in a randomised controlled trial of a peer intervention to promote engagement with hepatitis C services. The questionnaire also captured the reasons for incomplete vaccination. Descriptive, univariable and multivariable regression analyses were undertaken. Results: Three hundred fourty six participants completed the questionnaire. 1) 52.3% (n = 181) reported full HBV vaccination. 2) Within a multivariable model adjusting for sociodemographic variables, the presence of one or two or more socio-structural factors that are included in the national targeted vaccination policy was associated with protection against incomplete HBV vaccination (51.7% vaccine coverage in those with one factor, odds ratio 0.43 [95% confidence interval 0.20-0.92]); 70.1% coverage with two or more factors, 0.19 [0.09-0.39]; overall p-value < 0.001). Being female was also associated with lower vaccine uptake (2.37 [1.24-4.57], 0.01). Examining the socio-structural factors individually, intravenous drug use was associated with protection against incomplete HBV vaccination. 3) The most common reasons declared for incomplete vaccination were never being offered the vaccine or not returning for further doses. Conclusion: Within this study of HBV vaccination uptake among hard-to-reach population groups in London, UK, we document 52.3% coverage of the full vaccine course. Critically, although participants recommended for immunisation within national guidelines had an increased likelihood of receiving a complete vaccine course, we note surprisingly low coverage in the presence of the risk factors that are national indicators for vaccination. Public health bodies should make additional efforts to improve coverage in the hard-to-reach through improved vaccine delivery systems. Trial registration: ISRCTN24707359, Registered 19th October 2012.

Original languageEnglish
Article number372
JournalBMC Infectious Diseases
Issue number1
Publication statusPublished - 2 May 2019
Externally publishedYes

Bibliographical note

Funding Information:
This report is independent research funded by the National Institute for Health Research Policy Research Programme (“Effectiveness of testing for treatment of hard-to-reach groups for latent tuberculosis, hepatitis B virus and hepatitis C virus in England: The HALT Study”, 015/0306). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. The study funders and sponsor had no role in the design of the study; the collection, analysis, and interpretation of the data; in the writing of the paper; and in the decision to submit it for publication.

Funding Information:
HRS reports funding from the Department of Health during the course of the study. JS, JM and MF report funding from the Department of Health and NIHR Clinical Research Network, UK, during the conduct of the study. GF reports personal fees from AbbVie, Gilead and Merck during the conduct of the study. All other authors report that they have no competing interests.

Publisher Copyright:
© 2019 The Author(s).


  • Hard-to-reach
  • Hepatitis B virus
  • Homeless
  • Injecting drug users
  • Prisoners
  • Vaccination


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