Rajkumar Nalinikanta is the President of the Community Network for Empowerment (CoNE) in Manipur, India. A former drug user living with HIV for 20 years, he has worked in HIV and viral hepatitis since 2003. He leads impactful programs, including same-day hepatitis C testing and treatment in correctional facilities.

Background: Since 2012, the World Health Organization (WHO) has recommended a rapid-regimen hepatitis B (HBV) vaccination for people who inject drugs (PWID), with all three doses completed within 21 days. Although the need for prevention of HBV has been supported by WHO position papers, guidelines and the Global Fund in Grant Cycle 7, national programs utilizing rapid-regimen have seen minimal uptake due to insufficient data on its effectiveness and adherence among PWID.
Methodology: To evaluate the feasibility and effectiveness of a rapid-regimen HBV vaccination using the standard 1 ml dose (administered at 0, 7, and 21 days), a catch-up vaccination campaign was conducted from October 2017 to August 2022 in Manipur, India. During this period, 677 PWID and people living with HIV (PLHIV) received the rapid-regimen. All participants were born before introduction of national HBV birth dose vaccination program and had not previously received HBV vaccination. Chronic HBV was ruled out for all participants through negative rapid HBsAg test. To assess the effectiveness of the vaccination, anti-HBs tests were conducted on 372 participants (55%) 1 to 5 years after their initial dose.
Results: All 677 participants (100%) adhered to completing the full three-dose vaccination. Among the 372 samples tested, 316 (84.9%) achieved anti-HBs titres above 10 mIU/ml, indicating a robust immune response. 56 (15%) had titres below this threshold of which 50 received a booster dose. 43 (86%) achieved anti-HBs titres above 10 mIU/ml, indicating an improved immune response, while 7 (14%) had titres below the threshold.
Conclusion: Results demonstrates rapid HBV vaccination with a standard dose is effective among PWID and PLHIV, offering high immunity rates and easy to adhere. Wider adoption and integration of this regimen in harm reduction and closed settings, as a public health approach, could prevent new infections and improve hepatitis B control and elimination.