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. 2024 Jun 3;7(6):e2415220.
doi: 10.1001/jamanetworkopen.2024.15220.

COVID-19 Vaccination Coverage and Factors Associated With Vaccine Uptake Among People With HIV

Rulin C Hechter  1   2 , Lei Qian  1 , In-Lu Amy Liu  1 , Lina S Sy  1 , Denison S Ryan  1 , Stanley Xu  1 , Joshua T B Williams  3 , Nicola P Klein  4 , Robyn M Kaiser  5 , Elizabeth G Liles  6 , Jason M Glanz  7 , Lisa A Jackson  8 , Maria E Sundaram  9 , Eric S Weintraub  10 , Hung Fu Tseng  1   2
Affiliations

COVID-19 Vaccination Coverage and Factors Associated With Vaccine Uptake Among People With HIV

Rulin C Hechter et al. JAMA Netw Open. .

Abstract

Importance: People with HIV (PWH) may be at increased risk for severe outcomes with COVID-19 illness compared with people without HIV. Little is known about COVID-19 vaccination coverage and factors associated with primary series completion among PWH.

Objectives: To evaluate COVID-19 vaccination coverage among PWH and examine sociodemographic, clinical, and community-level factors associated with completion of the primary series and an additional primary dose.

Design, setting, and participants: This retrospective cohort study used electronic health record data to assess COVID-19 vaccination information from December 14, 2020, through April 30, 2022, from 8 health care organizations of the Vaccine Safety Datalink project in the US. Participants were adults diagnosed with HIV on or before December 14, 2020, enrolled in a participating site.

Main outcomes and measures: The percentage of PWH with at least 1 dose of COVID-19 vaccine and PWH who completed the COVID-19 vaccine primary series by December 31, 2021, and an additional primary dose by April 30, 2022. Rate ratios (RR) and 95% CIs were estimated using Poisson regression models for factors associated with completing the COVID-19 vaccine primary series and receiving an additional primary dose.

Results: Among 22 058 adult PWH (mean [SD] age, 52.1 [13.3] years; 88.8% male), 90.5% completed the primary series by December 31, 2021. Among 18 374 eligible PWH who completed the primary series by August 12, 2021, 15 982 (87.0%) received an additional primary dose, and 4318 (23.5%) received a booster dose by April 30, 2022. Receipt of influenza vaccines in the last 2 years was associated with completion of the primary series (RR, 1.17; 95% CI, 1.15-1.20) and an additional primary dose (RR, 1.61; 95% CI, 1.54-1.69). PWH with uncontrolled viremia (HIV viral load ≥200 copies/mL) (eg, RR, 0.90 [95% CI, 0.85-0.95] for viral load 200-10 000 copies/mL vs undetected or <200 copies/mL for completing the primary series) and Medicaid insurance (eg, RR, 0.89 [95% CI, 0.87-0.90] for completing the primary series) were less likely to be fully vaccinated. By contrast, greater outpatient utilization (eg, RR, 1.07 [95% CI, 1.05-1.09] for ≥7 vs 0 visits for primary series completion) and residence in counties with higher COVID-19 vaccine coverage (eg, RR, 1.06 [95% CI, 1.03-1.08] for fourth vs first quartiles for primary series completion) were associated with primary series and additional dose completion (RRs ranging from 1.01 to 1.21).

Conclusions and relevance: Findings from this cohort study suggest that, while COVID-19 vaccination coverage was high among PWH, outreach efforts should focus on those who did not complete vaccine series and those who have uncontrolled viremia.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Hechter reported receiving funding support paid to her institution from Gilead Sciences outside the submitted work. Dr Qian reported receiving grants from Moderna, GlaxoSmithKline, and Dynavax outside the submitted work. Ms Sy reported receiving contract fees from Moderna, GlaxoSmithKline, and Dynavax outside the submitted work. Dr Klein reported receiving grants from Pfizer during the conduct of the study and from Merck, GlaxoSmithKline, Sanofi Pasteur, and Seqirus paid to her institution outside the submitted work. Dr Jackson reported receiving contract funding from Pfizer paid to her institution outside the submitted work. Dr Sundaram reported receiving grants from GlaxoSmithKline outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Uptake of COVID-19 Vaccination Primary Series and Additional Primary or Booster Dose Among Persons With HIV in the Vaccine Safety Datalink
Uptake of COVID-19 primary series was assessed from December 14, 2020, through December 31, 2021. Uptake of an additional primary vaccination or booster dose was assessed from August 12, 2021, through April 30, 2022, among persons with HIV who completed the primary series. The index date was December 14, 2020, for the assessment of primary series completion, and August 12, 2021, for the assessment of uptake of additional primary or booster dose.
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