S2936 Improving Hepatitis A Vaccination Rates in Cirrhosis and HIV Populations: A QA/QI Initiative at an Academic Center

Introduction: Patients with cirrhosis and HIV are at increased risk for severe complications from Hepatitis A virus (HAV) infection. Despite national recommendations for HAV vaccination in these high-risk populations, uptake remains suboptimal. This QA/QI project aimed to evaluate and improve HAV vaccination rates at an academic outpatient setting through targeted interventions. Methods: We conducted a retrospective and prospective analysis of HAV vaccination practices at 3 primary care clinics within University Hospital. Adult patients with a diagnosis of cirrhosis or HIV seen between October 2023 and October 2024 were reviewed. In November 2024, a 2-part intervention was implemented: (1) an educational email outlining HAV vaccination guidelines was sent to Internal Medicine residents, and (2) “Hepatitis A Vaccination” was added to the EMR health maintenance section. Post-intervention data were collected for patients seen between December 2024 and February 2025. Outcomes included rates of HAV serologic testing, vaccination documentation, and planned vaccination. Results: Among cirrhosis patients seen in the IM clinic, the proportion with unaddressed vaccination decreased from 25% pre-intervention to 8% post-intervention (P = 0.11). Additionally, 8% of patients post-intervention had documented plans for vaccination compared to 0% pre-intervention. In contrast, HIV patients showed a significant decline in HAV serologic testing post-intervention (64% to 38%, P = 0.012), and a reduction in documented immunity (48% to 25%, P = 0.025), likely reflecting documentation or sampling differences. Conclusion: A dual intervention involving provider education and EMR modification led to modest improvements in HAV vaccination practices for cirrhosis patients but had mixed results in the HIV population. Further efforts are needed to ensure guideline adherence across clinical settings.