BMJ open · 2026
COVID-19 vaccination among people affected by sexually transmitted and bloodborne infections, methamphetamine use and their intersection in Manitoba, Canada: a retrospective matched cohort analysis using population-based administrative healthcare data (2020-2022).
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Shaw Souradet Y, Mahar Alyson, Bailey Kim, Payne Michael, Kindrachuk Jason, Kelly Christine, Friesen Kevin J, Bernstein Charles N, Reimer Joss N, Becker Marissa L, McClarty Leigh Michelle, Stein Derek, Nickel Nathan C
Аннотация
OBJECTIVES: To examine COVID-19 vaccine uptake among people diagnosed with sexually transmitted and bloodborne infections (STBBIs), people with healthcare-documented methamphetamine use and those experiencing both exposures in Manitoba, Canada.
DESIGN: Population-based retrospective matched cohort study using linked administrative healthcare, laboratory and vaccination data.
SETTING: Manitoba, Canada, from 1 March 2020 to 31 March 2022.
PARTICIPANTS: Manitoba residents aged ≥16 years with laboratory-confirmed chlamydia or gonorrhoea, syphilis or HIV and/or healthcare-documented methamphetamine use during the 4 years before 1 March 2020 were classified into eight mutually exclusive exposure cohorts. Individuals were matched with comparators without the corresponding exposure based on age, sex, geographical region and area-level income quintile.
PRIMARY OUTCOME MEASURE: Receipt of ≥2 COVID-19 vaccine doses. Poisson regression models incorporating person-time were used to estimate adjusted rate ratios (aRRs) and 95% CIs.
RESULTS: Compared with matched comparators, vaccine uptake was lower in the Syphilis Only (aRR 0.83, 95% CI 0.80 to 0.86), Syphilis Plus (aRR 0.77, 95% CI 0.74 to 0.79), Chlamydia/Gonorrhoea Only (aRR 0.91, 95% CI 0.90 to 0.92), Chlamydia/Gonorrhoea Plus (aRR 0.74, 95% CI 0.72 to 0.77), Methamphetamine Only (aRR 0.71, 95% CI 0.68 to 0.73) and Methamphetamine plus STBBI cohorts (aRR 0.64, 95% CI 0.62 to 0.67). Uptake in the HIV Only cohort was similar to that among matched comparators (aRR 0.97, 95% CI 0.93 to 1.00). Lower uptake was concentrated among individuals living in lower-income areas.
CONCLUSIONS: COVID-19 vaccine uptake was lower among several populations affected by STBBIs, methamphetamine use or both, with the greatest disparity among people experiencing intersecting STBBI and methamphetamine-related exposures. Integrating vaccination with HIV, STBBI, harm-reduction and addiction services may improve vaccine equity during future public health emergencies.
DESIGN: Population-based retrospective matched cohort study using linked administrative healthcare, laboratory and vaccination data.
SETTING: Manitoba, Canada, from 1 March 2020 to 31 March 2022.
PARTICIPANTS: Manitoba residents aged ≥16 years with laboratory-confirmed chlamydia or gonorrhoea, syphilis or HIV and/or healthcare-documented methamphetamine use during the 4 years before 1 March 2020 were classified into eight mutually exclusive exposure cohorts. Individuals were matched with comparators without the corresponding exposure based on age, sex, geographical region and area-level income quintile.
PRIMARY OUTCOME MEASURE: Receipt of ≥2 COVID-19 vaccine doses. Poisson regression models incorporating person-time were used to estimate adjusted rate ratios (aRRs) and 95% CIs.
RESULTS: Compared with matched comparators, vaccine uptake was lower in the Syphilis Only (aRR 0.83, 95% CI 0.80 to 0.86), Syphilis Plus (aRR 0.77, 95% CI 0.74 to 0.79), Chlamydia/Gonorrhoea Only (aRR 0.91, 95% CI 0.90 to 0.92), Chlamydia/Gonorrhoea Plus (aRR 0.74, 95% CI 0.72 to 0.77), Methamphetamine Only (aRR 0.71, 95% CI 0.68 to 0.73) and Methamphetamine plus STBBI cohorts (aRR 0.64, 95% CI 0.62 to 0.67). Uptake in the HIV Only cohort was similar to that among matched comparators (aRR 0.97, 95% CI 0.93 to 1.00). Lower uptake was concentrated among individuals living in lower-income areas.
CONCLUSIONS: COVID-19 vaccine uptake was lower among several populations affected by STBBIs, methamphetamine use or both, with the greatest disparity among people experiencing intersecting STBBI and methamphetamine-related exposures. Integrating vaccination with HIV, STBBI, harm-reduction and addiction services may improve vaccine equity during future public health emergencies.