COVID-19 vaccination among people with HIV in Uganda: lessons from a high-risk group with high vaccine uptake for the next pandemic

Abstract

Background: Despite the effectiveness of the COVID-19 vaccine, vaccination rates vary across settings and populations, especially among people living with HIV (PLHIV). We assessed factors associated with COVID-19 vaccination among PLHIV in Mbarara, Uganda. Methods: We conducted a cross-sectional, secondary analysis of a prospective cohort study consisting of PLHIV ≥18 years old on antiretroviral therapy (ART). We collected data on COVID-19 vaccine uptake and associated factors beginning in December 2021, 9 months after the vaccine became available in Uganda. Reasons for vaccine acceptance and hesitancy were analyzed descriptively, while factors associated with vaccine uptake were assessed using Poisson models with robust standard errors. Results: We analyzed data from 449 participants with a mean age of 46 years (SD 9) and ART duration of 10 years (SD 4). 42% were female, 96% were virally suppressed (<50 copies/mL), and 83% (95% CI=75%−92%) reported vaccination for COVID-19. In unadjusted analyses, greater concern about COVID-19, obtaining COVID-19 information from health resources, longer ART duration in years, and continuous access to soap and water were positively and significantly correlated with vaccine uptake (p<0.05). Among those unvaccinated (n=77/449, 17%), fear of side effects (n=32/77, 42%) and beliefs that vaccination increased infection risk (n=12/77, 16%) were predominant reasons for vaccine hesitancy. Conclusions: We found high rates of COVID-19 vaccination among PLHIV on ART in Uganda. Among those unvaccinated, lack of confidence in the safety of the vaccine was the primary barrier to uptake. Future vaccine campaigns should emphasize vaccine safety and efficacy and actively combat misinformation to promote uptake.