Vaccination Coverage and Uptake in Young People Experiencing or at Risk of Homelessness

This retrospective audit will investigate if young people who are homeless or at risk of homelessness in Melbourne were up-to-date with routine childhood and adolescent vaccines on first encounter with a nurse-led primary health clinic (the Young People's Health Service), and if they commenced and completed immunisation catch-up plans following referral to the Young People's Health Service immunisation nurse.

The purpose of the proposed study is to establish baseline immunisation coverage within the targeted population, then to explore the impact of an immunisation nurse role on immunisation coverage in a population of young people aged 15-24 years who are experiencing or at risk of homelessness.

The Young People's Health Service is a program of the Royal Children's Hospital Department of Adolescent Medicine. The data collected will be sourced solely from the Royal Children's Hospital Electronic Medical Records.

Study Overview

• Status: Completed
• Conditions: Homeless Youth
• Intervention / Treatment: Other: Referral to the Young People's Health Service immunisation nurse

• Study Type: Observational
• Enrollment (Actual): 400

Contacts and Locations

Study Locations

• Australia
  • Victoria
    • Parkville, Victoria, Australia, 3052
      • The Royal Children's Hospital Melbourne

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 24 years (Child, Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Young people aged 15-24 years of all genders who have been referred to the Young People's Health Service immunisation nurse will be included. They have accessed a homeless youth service, refuge, or flexible learning centre in Melbourne, Australia. The study will include those who were referred between 19th February 2019 to 19th July 2020.

Description

Inclusion Criteria:

• Is between the ages of 15-24 years inclusive at enrolment
• Has a signed general consent/referral form to the Young People's Health Service immunisation nurse between 19th February 2019 - 19th July 2020 and scanned into their EMR. Verbal consent is accepted.
• Was referred from a clinic or outreach location attended by the Young People's Health Service (i.e. a service for people experiencing homelessness)

Exclusion Criteria:

• Does not have a signed consent/referral form to Young People's Health Service immunisation nurse

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Young people who are experiencing or at risk of homelessness; Young people aged 15-24 years who have accessed a homeless youth service, refuge, or flexible learning center in Melbourne, Australia.	Other: Referral to the Young People's Health Service immunisation nurse; Young people who have been referred to an immunisation nurse at the Young People's Health Service.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of participants referred to the Young People's Health Service immunisation nurse who were up-to-date for their age for vaccines on both the National Immunisation Program and the Victorian State Government Schedule.	Young people who meet eligibility criteria will be considered up-to-date on referral if their immunisation history statement at the time of referral meets the criteria to be considered up to date as detailed in Appendix II in the Study Protocol. The percentage of the young people in the population who are up-to-date for their age with each vaccine will be described.	Participants who were referred to the Young People's Health Service between the study time period (Between 19th February 2019 - 19th May 2021)
Proportion of participants referred to the Young People's Health Service immunisation nurse who were are at increased risk of vaccine-preventable diseases.	Where available, data collected from the Electronic Medical Records (EMR) will include risk factors for vaccine-preventable diseases and relevant social determinants of health based on the Australian Institute of Health and Welfare, the Australian Government Department of Health and the National Centre for Immunisation Research and Surveillance publications. Participants will be considered at increased risk of vaccine-preventable diseases if the EMR includes documentation of at least one of: a history of identifying as Aboriginal or Torres Strait Islander, of arriving in Australia as a migrant, refugee or asylum seeker, of incarceration, of men who have sex with men, of alcohol or other drug misuse, of smoking cigarettes, of living with Hepatitis C or HIV, of out of home care, of being a young parent, of having non-professional tattoos, or of sex work.	All available medical records for the participant on the Royal Children's Hospital Electronic Medical Records regardless of time frame

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of participants referred to the Young People's Health Service immunisation nurse who commence a vaccine catch-up plan.	Electronic medical records will be reviewed to record the percentage of participants who were not up-to-date with scheduled vaccines for their age on referral, and commenced a vaccine catch-up plan following referral to an immunisation nurse at the Young People's Health Service. Vaccines required to complete a vaccine catch-up plan will depend on the age of the participant and will be determined by an immunisation nurse. A participant will be considered to have commenced an immunisation catch-up plan if they receive at least one immunisation on the plan.	Between 19th February 2019 - 19th May 2021
Proportion of participants referred to the Young People's Health Service immunisation nurse who complete a vaccine catch-up plan.	Electronic medical records will be reviewed to record the percentage of participants who were not up-to-date with scheduled vaccines for their age, and completed a vaccine catch-up plan following an encounter with an immunisation nurse at the Young People's Health Service. Vaccines required to complete a vaccine catch-up plan will depend on the age of the participant and will be determined by an immunisation nurse. A participant will be considered to have completed an immunisation catch-up plan if they receive all immunisations on the plan.	Between 19th February 2019 - 19th May 2021
Mean number of follow-up contact attempts (all types) sent to young people attending the Young People's Health Service per immunisation visit.	The mean number of contact attempts sent by staff of the Young People's Health Service to young people who require immunisation catch-up visits. Contact attempts include SMS, email, phone call, in person reminder, and letter.	Between 19th February 2019 - 19th May 2021

Collaborators and Investigators

• Sponsor: Murdoch Childrens Research Institute
• Collaborators: Royal Children's Hospital; RCH League of Former Trainees and Associates Inc
• Investigators: Principal Investigator: Belinda L Tominc, MNSc, Royal Children's Hospital, Melbourne

Study record dates

Study Major Dates

• Study Start (Actual): May 21, 2021
• Primary Completion (Actual): November 17, 2021
• Study Completion (Actual): December 9, 2021

Study Registration Dates

• First Submitted: January 28, 2021
• First Submitted That Met QC Criteria: April 25, 2021
• First Posted (Actual): April 29, 2021

Study Record Updates

• Last Update Posted (Actual): January 28, 2022
• Last Update Submitted That Met QC Criteria: January 13, 2022
• Last Verified: January 1, 2022

More Information

Terms related to this study

• Keywords: vaccination; homeless youth
• Other Study ID Numbers: 60835

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No