The County of San Diego HIV, STD and Hepatitis Branch offers clients a risk-based services package that includes selective hepatitis B vaccination, selective hepatitis B and C screening, and universal hepatitis information and risk-reduction counseling. This service package is available in the County of San Diego's STD clinics and HIV Counseling and Testing sites. Eligibility for services is determined through a risk-assessment screening. Eligible clients include intravenous drug-users (IDUs) and their sex partners, men who have sex with men (MSMs), female commercial sex workers, and those who received a blood transfusion or other blood products prior to 1992.

The County of San Diego HIV, STD and Hepatitis Branch now has hepatitis A vaccine and Twinrix vaccine available in addition to the hepatitis B vaccine at the STD clinic sites. Vaccines are still provided based on criteria as noted below:

• Hepatitis A vaccine: MSM, IDU, sex partner of IDU, chronic HBV infection, HCV infection
• Hepatitis B vaccine: age less than 45 years, 3 or more sex partners in the last 3 months, MSM, female commercial sex worker, IDU, sex partner of IDU, sex partner has hepatitis, HCV-infected.
• Twinrix is given to those who meet criteria for both A and B vaccinations.

In 2001, the San Diego program published Hepatitis B Immunization in a STD Clinic: Lessons Learned in San Diego County - A Practical Guide. The guidebook addresses integrating hepatitis B vaccination into a STD program. It also provides information from San Diego's experience, including educational materials, protocols, and data collection tools developed.

The complete guide can be downloaded free of charge at: http://hepprograms.org/std/manual/index.htm