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Jalloh MF, Tinuga F, Dahoma M, Rwebembera A, Kapologwe NA, Magesa D, Mukurasi K, Rwabiyago OE, Kazitanga J, Miller A, Sando D, Maruyama H, Mbatia R, Temu F, Matiko E, Kazaura K, Njau P, Imaa J, Pinto T, Nur SA, Schaad N, Malero A, Damian D, Grund J, Mgomella GS, Johnson A, Cole G, Mmari E, Gatei W, Swaminathan M. Accelerating COVID-19 Vaccination Among People Living With HIV and Health Care Workers in Tanzania: A Case Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300281. [PMID: 38806223 PMCID: PMC11216698 DOI: 10.9745/ghsp-d-23-00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/30/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND There is limited evidence on COVID-19 vaccination uptake among people living with HIV (PLHIV) and health care workers (HCWs), with the current evidence concentrated in high-income countries. There is also limited documentation in the published literature regarding the feasibility and lessons from implementing targeted vaccination strategies to reach PLHIV and HCWs in low- and middle-income countries. PROGRAM DEVELOPMENT, PILOTING, AND IMPLEMENTATION We designed and implemented multifaceted strategies to scale up targeted COVID-19 vaccination among PLHIV and HCWs in 11 administrative regions on the mainland of Tanzania plus Zanzibar. An initial 6-week intensification strategy was implemented using a diverse partnership model comprising key stakeholders at the national- and subnational levels. A layered package of strategies included expanding the number of certified vaccinators, creating vaccination points within HIV clinics, engaging HCWs to address their concerns, and building the capacity of HCWs as "champions" to promote and facilitate vaccination. We then closely monitored COVID-19 vaccination uptake in 562 high-volume HIV clinics. Between September 2021 and September 2022, the proportion of fully vaccinated adult PLHIV increased from <1% to 97% and fully vaccinated HCWs increased from 23% to 80%. LESSONS AND IMPLICATIONS Our intra-action review highlighted the importance of leveraging a strong foundation of existing partnerships and platforms, integrating COVID-19 vaccination points within HIV clinics, and refining strategies to increase vaccination demand while ensuring continuity of vaccine supply to meet the increased demand. Lessons from Tanzania can inform targeted vaccination of vulnerable groups in future health emergencies.
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Affiliation(s)
- Mohamed F Jalloh
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania.
| | - Florian Tinuga
- Immunization and Vaccine Development, Tanzania Ministry of Health, Dar es Salaam, Tanzania
| | - Mohamed Dahoma
- Zanzibar Integrated HIV, Hepatitis, TB and Leprosy Program, Zanzibar, Tanzania
| | - Anath Rwebembera
- National AIDS Control Programme, Tanzania Ministry of Health, Dodoma, Tanzania
| | - Ntuli A Kapologwe
- President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Daniel Magesa
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Kokuhabwa Mukurasi
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Oscar Ernest Rwabiyago
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Jaiving Kazitanga
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Angela Miller
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - David Sando
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Haruka Maruyama
- Tanzania Country Office, ICAP at Columbia University, Dar es Salaam, Tanzania
| | | | - Florence Temu
- Tanzania Country Office, Amref Health Africa, Dar es Salaam, Tanzania
| | - Eva Matiko
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Kokuhumbya Kazaura
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Prosper Njau
- National AIDS Control Programme, Tanzania Ministry of Health, Dodoma, Tanzania
| | - Jennifer Imaa
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Tara Pinto
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Sophia A Nur
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Nicolas Schaad
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Augustine Malero
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Damian Damian
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Jonathan Grund
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - George S Mgomella
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Alison Johnson
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Gbolahan Cole
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Eunice Mmari
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Wangeci Gatei
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Mahesh Swaminathan
- Tanzania Country Office, U.S. Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
