COVID-19 vaccine hesitancy and uptake among people living with HIV: a systematic review and meta-analysis

The COVID-19 pandemic presented unprecedented challenges to global public health, with vulnerable populations, such as people living with HIV (PLWH), facing heightened risks due to their compromised immune systems. Effective vaccination strategies were crucial to mitigating these risks. However, vaccine hesitancy poses a significant barrier to achieving herd immunity and protecting vulnerable groups. This study addresses the critical need to understand COVID-19 vaccine hesitancy and uptake among PLWH. The global distribution of HIV, coupled with varying healthcare access and socio-economic factors across different regions, necessitates a comprehensive review of the existing literature to identify patterns, key determinants, and potential strategies for improving vaccine uptake within this population. Understanding the complexities of vaccine hesitancy in this context is essential for developing tailored interventions to ensure equitable access and protection against COVID-19. The objective of this review is to synthesize existing evidence on COVID-19 vaccine hesitancy and uptake among PLWH, identifying key determinants and informing the development of effective public health strategies. This study aims to provide a comprehensive overview of the factors influencing vaccine uptake, including demographic characteristics, health beliefs, access to healthcare, and societal factors. The findings are intended to guide the design of targeted interventions to improve vaccine acceptance and coverage among PLWH globally. The improved understanding resulting from this work can ultimately contribute to better health outcomes and reduce the disparities in COVID-19 protection experienced by this population.

The review incorporates existing studies examining COVID-19 vaccine hesitancy and uptake, focusing specifically on PLWH. It covers a wide range of literature, including systematic reviews, meta-analyses, cross-sectional surveys, and qualitative studies. Studies from diverse geographical regions (high, middle, and low-income countries) are included to capture the global variability in vaccine acceptance patterns and associated factors. The literature review considers studies that explore the influence of demographic characteristics (age, sex, race, ethnicity), socioeconomic factors (income, education, employment status), healthcare access (insurance coverage, proximity to healthcare facilities), and health beliefs (perceived risk, vaccine efficacy, safety concerns) on vaccine hesitancy and uptake among PLWH. The review also incorporates literature exploring the interplay between HIV status, other comorbidities, and COVID-19 vaccine-related outcomes.

The authors employed a systematic approach adhering to PRISMA guidelines. A comprehensive literature search was conducted across various databases (e.g., PubMed, Web of Science, Scopus, Embase) using keywords related to COVID-19, HIV, vaccines, hesitancy, uptake, and acceptance. Inclusion criteria specified studies published in English that quantitatively assessed vaccine hesitancy or uptake among PLWH. Study selection was performed independently by two reviewers, with disagreements resolved through consensus or consultation with a third reviewer. Quality assessment of included studies was carried out using appropriate tools (e.g., Newcastle-Ottawa Scale, Cochrane Risk of Bias tool). Data extraction included information on study characteristics (population, setting, year of publication), vaccine acceptance rates, and factors associated with vaccine hesitancy. Meta-analysis was performed to pool prevalence rates of vaccine hesitancy and uptake, employing appropriate statistical methods (e.g., random-effects models) to account for study heterogeneity. Subgroup analyses were conducted to explore variations in vaccine hesitancy and uptake across different demographic and geographical groups. Publication bias was assessed using appropriate graphical and statistical methods (e.g., funnel plots, Egger's test).

The meta-analysis revealed a significant variation in COVID-19 vaccine uptake and hesitancy among PLWH across different studies and regions. Several factors consistently emerged as significant predictors of vaccine hesitancy, including lower levels of education, mistrust in healthcare systems, concerns about vaccine side effects, and lack of access to reliable health information. In some studies, higher HIV viral loads were associated with lower vaccine uptake. Subgroup analyses indicated higher vaccine hesitancy in specific populations, such as individuals from low-income countries or those with lower levels of health literacy. The findings highlight the complex interplay between individual, societal, and structural factors influencing vaccine acceptance among PLWH. The variations observed underscore the need for context-specific interventions.

The findings of this systematic review and meta-analysis underscore the significant challenge of COVID-19 vaccine hesitancy among PLWH and highlight the urgent need for tailored interventions to increase vaccine uptake within this population. The considerable variation in acceptance rates across different studies and settings emphasizes the importance of considering contextual factors when designing and implementing vaccine campaigns. Addressing mistrust in healthcare systems and improving access to reliable health information are crucial for enhancing vaccine confidence. Furthermore, the findings suggest a need to address health literacy disparities and tailor interventions to meet the specific needs of various subgroups within the PLWH population. The results of this review support the development of context-specific interventions that focus on addressing the specific concerns and barriers to vaccination identified within diverse communities of PLWH.

This systematic review and meta-analysis provided valuable insights into COVID-19 vaccine hesitancy and uptake among PLWH. Significant variations were observed across different geographical regions and subgroups, emphasizing the need for targeted and context-specific interventions. Future research should focus on evaluating the effectiveness of such interventions and exploring innovative strategies to improve vaccine confidence and uptake among PLWH.

The review was limited to studies published in English, potentially excluding relevant literature from other languages. Heterogeneity across studies limited the generalizability of certain findings. The reliance on self-reported data for some studies might have introduced biases.