Anticipated Protection Overcomes Vaccine Hesitancy and Mistrust Among Women Enrolled in the DC MACS/WIHS Combined Cohort Study.

BACKGROUND

Despite efficacy of COVID-19 vaccines in preventing severe complications of infection, there remains vaccine hesitancy. We examined COVID-19 vaccine uptake and vaccine hesitancy among persons living with HIV (PWH).

METHODS

A nested survey was administered to women in the District of Columbia MACS-WIHS Combined Cohort Study (October 01, 2020-September 30, 2022). The survey included questions on vaccine receipt, medical mistrust, government trust, and vaccine attitudes. Sociodemographic and medical comorbidity data were collected at routine study visits.

RESULTS

Among 254 women, 75% (n = 190) were African American/Black, and 70% (n = 178) were PWH, and 82% (n = 208) received a complete COVID-19 vaccine series. Vaccine completion rate was similar among PWH and women without HIV. The top reasons for a participant's vaccine decision were personal choice 46% (n = 113), health care provider recommendation 24% (n = 60), and family influence 31% (n = 13). Sixty-five percent (n = 159) endorsed concern about unknown vaccine side effects. The mean medical mistrust score was 32.4 (SD 3.8, range 12-60, higher scores indicate more mistrust). In adjusted analysis, older age [aOR = 1.05 (95% CI: 1 to 1.1, P = 0.032)], prior testing for COVID-19 [aOR = 3.50 (95% CI: 1.23 to 9.99, P = 0.019)], and feeling protected after being vaccinated [aOR = 4.65 (95% CI: 1.98 to 10.91, P < 0.001)] were associated with receipt of COVID-19 vaccines. There was no association between medical mistrust [aOR = 1.01 (95% CI: 0.95 to 1.06, P = 0.87)] or concerns about vaccine safety [aOR = 0.57 (95% CI: 0.26 to 1.28, P = 0.17)] and receipt of COVID-19 vaccines.

CONCLUSIONS

Concern about potential risks associated with vaccines remains a significant challenge. Interventions emphasizing protective benefits of vaccines using shared decision making may be useful for public health campaigns.