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Erly S, Menza TW, Granillo L, Navejas M, Udeagu CCN, Brady KA, Hixson LK, Raj-Sing S, Nassau T, Kaasa C, Buskin S. Impact of COVID-19 on People Living With HIV: Data From Five Medical Monitoring Project Sites, 2020-2022. J Acquir Immune Defic Syndr 2024; 96:106-113. [PMID: 38567932 DOI: 10.1097/qai.0000000000003403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/18/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted global economic and healthcare systems. People living with HIV (PLWH) represent a marginalized and stigmatized population who may have been particularly impacted. The purpose of this analysis was to describe the impact of the COVID-19 pandemic on PLWH in the United States. SETTING United States. METHODS We analyzed surveys of behavioral and clinical characteristics of PLWH residing in 5 states that participated in the Medical Monitoring Project between 2020 and 2022. We described the impact of COVID-19 illness, testing, and diagnoses; receipt of medical care; social service access; employment; and preventive measures by project site and demographic characteristics. RESULTS Unweighted data from 1715 PLWH were analyzed. A high proportion of PLWH had medical care disrupted by the pandemic; 31% of PLWH missed medical appointments, 26% missed routine laboratory test results, and 7% missed antiretroviral therapy doses. In total, 30% of PLWH reported losing wages and 19% reported difficulty in accessing social services. Overall, 88% reported receiving at least 1 dose of COVID-19 vaccine, but vaccine uptake was low among younger, Black, and Hispanic or Latina/o/x PLWH. CONCLUSIONS This descriptive analysis reinforces previous findings that show that COVID-19 negatively impacted PLWH and their ability to obtain medical care. Additional efforts will be critical to ameliorating the longer-term impacts of COVID-19 on the health of PLWH and supporting PLWH through future pandemics and healthcare system disruptions.
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Affiliation(s)
- Steven Erly
- Washington State Department of Health Office of Infectious Disease, Olympia, WA
- University of Washington Department of Epidemiology, Seattle WA
| | - Tim W Menza
- Oregon Health Authority Department of Public Health, Salem, OR
- Oregon Health & Science University Division of General Internal Medicine, Portland, OR
| | - Lauren Granillo
- Office of AIDS, Center for Infectious Diseases, California Department of Public Health. Sacramento, CA
| | - Michael Navejas
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Chi-Chi N Udeagu
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Kathleen A Brady
- Philadelphia Department of Public Health Division of HIV Health, Philadelphia, PA; and
| | | | - Shavvy Raj-Sing
- New York City Department of Health and Mental Hygiene, New York City, NY
| | - Tanner Nassau
- Philadelphia Department of Public Health Division of HIV Health, Philadelphia, PA; and
| | - Chelsey Kaasa
- Washington State Department of Health Office of Infectious Disease, Olympia, WA
| | - Susan Buskin
- University of Washington Department of Epidemiology, Seattle WA
- Public Health Seattle & King County HIV/STD Program, Seattle, WA
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Sulaiman SK, Musa MS, Tsiga-Ahmed FI, Sulaiman AK, Bako AT. A systematic review and meta-analysis of the global prevalence and determinants of COVID-19 vaccine acceptance and uptake in people living with HIV. Nat Hum Behav 2024; 8:100-114. [PMID: 37904021 PMCID: PMC10810755 DOI: 10.1038/s41562-023-01733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
People living with HIV (PLHIV) are at higher risk of poor outcomes of SARS-CoV-2 infection. Here we report the pooled prevalence of COVID-19 vaccine acceptance/uptake and determinants among this vulnerable population of PLHIV based on a systematic review and meta-analysis of studies published by 25 August 2023. Among the 54 included studies (N = 167,485 participants), 53 (N = 166,455) provided data on vaccine acceptance rate, while 27 (N = 150,926) provided uptake data. The global prevalences of COVID-19 vaccine acceptance and uptake were 67.0% and 56.6%, respectively. Acceptance and uptake rates were 86.6% and 90.1% for the European Region, 74.9% and 71.6% for the Region of the Americas, 62.3% and 78.9% for the South-East Asian Region, 64.6% and 19.3% for the Eastern Mediterranean Region, 58.0% and 35.5% for the African Region, and 57.4% and 44.0% for the Western Pacific Region. The acceptance rate increased from 65.9% in 2020 to 71.0% in 2022, and the uptake rate increased from 55.9% in 2021 to 58.1% in 2022. Men, PLHIV aged ≥40 years and those who had recently received the influenza vaccine were more likely to accept and receive the COVID-19 vaccine. Factors associated with lower uptake included Black race, other races (Latinx/Hispanic/mixed race), low education level and being unemployed. Vaccine-related factors associated with higher acceptance included belief in vaccine effectiveness, vaccine trust, perceived high susceptibility to SARS-CoV-2 infection and fear of potential COVID-19 effect in PLHIV. Sustained efforts and targeted interventions are needed to reduce regional disparities in COVID-19 vaccine uptake among PLHIV.
