The authors have declared that no competing interests exist.
HIV causes immunosuppression, which reduces the body's immunity to diseases like COVID-19 by decreasing CD4 cells. The goal of this study is to determine whether persons living with HIV/AIDS (PLWHA) who are using anti-retroviral therapy (ART) are willing to accept the Coronavirus illness 2019 vaccination and the factors that influence their decision.
From February 15 to March 15, 2022, 332 PLWHA on ART participated in this facility-based cross-sectional study. The correlation of outcome variables with predictors was investigated using binary and multivariable logistic regression.
Of the 332 study participants, 110 (33.1 %) and 118 (35.5 %) had poor knowledge and a negative attitude toward the COVID-19 vaccination, respectively. Approximately 31 (9.3%) of study participants believe ART medications can also prevent COVID-19 infection. The willingness to receive the COVID-19 vaccine was 66.3 % with a 95 % confidence interval (60.9, 71.5). Knowledge, attitude, educational status, marital status, residency, duration, and monthly income were all significant predictors of willingness to receive COVID-19 vaccination.
Increased sensitization regarding the necessity of vaccines and the negative consequences of diseases, particularly among PLWHA, should be emphasized in the preparation of the COVID-19 immunization campaign involving prominent individuals such as health professionals and religious leaders.
The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) causes Coronavirus Disease 2019 (COVID-19), which has been affecting worldwide health since December 2019
In May 2020, the 73rd World Health Assembly delivered a resolution identifying the role of wide-ranging immunization as a global public-health goal for stopping, containing, and halting transmission of SARS-CoV-2. The vaccine has been shown to reduce infections even among individuals who are not vaccinated, through the development of herd immunity, if most of the population become vaccinated
Ethiopia has planned to vaccinate about 20% of the population until the end of 2021 being high priority was given to health care professionals, elderly and patients with chronic disease above the age of 55 years old
Even if every segment of population is likely to be affected by COVID-19 infection, patients with co-morbidities like hypertension, obesity and diabetes are mainly at increased risk of complicating outcomes compared to those without
A facility-based cross-sectional study was conducted from February 15 to March 15, 2022, in Woldia comprehensive specialized hospital located in Northern Ethiopia.
The sample size was calculated using a single population proportion formula, taking into account the prevalence of readiness to accept COVD-19 vaccine among persons living with HIV in Butajira, which was 59.4 percent, with a margin of error (d) of 0.05 and a 95 percent confidence range. A consecutive sampling technique was employed to recruit study participants.
The source population of the study was all people living with HIV who had visited Woldia Comprehensive Specialized Hospital ART clinic, whereas the study population was all people living with HIV on ART who had visited Woldia Comprehensive Specialized Hospital during the data collection time.
People living with HIV and who were under the age of 18 and those who were unable to respond owing to a severe illness were excluded from the study.
The information was gathered using a pre-tested structured questionnaire based from various published articles. To maintain uniformity, the questionnaire was written in English, translated into the local language (Amharic), and then re-translated back into English. Data collectors and supervisors were trained on the purpose of the study, the clarity of the measurement tool, and ethical considerations. Three BSc nurses collected the data, and one supervisor oversaw the entire operation. A daily meeting and monitoring were also established in order to analyze difficulties that arose during data gathering.
Epi data 4.4.3 and IBM SPSS 25 software were used to enter the data. The variable was summarized using a descriptive summary (frequency distribution, proportion, mean, and standard deviation). To study factors related with vaccine acceptance, a binary logistic regression model was used. Variables having a p value of 0.25 in the bivariate analysis were incorporated into the multivariable analysis to compensate for potential confounder effects. To declare statistical significance, a P value of less than 0.05 was employed.
Ethical approval was obtained from Woldia university ethical review committee. Permission letter was obtained from woldia comprehensive specialized hospital medical director office. Informed consent was obtained from the study participants. Confidentiality of patients’ information was kept anonymous in any process of the study.
