Hepatitis A, B, and C Prevention Programs
Information and Programs for Adults and Adolescents at Risk
Presented by the Immunization Action Coalition with dedicated funding from the
Division of Viral Hepatitis at the Centers for Disease Control and Prevention
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Homeless programs

Health Care for the Homeless, Baltimore, MD
Program name: Health Care for the Homeless, Baltimore, MD
Population served: The homeless
Eligibility: Homeless clients presenting at our clinic or contacted through outreach
Region served: Baltimore, MD
Funding: Federal
Program started: The community health clinic began serving clients in1985; this specific hepatitis initiative began in 1997
Number of clients: 5,300/year
Contact: Njide Udochi, MD, MPH
Medical Director
Health Care for the Homeless
111 Park Avenue
Baltimore, MD 21201
Phone: (410) 837-5533
Fax: (410) 837-8020
Email: nudochi@hchmd.org
Website: None

Health Care for the Homeless (HCH) serves 5,300 clients a year in Baltimore; 3,200 at the HCH clinic and 2,100 more in outreach. Basic demographics: 96% are homeless, 69% are men, 82% are African-American, 18% have a history of mental illness, 4% are HIV positive, and 18% report illicit drug use. Because hepatitis C is particularly severe among clients with HIV and/or alcohol abuse, we began screening for hepatitis C in 1997.

We were interested in risk factors for clients testing positive for hepatitis C, and especially what percentage of them would be eligible for vaccination against hepatitis B and A. We conducted a study from January 1, 1997-June 30, 2000, testing HCH clinic clients for hepatitis C infection. We collected basic demographic data and information on behavioral risk factors, such as unprotected heterosexual sex, men having sex with men, injection drug use, non-injection drug use, and alcohol use.

During this time period, we had 397 clients test positive for hepatitis C. Out of these, 274 were eligible for hepatitis B immunization and approximately 313 were eligible for hepatitis A immunization.

We then compared these 397 hepatitis C positive clients (cases) with 2,535 hepatitis C negative clients (controls). These cases and controls were very similar in terms of their basic demographics. We looked at the hepatitis C clients’ risk factors and co-morbidities compared to the controls, and got the following results:

Risk factor/co-morbidity

Odds ratio

95% confidence interval

Heterosexual sex (unprotected)






Illicit drug use






Alcohol abuse



Hepatitis B




  1. Hepatitis C positive homeless clients are at higher risk for the transmission of hepatitis B than hepatitis C negative homeless clients.
  2. 70% of hepatitis C positive clients are eligible for hepatitis A and hepatitis B immunization.
  3. Hepatitis C clients are seen frequently enough at HCH to complete a 2 or 3-shot vaccine series (the hepatitis C positive clients surveyed had an average of 17 visits each to the clinic during the 3˝ year period of this study).

We have applied to several grantors for funding to support our immunization program and recently received $10,000 to purchase vaccine. We will begin providing vaccination against hepatitis A and B for hepatitis C positive clients, using Twinrix, in December 2001. To assist in tracking clients in our Hepatitis Immunization Program we will be using VacTrac, a vaccination tracking computer program.

Immunization Action Coalition
          Hepatitis Prevention Programs

1573 Selby Ave, Ste 234   St Paul, MN 55104   Tel (651) 647-9009   Fax (651) 647-9131