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Affiliation(s)
| | - Muhammad Sale Musa
- Department of Medicine, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | | | - Abdulwahab Kabir Sulaiman
- Department of Medicine, Murtala Muhammad Specialist Hospital, Kano, Nigeria
- Kwanar Dawaki COVID-19 Isolation Center, Kano, Nigeria
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Nomah DK, Reyes-Urueña J, Alonso L, Díaz Y, Moreno-Fornés S, Aceiton J, Bruguera A, Martín-Iguacel R, Imaz A, Gutierrez MDM, Román RW, Suanzes P, Ambrosioni J, Casabona J, Miro JM, Llibre JM. Comparative Analysis of Primary and Monovalent Booster SARS-CoV-2 Vaccination Coverage in Adults with and without HIV in Catalonia, Spain. Vaccines (Basel) 2023; 12:44. [PMID: 38250857 PMCID: PMC10819920 DOI: 10.3390/vaccines12010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 01/23/2024] Open
Abstract
People with HIV (PWH) may be more susceptible to SARS-CoV-2 infection and worse clinical outcomes. We investigated the disparity in SARS-CoV-2 vaccination coverage between PWH and those without HIV (PWoH) in Catalonia, Spain, assessing primary and monovalent booster vaccination coverage from December 2021 to July 2022. The vaccines administered were BNT162, ChAdOx1-S, mRNA-127, and Ad26.COV2.S. Using a 1:10 ratio of PWH to PWoH based on sex, age, and socioeconomic deprivation, the analysis included 201,630 individuals (183,300 PWoH and 18,330 PWH). Despite a higher prevalence of comorbidities, PWH exhibited lower rates of complete primary vaccination (78.2% vs. 81.8%, p < 0.001) but surpassed PWoH in booster coverage (68.5% vs. 63.1%, p < 0.001). Notably, complete vaccination rates were lower among PWH with CD4 <200 cells/μL, detectable HIV viremia, and migrants compared to PWoH (p < 0.001, all). However, PWH with CD4 < 200 cells/μL received more boosters (p < 0.001). In multivariable logistic regression analysis of the overall population, a prior SARS-CoV-2 diagnosis, HIV status, migrants, and mild-to-severe socioeconomic deprivation were associated with lower primary vaccination coverage, reflecting barriers to healthcare and vaccine access. However, booster vaccination was higher among PWH. Targeted interventions are needed to improve vaccine coverage and address hesitancy in vulnerable populations.
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Affiliation(s)
- Daniel Kwakye Nomah
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Juliana Reyes-Urueña
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
| | - Lucía Alonso
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
| | - Yesika Díaz
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 08003 Barcelona, Spain
| | - Sergio Moreno-Fornés
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 08003 Barcelona, Spain
| | - Jordi Aceiton
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Andreu Bruguera
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 08003 Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Raquel Martín-Iguacel
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark
| | - Arkaitz Imaz
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-(IDIBELL), 08907 L’Hospitalet de Llobregat, Spain;
| | | | - Ramón W. Román
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, 08005 Barcelona, Spain;
| | - Paula Suanzes
- Hospital Universitari Vall d’Hebron, Vall d’Hebron Research Institute (VHIR), 08035 Barcelona, Spain;
| | - Juan Ambrosioni
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (J.A.); (J.M.M.)
