COVID-19 vaccine acceptability, and uptake among people living with HIV in Uganda

PLOS ONE RESEARCH ARTICLE COVID-19 vaccine acceptability, and uptake among people living with HIV in Uganda Richard Muhindo ID1*, Stephen Okoboi2, Agnes Kiragga2, Rachel King3, Walter Joseph Arinaitwe ID2, Barbara Castelnuovo2 1 Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda, 2 Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda, 3 University of California, San Francisco, California, United states of America * a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Abstract Background OPEN ACCESS Citation: Muhindo R, Okoboi S, Kiragga A, King R, Arinaitwe WJ, Castelnuovo B (2022) COVID-19 vaccine acceptability, and uptake among people living with HIV in Uganda. PLoS ONE 17(12): e0278692. https://doi.org/10.1371/journal. pone.0278692 Editor: Chidinma Ihuoma Ihuoma Amuzie, Federal medical centre Umuahia, Abia State, Nigeria, NIGERIA Received: May 31, 2022 Accepted: November 21, 2022 Published: December 2, 2022 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0278692 Copyright: © 2022 Muhindo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Despite being a priority population for COVID-19 vaccination, limited data are available regarding acceptability of COVID-19 vaccines among people living with HIV (PLWH) in SubSaharan Africa. We described COVID-19 vaccine acceptability and factors associated with vaccine acceptability among PLWH in Uganda. Methods This was a cross-sectional study conducted among PLWH, aged �18 years, enrolled participants who were seeking HIV care from six purposely selected accredited ART clinics in Kampala. We obtained data on vaccine acceptability defined as willingness to accept any of the available COVID-19 vaccines using interviewer-administered questionnaires. In addition, we assessed vaccination status, complacency regarding COVID-19 disease, vaccine confidence, and vaccine convenience. Factors associated with COVID-19 vaccine acceptability were evaluated using modified Poisson regression with robust standard errors. Results We enrolled 767 participants of whom 485 (63%) were women. The median age was 33 years [interquartile range (IQR) 28–40] for women and 40 years [IQR], (34–47) for men. Of the respondents 534 (69.6%,95% confidence interval [CI]: 66.3%-72.8%) reported receiving at least one vaccine dose, with women significantly more likely than men to have been vaccinated (73% vs. 63%; p = 0.003). Among the unvaccinated 169 (72.7%, 95% CI: 66.6%78.0%) were willing to accept vaccination, had greater vaccine confidence (85.9% had strong belief that the vaccines were effective; 81.9% that they were beneficial and 71% safe for PLWH; 90.5% had trust in health care professionals or 77.4% top government officials), and believed that it would be easy to obtain a vaccine if one decided to be vaccinated (83.6%). Vaccine acceptability was positively associated with greater vaccine confidence (adjusted prevalence ratio [aPR] 1.44; 95% CI: 1.08–1.90), and positive perception that it would be easy to obtain a vaccine (aPR 1.57; 95% CI: 1.26–1.96). PLOS ONE | https://doi.org/10.1371/journal.pone.0278692 December 2, 2022 1 / 14 PLOS ONE Funding: This study was supported through grant number D43TW009771 by National Institute for Health (NIH), Fogarty International Center. Competing interests: The author(s) declare that they have no competing interests. COVID-19 vaccine acceptability, and uptake among people living with HIV in Uganda Conclusion vaccine acceptance was high among this cohort of PLWH, and was positively associated with greater vaccine confidence, and perceived easiness (convince) to obtained the vaccine. Building vaccine confidence and making vaccines easily accessible should be a priority for vaccination programs targeting PLWH. Background Despite the current global decline in new infections, Coronavirus disease-2019 (COVID-19) still poses serious socio-economic, and health threats [1, 2]. As of 27th May2022, there had been more than 525 million reported infections with the severe acute respiratory coronavirus2 (SARS CoV-2), the novel coronavirus that causes COVID-19, and more than 6.2 million reported deaths globally [3]. Over 8.9 million cases and 170,471 deaths had been reported in Africa, of which 164,366 cases and over 3,602 deaths in Uganda during the same period [3]. However, both cases, and deaths are likely to be underreported. Poor COVID-19 related health outcomes are substantial among high-risk persons, such as PLWH, diabetes mellitus, and cardiovascular diseases among others [4–8]. Compared to HIV-negative individuals, PLWH had a higher risk of SARS CoV-2 infection ([risk ratio (RR) 1.24, 95% confidence interval (CI), 1.05–1.46], and mortality (RR 1.78, 95% CI 1.21–2.60) [9]. COVID-19 vaccines have been shown to reduce infection severity and prevent deaths [10]. The increased risk of severe COVID-19 makes vaccination a priority for PLHIV, however concerns about adverse side effects, and negative impact on progression of HIV or antiretroviral therapy (ART) have been reported [11]. Vaccine acceptance defined by the degree to which individuals accept, question, or refuse vaccination [12], was already a global concern prior to the COVID-19 pandemic [13, 14]. Regional variations in COVID-19 vaccine acceptance have been reported in studies conducted mainly in Europe, North America, and Asia. In Canada, one survey found that compared to HIV-negative individuals, PLWH had lower intentions to vaccinate (65.2% versus 79.6%) [15]. Low intentions to vaccinate were also reported in China, as only 57.2% of PLWH were willing to receive a COVID-19 vaccine [16]. In India, the prevalence of vaccine hesitancy was found to be 38% among PLWH [17]. In the USA, one study found high acceptability (72%) among PLHIV [18], however it was lower among PLWH who reside in rural areas or inject drugs [18]. Sub-Saharan surveys in Ethiopia, and Nigeria have reported high prevalence (66.3%, and 53.8% respectively) of vaccine hesitancy among PLWH [19, 20]. Since the launch of the vaccination rollout in March 2021, Uganda aims to vaccinate 70% of the population [21–23] but as of. April 2022, only 21.5% of the Uganda population are estimated to have received two-vaccine doses [24, 25]. Proactively identifying vulnerable populations with co-morbidities to be prioritized for vaccination, and conducting (...truncated)