Improving Hepatitis A Vaccination Rates in Cirrhotic and HIV+ Patients: A Quality Improvement Initiative at an Academic Center

BACKGROUND: Hepatitis A virus (HAV) infection remains a preventable cause of acute viral hepatitis with disproportionate morbidity among adults with chronic liver disease and people living with HIV. Despite longstanding Advisory Committee on Immunization Practices recommendations, HAV vaccination coverage in high-risk adults remains suboptimal. We conducted a quality improvement initiative to improve HAV vaccination practices in an academic ambulatory clinic. METHODS: This QI project was implemented at an academic ambulatory care center using Plan-Do-Study-Act (PDSA) cycles from October 2024 to April 2025. Interventions included electronic health record smart-phrase modification, resident and nursing education, workflow integration, and patient education. Adults with cirrhosis or HIV seen during preintervention (October 2023-October 2024) and postintervention (December 2024-April 2025) periods were included in the analysis. Primary outcomes were HAV vaccination initiation and completion rates; secondary outcomes included documentation of HAV discussions and patterns of serologic testing. Proportions were compared using 2-proportion z-tests. RESULTS: Among patients with HIV (n = 91), overall HAV serologic testing declined significantly postintervention (64% vs 38%, P < 0.05). The completion rate of the HAV vaccine series increased from 18% to 30%, although this did not reach statistical significance. Documentation of planned vaccination improved modestly within the internal medicine clinic. Among patients with cirrhosis (n = 100), HAV immunity and vaccination rates were high at baseline and remained stable postintervention, with a nonsignificant increase in HAV addressal (78% vs 84%). Across both cohorts, documentation of vaccination plans improved slightly but remained limited. CONCLUSIONS: A multifaceted, electronic health record-integrated QI intervention was associated with reduced HAV serologic testing and modestly improved vaccination practices, particularly in patients with HIV. Persistent gaps in vaccine completion highlight the need for sustained workflow and follow-up strategies to improve HAV immunization among high-risk adults.