Hepatitis B virus (HBV) and hepatitis C virus (HCV) are endemic among adult injection drug users (IDUs). Children of IDUs (CIDU) are known to be at risk for HBV and HCV because of maternal-fetal transmission, and possibly, other factors as well. CIDU often live below the poverty level and - 1/3 of homeless children are CIDU. Although both poverty and the condition of being homeless are associated with low immunization rates, strategies to improve immunization for HBV in CIDU have not been systematically studied, and the epidemiology of HCV in this high-risk population has not been characterized. Therefore, the specific aims of this project are: 1) To develop a new multi-component intervention strategy (culturally adapted CD ROM-based educational materials, reminder systems, and clinic/shelter-based vaccines) to improve HBV immunization rates in CIDU and compare this strategy to conventional strategies 2) To characterize the epidemiology of HCV in CIDU. In Baltimore, we have identified three large cohorts of CIDU which are well-suited to accomplish the aims of this proposal: 1) 900 homeless children 2) 100 CIDU in the AIDS Linked to Intravenous Experience (ALIVE) study of adult IDUs and 3) 200 CIDU in the ongoing Risk, Evaluation and Assessment of Community Health (REACH) study of young IDUs. 1. In the immunization studies, we will partner with Hepatitis Foundation International (HFI) and Johns Hopkins Medical Video to adapt HFI educational materials about viral hepatitis to age- and culturally appropriate CDROM based presentations. Subjects will be randomized as to a """"""""standard"""""""" or """"""""special"""""""" prevention approach and ongoing critique and validation of the materials will be performed. 2. The epidemiologic studies in CIDU will include determination of HCV prevalence and will utilize an Automated Computer Assisted Self Interview to investigate injection drug use by parents and children, and other potential correlates of HCV infection among CIDU (e.g., tattooing, piercing). The novel approach of using a salivary anti-HCV (S-anti-HCV) assay for non-invasive screening in CIDU will be studied, after first validating the test in 60 children with chronic HCV infection. CIDU who test S-anti-HCV+ will have blood assayed for serologic markers for HCV, HBV, and human immunodeficiency virus. It has been estimated that complete eradication of hepatitis B and C infection from all children in the U.S. could save at least $200 million over the next 10 years, Preventative strategies emanating from this proposal could contribute significantly to reduction of both the high medical costs and human suffering secondary to these infections in children.
| Schwarz, Kathleen; Garrett, Beth; Lee, Jennifer et al. (2008) Positive impact of a shelter-based hepatitis B vaccine program in homeless Baltimore children and adolescents. J Urban Health 85:228-38 |
| Schwarz, Kathleen B; Garrett, Beth; Alter, Miriam J et al. (2008) Seroprevalence of HCV infection in homeless Baltimore families. J Health Care Poor Underserved 19:580-7 |
| Schwarz, Kathleen B; Garrett, Beth; Hampsey, Jenifer et al. (2007) High prevalence of overweight and obesity in homeless Baltimore children and their caregivers: a pilot study. MedGenMed 9:48 |
| Schwarz, K; Garrett, B; Lamoreux, J et al. (2005) Hepatitis B vaccination rate of homeless children in Baltimore. J Pediatr Gastroenterol Nutr 41:225-9 |