- CIBERINFEC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jordi Casabona
- Center for Epidemiological Studies of Sexually Transmitted Diseases and HIV/AIDS in Catalonia (CEEISCAT), Department of Health, Government of Catalunya, 08916 Badalona, Spain; (J.R.-U.); (L.A.); (Y.D.); (S.M.-F.); (J.A.); (A.B.); (R.M.-I.); (J.C.)
- Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 08003 Barcelona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Jose M. Miro
- Hospital Clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain; (J.A.); (J.M.M.)
- CIBERINFEC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Josep M. Llibre
- Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain;
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Baker P, Cepeda JA, Schluth C, Astemborski J, Feder KA, Rudolph J, Sun J, Kirk GD, Mehta SH, Genberg BL. Time-to-completion of COVID-19 vaccination primary series varies by HIV viral load status among people who inject drugs in Baltimore, Maryland. Prev Med Rep 2023; 36:102448. [PMID: 37840593 PMCID: PMC10570701 DOI: 10.1016/j.pmedr.2023.102448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
People who inject drugs (PWID) may have diminished access to essential preventive services like COVID-19 vaccination given structural and substance use barriers. We aimed to assess the role of HIV on COVID-19 vaccination uptake among adult PWID participating in the ALIVE cohort study in Baltimore, Maryland who were alive as of April 2021. We abstracted COVID-19 vaccination data from electronic medical records via the regional health information exchange. We used Kaplan-Meier method to estimate time from universal vaccine eligibility (April 6, 2021) to completion of the COVID-19 vaccination primary series (1 dose J&J or 2 doses mRNA) by HIV viral load status (uninfected, PWH [HIV-RNA < 400 copies/mL], PWH [HIV-RNA ≥ 400 copies/mL]) and Cox Proportional Hazards regression to adjust for potential confounders. Our sample (N = 960) was primarily black (77%) and male (65%) with 31% reporting recent injection drug use. Among 265 (27%) people living with HIV (PWH) in our sample, 84% were virally suppressed. As of February 22, 2022, 539 (56%) completed the primary series, 131 (14%) received a single dose of mRNA vaccine and 290 (30%) remained unvaccinated. Compared to PWID without HIV, virally suppressed PWH were more likely to complete the primary series (Adjusted Hazard Ratio [aHR]:1.23,95% Confidence Interval [95 %CI]:1.07,1.50), while PWH who were not virally suppressed were less likely (aHR:0.72,95 %CI:0.45,1.16), although this was not statistically significant. We conclude that among PWID, HIV infection and viral suppression is associated with quicker vaccination uptake, likely due to HIV care engagement. Targeted improvements along the HIV care continuum may bolster vaccine uptake.
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Affiliation(s)
- Pieter Baker
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Catherine Schluth
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Kenneth A. Feder
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Jacqueline Rudolph
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Jing Sun
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
- School of Medicine, Johns Hopkins University, Baltimore, United States
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
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Cummings PE, Lakoh S, Yendewa SA, Massaquoi SPE, James PB, Sahr F, Deen GF, Salata RA, Gevao P, Yendewa GA. Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study. Vaccines (Basel) 2023; 11:1685. [PMID: 38006017 PMCID: PMC10674940 DOI: 10.3390/vaccines11111685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
People with HIV (PWH) incur a higher risk of COVID-19-related morbidity and mortality rates, yet less is known about COVID-19 vaccine uptake and hesitancy in this group. We conducted a cross-sectional study in Freetown, Sierra Leone, from April to June 2022, using the VAX scale, a validated instrument, to assess attitudes towards COVID-19 vaccination and calculate the hesitancy (VAX) scores. We used generalized linear models to identify the factors associated with vaccine hesitancy. Overall, 490 PWH were enrolled (71.4% female, median age: 38 years, median CD4 count: 412 cells/mm3). About 17.3% received ≥1 dose of a COVID-19 vaccine. The mean VAX score was 43.14 ± 7.05, corresponding to 59.9% participants being vaccine-hesitant. A preference for natural immunity (65.8%) and concerns about profiteering (64.4%) were the commonest reasons for hesitancy, followed by a mistrust of vaccine benefits (61.4%) and worries about future effects (48.0%). In the adjusted regression analysis, being a Muslim (β = 2.563, p < 0.001) and having an urban residence (β = 1.709, p = 0.010) were associated with greater vaccine hesitancy, while testing for COVID-19 was associated with reduced vaccine hesitancy (β = -3.417, p = 0.027). These findings underscore the importance of addressing vaccine hesitancy as a critical element boosting COVID-19 vaccine uptake among PWH.
