A systematic review and meta-analysis of the global prevalence and determinants of COVID-19 vaccine acceptance and uptake in people living with HIV

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.

HIV stigma and other barriers to COVID-19 vaccine uptake among Georgian people living with HIV/AIDS: A mixed-methods study

“…The main finding of our study was the low coverage of vaccination (only slightly more than half) among PLWH. Our finding is slightly lower than a global COVID-19 vaccine uptake among PLWH of 56.6%, but at the same time notably lower than the rate of 90.1% for the European Region as reported by Sulaiman et al [ 6 ]. When considering the broader context, our findings also underscore a significant gap compared to the global vaccine uptake among the general population, which stands at a higher rate of 70.6% [ 28 ].…”

“…In-depth interviews, during which unvaccinated respondents mostly talked about the uselessness of COVID-19 vaccines since they could quickly recover from the mild disease with no complications, also confirmed these findings. A systematic review and meta-analysis conducted by Sulaiman et al reported association of perceived high susceptibility to SARS-CoV-2 infection and a strong belief in the vaccine’s effectiveness and utility with higher COVID-19 vaccine acceptance and uptake among PLWH [ 6 ]. HBM constructs, such as perceived severity of COVID-19 infection and perceived benefits of a COVID-19 vaccine have also been linked to vaccination acceptability among general population [ 29 , 30 ].…”

“…Therefore, vaccinating PLWH against COVID-19 is a priority public health measure to avoid complications from the disease and stop the spread of the virus. The existing literature suggests that COVID-19 vaccines are effective in PLWH [ 4 , 5 ], although global uptake among this population has been reported to be 56.6% [ 6 ]. Substantial regional variations in COVID-19 vaccine uptake among PLWH are evident, with notably high rates observed in the European Region (90.1%) and the Region of the Americas (71.6%), while lower rates are reported in the Eastern Mediterranean Region (19.3%) and the African Region (35.5%) [ 6 ].…”

“…The existing literature suggests that COVID-19 vaccines are effective in PLWH [ 4 , 5 ], although global uptake among this population has been reported to be 56.6% [ 6 ]. Substantial regional variations in COVID-19 vaccine uptake among PLWH are evident, with notably high rates observed in the European Region (90.1%) and the Region of the Americas (71.6%), while lower rates are reported in the Eastern Mediterranean Region (19.3%) and the African Region (35.5%) [ 6 ]. Studies also indicate that COVID-19 vaccine hesitancy (defined by the World Health Organization as the delay in acceptance or refusal of vaccination despite the availability of vaccination services [ 7 ]) is higher among this population and that factors influencing vaccine hesitancy are different for PLWH compared to HIV-negative individuals.…”