High rates of COVID-19 vaccination among PLHIV on ART in Uganda are found, and lack of confidence in the safety of the vaccine was the primary barrier to uptake.
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.
BACKGROUND
People living with HIV (PLHIV) are at increased risk of severe influenza-related complications, and annual vaccination is recommended. Uptake remains suboptimal and Australian data are limited. We assessed influenza vaccination uptake among PLHIV at a Melbourne specialist clinic and explored reasons for non-vaccination.
METHODS
We conducted a repeated cross-sectional analysis of PLHIV attending the Melbourne Sexual Health Centre (MSHC), 2015-2025. Vaccination status was based on vaccines administered at the clinic. Segmented logistic regression assessed trends before and after the COVID-19 pandemic. A random sample of 1100 unvaccinated individuals (100/year) underwent chart review to identify reasons for non-vaccination, and an adjusted estimate incorporated self-reported external vaccination.
RESULTS
Among 18,879 PLHIV records (median age 42, IQR 34-53), 39.6% (7474/18,879) were vaccinated at MSHC. Uptake rose from 40.4% (527/1305) in 2015 to 46.7% (779/1667) in 2019, fell to 22.9% (388/1691) in 2021, and partially recovered to 40.1% (891/2221) in 2025. Pre-pandemic uptake increased 4.8% annually (95% CI: 2.3-7.4, p < 0.001). After COVID-19 onset, vaccination odds were 65.5% lower than expected (95% CI: 60.9-69.7, p < 0.001), with subsequent annual increases of 20.3% (95% CI: 16.7-24.0). Of 1100 unvaccinated individuals reviewed, 40.6% (447) had no documented reason, 31.8% (350) reported vaccination elsewhere, and 13.5% (146) declined. Adjusted uptake including external vaccination was 58.6% (11,058/18,879).
CONCLUSIONS
Influenza vaccination uptake among PLHIV in Melbourne remains suboptimal and was disrupted by the COVID-19 pandemic. External vaccination contributes substantially, so clinic records alone underestimate true uptake. Improved prompts, standardised documentation, and integration with the Australian Immunisation Register may optimise preventive care and better capture vaccination delivery.
Amirpasha Rafizadeh, D. Wijekoon, Ei T. Aung et al.· Vaccine· 0 citations
Background: People living with human immunodeficiency virus (HIV) (PLWH) remain at increased risk of severe COVID-19 outcomes; however, conflicting evidence exists regarding the seroconversion rates of COVID-19 vaccines in this population. Methods: A systematic review and meta-analysis were conducted on studies reporting seroconversion outcomes following COVID-19 vaccination in PLWH. Results: Forty-four studies (5391 PLWH) were included in the meta-analysis. The overall pooled seroconversion proportion was 93.5%. Bootstrap analysis confirmed robustness (92.8%). Subgroup analyses revealed significantly higher seroconversion rates for mRNA vaccines (98.2%) compared to non-mRNA vaccines (80.5%). CD4 count demonstrated a graded association: <200 cells/mm3 (53.8%), 200–500 cells/mm3 (86.2%), and >500 cells/mm3 (93.5%). Prior COVID-19 infection (99.1% vs. 89.5%) and antiretroviral therapy (ART) status (93.5% vs. 49.6%) were significant determinants. Safety data demonstrated a favorable profile, with predominantly mild-to-moderate local (injection-site pain: 23.8%) and systemic (headache: 12.95%, fatigue: 6.4%) adverse events; serious adverse events were rare and no consistent association with HIV disease progression was observed. Conclusions: COVID-19 vaccination induces high seroconversion rates in PLWH, particularly among those receiving mRNA vaccines, with preserved CD4 counts, on ART, or with prior infection.
Maya Alkhidir, K. Sridharan· Vaccines· 0 citations
Background/Objectives: Seasonal influenza vaccination (SIV) coverage remains suboptimal among adults aged ≥50 years, and the COVID-19 pandemic might influence the determinants of SIV uptake. This systematic review aimed to identify determinants of SIV uptake among adults aged ≥50 years during and after the COVID-19 pandemic. Methods: We searched PubMed, MEDLINE, Embase, Web of Science, Global Health, CINAHL, Cochrane Library, APA PsycINFO, and APA PsycArticles for studies published between 1 December 2019 and 1 January 2026. The pooled prevalence of SIV uptake was synthesized using random-effects models in meta-analysis. Results: A total of 50 studies were included in the systematic review. COVID-19-related factors, such as perceived risk of co-infection with SARS-CoV-2 and seasonal influenza and concerns about potential interactions between COVID-19 vaccines and SIV, were determinants of SIV uptake. Other modifiable determinants included those that existed before the pandemic (e.g., knowledge and perceptions of seasonal influenza and SIV). Subgroup analysis showed that cost and inaccessibility were barriers to receiving SIV in places without a fully subsidized SIV, and perceived susceptibility and vaccine safety concerns were commonly identified as facilitators and barriers in studies with data collected after the pandemic. The pooled prevalence of SIV uptake among adults aged 50 years or above was 53% (95% confidence interval: 44–62%). Such uptake appeared lower among adults aged 50–64 years, in regions without a fully subsidized SIV, and after the COVID-19 pandemic. Conclusions: These findings could inform service planning and interventions promoting SIV uptake among adults aged ≥50 years in the post-pandemic era. More studies are needed to explore determinants specific to people aged 50–64 years to inform health promotion tailored to their needs.
Targeted communication, such as risk-stacking to improve risk-awareness, harmonized eligibility criteria, and co-administration, may help overcome remaining vaccination barriers in high-risk individuals.
Lucas Grape, Wilma Persson, Adam Sergejev et al.· Human Vaccines & Immunothera...· 0 citations
