Title : Predictors of vaccination rates in people living with HIV/AIDS followed at a specialty care Clinic Ribeirao Preto, Sao Paulo, Brazil
Abstract:
Introduction: Vaccine hesitancy was considered by the World Health Organization as one of the 10 threats to global public health in 2019. In Brazil, the National Immunization Program offers the population vaccines free of charge through the Unified Health System. However, people living with the human immunodeficiency virus (PLHIV) may have a worse prognosis for diseases prevented by vaccination and therefore have a special indication for vaccination.
Objective: This study aimed to explore patient-specific predictors that influenced vaccination rates in people living with HIV/AIDS (PLWHA).
Methods: This single-center retrospective cohort review of all cases of PLWHA reported in Notifiable Diseases Information System (SINAN) for HIV/AIDS from the Ribeirão Preto, São Paulo, Brazil to explore patient-specific predictors that influenced vaccination rates in PLWH. The data were collected from the SINAN, which consolidates the registration of notifiable diseases and conditions nationwide. Information regarding the CD4 T-cell count and viral load was collected from the Laboratory Test Control System (SISCEL), while vaccination coverage indicators were obtained from the Computerized Outpatient Care System (Hygia-RP System), specifically from records related to immunization actions. Information about vaccine registration was accessed from the National Immunization Program Information System (SI-PNI Web) and VaciVida System. Univariate and multivariate logistic regression analyses expressed as crude odds ratios (cORs) and adjusted odds ratios (aORs), each with 95% confdence intervals (95% CI), were performed to compare the proportional diferences of factors associated with vaccine coverage.
Results: Our sample included data 645 people living with HIV/AIDS aged 14 to 72 years old and the mean age of the individuals was 32.1 years (SD+/- 11.1). Individuals aged 13 to 19 years had a better vaccination rate (12.8%, p=0.005), and none of those aged 50 years or older had completed the vaccination schedule. Receiving the last vaccine doses at the Specialized Assistance Service (SAE) was associated with completing the vaccination schedule compared to receiving vaccines at Basic Health Units (p=0.009), as well as demonstrating good adherence to antiretroviral therapy (p=0.003). Individuals vaccinated at SAE 4 had a higher rate of being adequately vaccinated; however, there was no association of this variable with the appropriate vaccination schedule (p=0.078). Considering the nine vaccines evaluated, individuals aged 40 years or older were 87.0% (aOR: 0.13, 95%CI: 0.02 – 0.72; p=0.020) less likely to be adequately vaccinated compared to individuals aged 10 to 19 years. With regard to the health facility where the last doses of the vaccine were received, individuals vaccinated in other health units were 10 times more likely to be adequately vaccinated compared to those who received their last vaccine doses at the SAE (aOR: 10.44, 95%CI: 1.35 – 80.83; p=0.025).
Conclusion: The decision to vaccinate is individual, and as such, it is necessary for vaccines to be available in healthcare services where the person receives follow-up care and easily accessible to the population, along with having trained healthcare professionals. Therefore, multifactorial health interventions are needed to address factors influencing vaccine coverage among PLHIV to improve vaccination rates.
