COVID-19 vaccine uptake among people with HIV: identifying characteristics associated with vaccine hesitancy.

People with HIV (PWH) are at increased risk of COVID-19 infection. Both Canadian (NACI) and US (CDC) guidelines recommend that all PWH receive at least 2 doses of COVID-19 vaccine, and a booster. We examined vaccination uptake among PWH in Southern Alberta, Canada. Among adult PWH, we evaluated COVID-19 vaccination uptake between December 2020 and August 2022. Poisson regression models with robust variance (approximating log binomial models) estimated crude and adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for receiving (1) any vs. no vaccine, and (2) primary series with booster (≥ 3 vaccines) versus primary series without booster. Among 1885 PWH, 10% received no COVID-19 vaccinations, 37% < 3 vaccines and 54% received ≥ 3 vaccines. Females (vs. males) were less likely to receive a vaccine booster. Receiving no COVID-19 vaccines was associated with White ethnicity, unsuppressed HIV viral load (> 200 copies/mL), and using illegal substances. Factors associated with decreased booster uptake included being younger, Black (vs. White) ethnicity, substance use, lower educational attainment, and having an unsuppressed HIV viral load. COVID-19 booster uptake among PWH does not meet vaccine guidelines, and receipt of vaccines is unevenly distributed. Booster uptake is lowest among young females and marginalized individuals. Focused outreach is necessary to close this gap.

The changing use and program costs of HIV-related laboratory testing over 20 years in an HIV cohort.

PURPOSE OF REVIEW: The improved health of persons with HIV (PWH) resulting from antiretroviral therapy (ART) has led to recommendations for reduced laboratory monitoring. We studied, for all PWH in care over 20 years at the Southern Alberta Clinic (SAC), Canada, the changing use and results of HIV-specific laboratory testing [i.e., CD4+ testing, plasma HIV viral load (PVL), and genotypic antiretroviral resistance testing (GART)].In this descriptive retrospective longitudinal cohort observational study, we examined HIV-specific laboratory testing for all PWH from 2000 to 2020 within the context of HIV-related health outcomes, program costs, and mortality. RECENT FINDINGS: The number of PWH in care increased from 755 in 2000 to 2050 in 2020. Annual CD4+ testing per PWH increased from 2.7 per person in 2000 peaking to 3.5 in 2005 but decreasing to 1.4 by 2020. Annual PVL tests per PWH gradually decreased from 3.2 in 2000 to 2.0 in 2020. GART increased from 93 tests in 2000 to 315 in 2008 decreasing to 127 in 2020. Patients received GART at baseline, and after a viral breakthrough when indicated. Viral suppression rates for the population increased from 66 to 96%; median CD4+ cell count increased from 443 to 470 cells/µl, and overall morbidity decreased from 9.2 to 2.0% by 2020, respectively. Annual per patient laboratory costs decreased from a high of $302 in 2008 to $161 by 2020. SUMMARY: The reduced annual laboratory surveillance per PWH associated with modern ART resulted in modest cost savings and no apparent loss in quality of HIV care.