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Affiliation(s)
- Peterlyn E. Cummings
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
| | - Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | - Sahr A. Yendewa
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | | | - Peter B. James
- Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia;
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
| | - Gibrilla F. Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.A.Y.); (S.P.E.M.)
| | - Robert A. Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Pelema Gevao
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone; (P.E.C.); (S.L.); (F.S.); (G.F.D.); (P.G.)
- Republic of Sierra Leone Armed Forces, Department of Defense, Freetown 00232, Sierra Leone
| | - George A. Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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7
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CUMMINGS PE, LAKOH S, YENDEWA SA, MASSAQUOI SAMUELP, JAMES PB, SAHR F, DEEN GF, GEVAO P, YENDEWA GA. Understanding COVID-19 Vaccine Uptake and Hesitancy Among People With HIV in Freetown, Sierra Leone: A Cross-sectional Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.11.23289882. [PMID: 37292603 PMCID: PMC10246027 DOI: 10.1101/2023.05.11.23289882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objectives People living with HIV (PWH) are at increased risk of COVID-19 related morbidity and mortality, yet less is known about COVID-19 vaccination uptake and hesitancy, especially in sub-Saharan Africa. We aimed to evaluate COVID-19 vaccine uptake and hesitancy among PWH in Sierra Leone. Methods We conducted a cross-sectional study in a convenience sample of PWH in routine care at Connaught Hospital in Freetown, Sierra Leone from April through June 2022. We collected sociodemographic and health-related data. We used the VAX Scale, a validated instrument to assess attitudes towards COVID-19 vaccination. From the responses, we constructed hesitancy (VAX) scores, with higher scores implying negative attitudes towards vaccination. We used generalized linear models to identify factors associated with vaccine hesitancy. Results A total of 490 PWH were enrolled (71.4% female, median age 38 years, median CD4 count 412 cells/mm3, 83.9% virologically suppressed). About 17.3% had received at least one dose of a COVID-19 vaccine. The mean VAX score was 43.14 ± 7.05, corresponding to 59.9% participants classified as vaccine hesitant. Preference for natural immunity (65.8%) and concerns about commercial profiteering (64.4%) were the commonest reasons for hesitancy, followed by mistrust of vaccine benefits (61.4%) and worries about future side effects (48.0%). In adjusted regression analysis, being Muslim (β = 2.563, p < 0.001) and residence in urban areas (β = 1.709, p = 0.010) were associated with greater vaccine hesitancy, while having tested ever for COVID-19 was associated with lesser vaccine hesitancy (β = -3.417, p = 0.027). Conclusion We observed a low COVID-19 vaccine uptake and high hesitancy among PWH in Sierra Leone. Our findings underscore the need to address vaccine hesitancy as a critical element of efforts to boost COVID-19 vaccine uptake among this population in Sierra Leone.
