COVID-19 and influenza vaccination among adults stably engaged in HIV care

Abstract

Introduction

Vaccination against COVID-19 and influenza is recommended for people living with HIV, but real-world uptake data remain incomplete, especially in populations facing socioeconomic barriers. We assessed uptake and associated factors at an HIV outpatient centre serving a socioeconomically disadvantaged area of Rome. Participants were in stable HIV care and were encouraged to receive vaccination at no cost, at a location of choice. COVID-19 vaccination was initially available both on-site and externally; influenza vaccination was only available externally.

Methods

We analysed a random 50 % sample of 750 adults, retrieving data from the vaccination registry and medical records. Full COVID-19 vaccination was defined as primary vaccination plus $\ge$1 additional dose. Logistic regression identified factors associated with uptake.

Results

Between December 2020 and July 2024, 331/375 (88.3 %) participants received primary COVID-19 vaccination (typically two mRNA vaccine doses 3–4 weeks apart) and 286/375 (76.3 %) received ≥1 additional dose, with most vaccinations occurring before September 2023. Odds of full vaccination were lower among participants <50 years and heterosexual men and women (vs. men who have sex with men). Other associated factors included migrant background, injecting drug use, history of advanced immunosuppression, HIV viraemia, and CD4 <500 cells/mm³. Influenza vaccination uptake (2022/2023) was low (99/375, 26.4 %), although almost 4-fold higher among those vaccinated against COVID-19.

Conclusions

Disparities in COVID-19 vaccine coverage and suboptimal influenza vaccination uptake persist among adults stably engaged in HIV care. Addressing barriers, particularly in those with additional vulnerabilities, and integrating vaccination into HIV services may improve uptake and reduce preventable illness.