A total of 332 HIV-positive patients on ART participated, with a response rate of 89.5%. The respondent’s age range was 18–57 years. Out of 332 study participants, 61.4% were female (
Variables | Willingness to accept vaccine | Total (%) | ||
Yes (%) | No (%) | |||
Sex | Male | 79(23.79) | 49(14.76) | 128(38.55) |
Female | 141(42.47) | 63(18.97) | 204(61.44) | |
Religion | Orthodox | 138(41.56) | 71(21.38) | 209(62.95) |
Muslim | 60(18.07) | 31(9.33) | 91(27.41) | |
Protestant | 17(5.12) | 10(3.01) | 27(8.13) | |
Other | 5(1.50) | 0(0) | 51.50) | |
Marital status | Married | 37(11.14) | 8(2.41) | 45(13.55) |
Single | 118(35.54) | 35(10.54) | 153(46.08) | |
Widowed | 46(13.85) | 44(13.25) | 90(27.11) | |
Divorced | 19(5.72) | 25(7.53) | 44(13.25) | |
Educational status | Illiterate | 56(16.87) | 66(19.88) | 122(36.75) |
in-formal | 24(7.23) | 28(8.43) | 52(15.66) | |
Primary | 66(19.88) | 9(2.71) | 75(22.59) | |
Secondary | 64(19.28) | 4(1.2) | 68(20.48) | |
College and above | 10(3.01) | 5(1.5) | 15(4.52) | |
Residence | Urban | 177(53.31) | 38(11.44) | 215(64.76) |
Rural | 43(12.95) | 74(22.29) | 117(35.24) | |
Occupation | House maid | 51(15.36) | 11(3.31) | 62(18.67) |
Farmer | 66(19.88) | 36(10.84) | 102(30.72) | |
Private | 78(23.49) | 51(15.36) | 129(38.85) | |
Government employee | 15(4.52) | 12(3.61) | 27(8.13) | |
Unemployed | 10(3.01) | 2(0.6) | 12(3.61) |
One hundred and ten (33.1%) and 118(35.5%) of the study participants had poor knowledge and negative attitude about COVID-19 vaccine respectively while 31(9.3%) of the study participants perceive ART drugs can also prevent COVID-19 infection. Twenty-seven (8.1%) participants perceive COVID-19 vaccination had negative impact on HIV/AIDS progress (
Variables | Frequency | Percentage | |
Can ART drug prevents COVID-19 | Yes | 31 | 9.3 |
No | 301 | 90.7 | |
COVID-19 vaccine has negative impact on diseases progress | Yes | 27 | 8.1 |
No | 305 | 91.9 | |
COVID-19 vaccine has negative interaction to ART drugs | Yes | 12 | 3.6 |
No | 320 | 96.4 | |
Any family member who get infected by COVID-19 | Yes | 81 | 24.4 |
No | 246 | 74.1 | |
Susceptibility to COVID-19 infection | Yes | 129 | 38.9 |
No | 203 | 61.1 | |
Knowledge about COVID-19 | Poor | 110 | 33.1 |
Good | 222 | 66.9 | |
Attitude towards COVID-19 | Negative | 118 | 35.5 |
Positive | 214 | 64.5 |
Two hundred and seven study participants got COVID-19 vaccine related information’s from health care workers, out of them about 85 study participants had willingness to accept COVID-19 vaccination (
Two hundred and twenty (66.3%) with 95% CI (60.9, 71.5) study participants were willing to take COVID-19 vaccination. Out of this, 141(64.1%), 177 (80.4%) and 78(35.4%) were female, urban resident and private worker. (
Variables | No. (%) | COR(95% CI) | AOR(95% CI) | p-value | |
Marital status | Married | 37(11.14) | Ref | - | |
Single | 118(35.54) | 0.16(0.06,0.43) | 0.34(0.07,1.66) | 0.18 | |
Widowed | 46(13.85) | 0.22(0.11,0.46) | 0.2(0.06,0.62) |
|
|
Divorced | 19(5.72) | 0.73(0.35,1.5) | 2.24(0.55,9.03) | 0.26 | |
Educational status | Illiterate | 56(16.87) | Ref | - | |
In-formal | 24(7.23) | 2.36(0.76,7.3) | 0.68(0.12,3.7) | 0.652 | |
Primary | 66(19.88) | 2.333(0.7,7.78) | 2.94(0.42,20.68) | 0.277 | |
Secondary | 64(19.28) | 0.273(0.07,0.98) | 0.13(0.02,0.88) |
|
|
College and above | 10(3.01) | 0125(0.03,0.55) | 0.07(0.009,0.62) |
|
|
Residency | Urban | 177(53.31) | Ref | ||
Rural | 43(12.95) | 0.12(0.07,0.21) | 0.12(0.05,0.32) |
|
|
Knowledge | Poor | 110(33.1) | Ref | ||
Good | 222(66.9) | 2.73(1.69,4.4) | 3.74(1.5,9.36) |
|
|
Attitude | Negative | 118(35.5) | Ref | ||
Positive | 214(64.5) | 2.55(1.59,4.09) | 4.34(1.6,11.79) |
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|
Monthly income (Mean±SD) | 2696.95±2353.00 | 1.00(1.00,1.00) | 1.00(1.00,1.01) |
|
|
Duration of ART (Mean±SD) | 8.45±4.16 | 0.86(0.81,0.91) | 0.80(0.71,0.90) |
|
In multivariable analysis, refusal to be vaccinated for COVID-19 vaccine was significantly associated with poor knowledge (AOR: 2.73; 95% CI (1.69, 4.4)) and negative attitude (AOR: 2.55; 95% CI (1.59, 4.09)) compared with their counters. PLWHA on ART who live in rural area were less likely (AOR: 0.12, 95% CI (0.07, 0.21) willing to be vaccinated compared to those who live in urban area.
