Assessing the Predictors of COVID-19 Vaccine Hesitancy Among People Living with HIV/AIDS: A Scoping Literature Review

Background: The administration of the COVID-19 vaccine at some points in the COVID-19 pandemic resulted in a significant reduction in the spread, risk of complications, and death from coronavirus infection. However, in the face of hesitancy against COVID-19 vaccination springing from the novelty of the vaccines and safety concerns, vulnerable population to COVID-19 infection such as people living with HIV/AIDS (PLWHA) were showing higher hesitancy to COVID-19 vaccines than the general population. This scoping review aims to identify factors COVID-19 vaccine hesitancy among people living with HIV/AIDS.

Methods: A scoping review was conducted to identify and summarize studies from all over the world on COVID-19 vaccine uptake/hesitancy among people living with HIV/AIDS.

The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) Extension for scoping reviews was used. Articles written in English, peer-reviewed, published within the years 2021-2023, and conducted in any part of the world with sample population being PLWHA, and with an outcome of uptake/hesitancy towards the COVID-19 vaccine were included.

Results: Fourteen articles met the inclusion criteria and were included in this review. The primary study settings were clinic and hospital-based and online self-reported. The prevalence of COVID-19 vaccine hesitancy was as high as 90.8% in an online survey done in the US and as low as 27.5% in a facility-based survey in China. The most common factors mentioned associated with COVID-19 vaccination were the fear of side effects of the COVID-19 vaccine, concerns about the safety of the vaccine, medical mistrust, vaccine novelty, disclosure of HIV status, and perceived interference with highly active antiretroviral therapy (HAART). Male gender, race, good knowledge of COVID-19 prevention practice, having a CD4 count > 200 cells (p=0.032) and lower or undetectable viral load (p<0.001) were identified as predictors of COVID-19 uptake.

Key findings: This wide margin in the prevalence of COVID-19 vaccine hesitancy between the US and China may be connected to the differences in the political climate, public perception and policies, and racial histories between the two countries. This review showed that those less willing to receive COVID-19 vaccination among people living with HIV/AIDS were those with high viral load and low CD4 count as they are more likely to have contact with healthcare system and more receptive of vaccination. Therefore, to limit the burden of COVID-19 vaccine hesitancy and the impact of COVID-19 disease among people living with HIV/AIDS, it is imperative for interventions to target people living with HIV/AIDS with suboptimal viral load and CD4 count (who are less likely to have contact with the healthcare system) as this predispose them to severe COVID-19 infection. A statistically significant association was found between COVID-19 vaccine hesitancy and black people living. So, it is important to address the root causes of negative perception and systemic racism experienced by the black race for steps to be made towards improving COVID-19 vaccine hesitancy and reducing the burden of disease among black people living with HIV/AIDS.