3 For Life, Hepatitis B Immunization and Screening Program

The 3 for Life Project provided low-cost hepatitis A and B vaccinations and hepatitis B screening to members of the San Francisco community. The program targeted foreign-born Chinese adults, but services were offered to interested clients regardless of race/ethnicity. Vaccination and screening were offered on two Saturdays per month for one year at a neighborhood YMCA. At the first visit, participants completed a brief survey (in either Chinese or English) assessing risk factors and past medical history.

In order to increase likelihood of series completion, a low-cost fee was assessed for the complete vaccination series at the first visit; the serological screening was provided for free. The initial screening and vaccination were conducted on the same day to avoid missed opportunities to vaccinate and to reduce the number of visits required. Follow up vaccinations were scheduled during the initial visit. Test results with a detailed explanation were mailed to participants within two weeks in Chinese and English with future medical care recommendations depending on serologic status.

To provide low-cost immunization for hepatitis A and B, screening for hepatitis B, and to increase community awareness about hepatitis B.

During the year-long project, 1206 adults participated in the program and 1106 participants received hepatitis B screening. Nine percent of all participants were chronically infected (compared to 0.2-0.5% of the U.S population). Fifty-three percent of all screened participants were susceptible to hepatitis B infection and 85% of this group completed the hepatitis B vaccination series with or without hepatitis A vaccination. Of those not needing to complete the hepatitis B vaccination, 82% of chronically infected participants and 92% of immune participants completed the hepatitis A vaccination series.

The rate of completion of vaccination series was slightly higher for middle-aged (RR = 2.3, 95% CI = 1.6-3.6) and Chinese participants (RR = 1.8, 95% CI = 1.0-3.0). Completion rates were similar for insured and uninsured participants (RR=1.0, 95% CI = 0.6-1.5). Seventy-nine percent of those who were able to recall their physicians' recommendations said they had not been advised to undergo hepatitis B screening. Based on its success in San Francisco, the 3 for Life program has been implemented in Los Angeles and Hawaii.