Trends in COVID-19 Vaccine Hesitancy and Uptake Among Persons Living With HIV in Washington, DC

Abstract

Objective: The COVID-19 pandemic has disproportionately affected older people, people with underlying health conditions, racial and ethnic minorities, socioeconomically disadvantaged, and people living with HIV (PWH). We sought to describe vaccine hesitancy and associated factors, reasons for vaccine hesitancy, and vaccine uptake over time in PWH in Washington, DC.

Methods: We conducted a cross-sectional survey between October 2020 and December 2021 among PWH enrolled in a prospective longitudinal cohort in DC. Survey data were linked to electronic health record data and descriptively analyzed. Multivariable logistic regression was performed to identify factors associated with vaccine hesitancy. The most common reasons for vaccine hesitancy and uptake were assessed.

Results: Among 1029 participants (66% men, 74% Black, median age 54 years), 13% were vaccine hesitant and 9% refused. Women were 2.6-3.5 times, non-Hispanic Blacks were 2.2 times, Hispanics and those of other race/ethnicities were 3.5-8.8 times, and younger PWH were significantly more likely to express hesitancy or refusal than men, non-Hispanic Whites, and older PWH, respectively. The most reported reasons for vaccine hesitancy were side effect concerns (76%), plans to use other precautions/masks (73%), and speed of vaccine development (70%). Vaccine hesitancy and refusal declined over time (33% in October 2020 vs. 4% in December 2021, P < 0.0001).

Conclusions: This study is one of the largest analyses of vaccine hesitancy among PWH in a US urban area highly affected by HIV and COVID-19. Multilevel culturally appropriate approaches are needed to effectively address COVID-19 vaccine concerns raised among PWH.

Figure 1.. Proportional Distribution of Vaccinated, Not Hesitant, Hesitant, and Vaccine Refusers among DC Cohort COVID-19 Survey Participants, October 2020-December 2021

Notes: This figure shows the percentage of PWH survey participants over time who reported being vaccinated or were not hesitant to get a COVID-19 vaccine, reported being hesitant or refused to get vaccinated.

Figure 2.. Reported Barriers to Vaccine Hesitancy or Refusal among DC Cohort COVID-19 Survey Participants by Vaccination Period^,

Notes: 1. Pre/Early Vaccine Period: 10/1/20–3/31/21; General Vaccine Period: 4/1/21–10/31/21; Booster Period: 11/1/21–12/31/21. 2. Responses limited to participants who responded on or after 1/11/2021 when barrier questions were added, had no missing date for survey response, and who responded hesitant or would refuse vaccine. N/A includes those with missing responses.