Vaccination is an important approach for mitigating the COVID-19 pandemic by instilling herd immunity in the community. The effectiveness of this technique is dependent on vaccine uptake in the population. According to the most recent COVID-19 estimates, up to 60–75 percent of the population needs to be vaccinated in order to stop the disease's spread and achieve herd immunity
The established risk factors for COVID-19 acquisition and consequences, such as heart disease, kidney disease, diabetes, chronic pulmonary disease, and obesity, may be more prevalent in PLWHA
The prevalence and parameters associated with PLWHA's willingness to receive COVID-19 immunization were investigated in this study. As a result, 66% of PLWHA expressed desire to get the COVID-19 vaccine. This study's findings agree with those of an Ethiopian study (62.6%)
The novelty of the COVID-19 disease may have contributed to the lower magnitude of vaccine adoption. As a result of the vaccine's rapid development, there may be ambiguity and misguided ideas about it, which leads to the false notion that the vaccine has not been sufficiently proven for safety and effectiveness, as well as restricted access to information, particularly in LMICs
In our study, PLWHA with secondary and college education levels were less likely to be willing to be vaccinated with COVID 19 vaccine than non-educated participants. This is confirmed by studies from Gondar, Ethiopia, which found that participants with a university degree were less likely to receive the vaccine than those with a college diploma
Negative claims about vaccine effectiveness can profoundly influence vaccine uptake
In present study, participants who had good knowledge towards COVID-19 vaccine were 3.7 more likely to accept the COVID-19 vaccine when compared to respondents with poor knowledge. This was consistent with the findings from Ethiopia
Respondents who had a positive attitude towards the COVID-19 vaccines had a significantly higher acceptance rate of the COVID-19 vaccine (AOR=4.3) which was supported by the findings from Ethiopia
Even though this study had strengths, there were some limitations. This study was cross sectional survey. Therefore the limitation of this study is temporal relationship can’t be determined. The other limitation is lack of control group (HIV negative persons)
Almost one-third of PLWHA on ART refused immunization. This study demonstrates the complexities of patients' imaginations regarding COVID-19 immunization and may aid physicians and other health care providers in understanding patients' perspectives on COVID-19 vaccination. Increased sensitization on the necessity of vaccines and the negative consequences of diseases, particularly among PLWHA, should be considered in the development of the COVID-19 vaccination campaign by prominent individuals such as health professionals and religious figures. Vaccination programs should be culturally appropriate and informed by people who have lived experiences in order to reach people who might otherwise be hesitant. Furthermore, the need of immunization and the negative implications of refusing the vaccine must be thoroughly explained.
Our heart full gratitude goes to the study participants and health care professionals working in Woldia comprehensive specialized hospital for their good face to conduct this work.
ART: Anti-retroviral Drug
COVID-19: Coronavirus disease 2019
HIV/AIDS: Human Immunodeficiency Virus / Acquired Immunodeficiency Syndromes
PLWHA: People living with HIV/AIDS
The data set used and analyzed for the study is available from the corresponding author on reasonable request.
No funds were available to conduct this study.
Not applicable.
AT conceptualized and designed the study, conducted data entry, cleaning and analysis, and drafted the manuscript. MS reviewed the study design and methodology, conducted data entry, cleaning and analysis, and reviewed the manuscript for substantial intellectual content. WK drafted the manuscript and reviewed the manuscript for substantial intellectual content. HM supervised the data collection process and critically reviewed the manuscript for substantial intellectual content finally authors read and approved the final manuscript.