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Affiliation(s)
- Peterlyn E. CUMMINGS
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman LAKOH
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Peter B. JAMES
- Faculty of Health, Southern Cross University, Lismore, Australia
| | - Foday SAHR
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Gibrilla F. DEEN
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Pelema GEVAO
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Republic of Sierra Leone Armed Forces, Department of Defense, Freetown, Sierra Leone
| | - George A. YENDEWA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Makadzange AT, Gundidza P, Lau C, Dietrich J, Myburgh N, Elose N, James W, Stanberry L, Ndhlovu C. Investigating Attitudes, Motivations and Key Influencers for COVID-19 Vaccination Uptake among Late Adopters in Urban Zimbabwe. Vaccines (Basel) 2023; 11:411. [PMID: 36851288 PMCID: PMC9958877 DOI: 10.3390/vaccines11020411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/24/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023] Open
Abstract
The rapid development of vaccines in response to the COVID-19 pandemic has provided an effective tool for the management of COVID-19. However, in many African countries there has been a poor uptake of COVID-19 vaccines with only 32.5% first vaccine dose coverage compared to the WHO global target of 70%. As vaccine access improves, one of the important drivers of low uptake has been vaccine hesitancy, driven by levels of confidence, convenience, and complacency. Between 4 January-11 February 2022, we conducted a survey of vaccine late adopters to assess factors that influenced adults in Harare, Zimbabwe to present for their first COVID-19 vaccine dose almost 12 months after the vaccination program began. Of the 1016 adults enrolled, 50% were female and 12.4% had HIV co-infection. Binary logistic regression models were developed to understand factors associated with vaccine confidence. Women were more likely to have negative views about the COVID-19 vaccine compared to men (OR 1.51 (95%CI 1.16, 1.97, p = 0.002). Older adults (≥40 years) compared with youth (18-25 years) were more likely to have 'major concerns' about vaccines. When asked about their concerns, 602 (59.3%) considered immediate side effects as a major concern and 520 (52.1%) were concerned about long-term health effects. People living with HIV (PLWH) were more likely to perceive vaccines as safe (OR 1.71 (95%CI: 1.07, 2.74, p = 0.025) and effective (1.68 (95%CI: 1.07, 2.64, p = 0.026). Internet users were less likely to perceive vaccines as safe (OR 0.72 (95% CI: 0.55, 0.95, p = 0.021) compared to non-Internet users; and social media was a more likely source of information for youth and those with higher education. Family members were the primary key influencers for 560 (55.2%) participants. The most important reason for receiving the COVID-19 vaccine for 715 (70.4%) participants was the protection of individual health. Improving vaccine coverage will need targeted communication strategies that address negative perceptions of vaccines and associated safety and effectiveness concerns. Leveraging normative behavior as a social motivator for vaccination will be important, as close social networks are key influences of vaccination.
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Affiliation(s)
| | - Patricia Gundidza
- Charles River Medical Group, 155 King George Avenue, Avondale, Harare, Zimbabwe
| | | | - Janan Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- African Social Sciences Unit of Research and Evaluation (ASSURE), Division of the Wits Health Consortium, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
- Health Systems Research Unit, South African Medical Research Council, Bellville 7530, South Africa
| | - Nellie Myburgh
- Wits Vaccines & Infectious Diseases Analytics (VIDA) Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Nyasha Elose
- Charles River Medical Group, 155 King George Avenue, Avondale, Harare, Zimbabwe
| | - Wilmot James
- Institute for Social and Economic Research and Policy, Columbia University, IAB 118th Street, New York, NY 10025, USA
| | - Lawrence Stanberry
- Vaccine Information Network, Columbia University, 533 W 218th St., New York, NY 10032, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Chiratidzo Ndhlovu
- Charles River Medical Group, 155 King George Avenue, Avondale, Harare, Zimbabwe
- Internal Medicine Unit, Faculty of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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COVID-19 in the Immunocompromised Host, Including People with Human Immunodeficiency Virus. Infect Dis Clin North Am 2022; 36:397-421. [PMID: 35636907 PMCID: PMC8806148 DOI: 10.1016/j.idc.2022.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This review describes the incidence, epidemiology, and risk factors for mortality of COVID-19 in immunocompromised patients, including persons with human immunodeficiency virus. It describes various preventive measures, including vaccines and their effectiveness and the role of monoclonal antibodies for pre-exposure prophylaxis. It also reviews the different treatment options for immunocompromised individuals, including antivirals, monoclonal antibodies, and immunomodulators. Lastly, it describes the impact of COVID-19 on transplantation and continuity care of this population.
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