Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design, Population, and Setting
2.2. Sample Size Calculation and Justification
2.3. Survey Instrument, Procedures, and Measures
2.4. Statistical Analysis
2.5. Ethical Approval
3. Results
3.1. Characteristics of Participants
3.2. COVID-19 Vaccine Uptake and Experiences
3.3. Prevalence of COVID-19 Vaccine Hesitancy
3.4. Factors Associated with COVID-19 Vaccine Hesitancy
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- World Health Organization. Coronavirus Disease (COVID-19) Weekly Epidemiological Updates and Monthly Operational Updates. 2023. Available online: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports (accessed on 25 April 2023).
- Singanayagam, A.; Hakki, S.; Dunning, J.; Madon, K.J.; Crone, M.A.; Koycheva, A.; Derqui-Fernandez, N.; Barnett, J.L.; Whitfield, M.G.; Varro, R.; et al. Community transmission and viral load kinetics of the SARS-CoV-2 delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: A prospective, longitudinal, cohort study. Lancet Infect. Dis. 2021, 21, e363, Erratum in Lancet Infect. Dis. 2022, 22, 183–195. [Google Scholar] [CrossRef] [PubMed]
- Salo, J.; Hägg, M.; Kortelainen, M.; Leino, T.; Saxell, T.; Siikanen, M.; Sääksvuori, L. The indirect effect of mRNA-based COVID-19 vaccination on healthcare workers’ unvaccinated household members. Nat. Commun. 2022, 13, 1162. [Google Scholar] [CrossRef]
- Tenforde, M.W.; Self, W.H.; Adams, K.; Gaglani, M.; Ginde, A.A.; McNeal, T.; Ghamande, S.; Douin, D.J.; Talbot, H.K.; Casey, J.D.; et al. Association Between mRNA Vaccination and COVID-19 Hospitalization and Disease Severity. JAMA 2021, 326, 2043–2054. [Google Scholar] [CrossRef] [PubMed]
- Kelly, J.D.; Leonard, S.; Hoggatt, K.J.; Boscardin, W.J.; Lum, E.N.; Moss-Vazquez, T.A.; Andino, R.; Wong, J.K.; Byers, A.; Bravata, D.M.; et al. Incidence of Severe COVID-19 Illness Following Vaccination and Booster With BNT162b2, mRNA-1273, and Ad26.COV2.S Vaccines. JAMA 2022, 328, 1427–1437. [Google Scholar] [CrossRef] [PubMed]
- Yendewa, G.A.; Perez, J.A.; Schlick, K.; Tribout, H.; A McComsey, G. Clinical Features and Outcomes of Coronavirus Disease 2019 Among People with Human Immunodeficiency Virus in the United States: A Multicenter Study From a Large Global Health Research Network (TriNetX). Open Forum Infect. Dis. 2021, 8, ofab272. [Google Scholar] [CrossRef] [PubMed]
- Bhaskaran, K.; Rentsch, C.T.; MacKenna, B.; Schultze, A.; Mehrkar, A.; Bates, C.J.; Eggo, R.M.; Morton, C.E.; Bacon, S.C.J.; Inglesby, P.; et al. HIV infection and COVID-19 death: A population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform. Lancet HIV 2021, 8, e24–e32. [Google Scholar] [CrossRef] [PubMed]
- Fulda, E.S.; Fitch, K.V.; Overton, E.T.; Zanni, M.V.; Aberg, J.; Currier, J.S.; Lu, M.T.; Malvestutto, C.; Fichtenbaum, C.J.; Martinez, E.; et al. COVID-19 Vaccination Rates in a Global HIV Cohort. J. Infect. Dis. 2022, 225, 603–607. [Google Scholar] [CrossRef]
- Shrestha, R.; Meyer, J.P.; Shenoi, S.; Khati, A.; Altice, F.L.; Mistler, C.; Aoun-Barakat, L.; Virata, M.; Olivares, M.; Wickersham, J.A. COVID-19 Vaccine Hesitancy and Associated Factors among People with HIV in the United States: Findings from a National Survey. Vaccines 2022, 10, 424. [Google Scholar] [CrossRef]
- Lwanga, S.K.; Lemeshow, S.; World Health Organization. Sample Size Determination in Health Studies: A Practical Manual. 1991. Available online: https://apps.who.int/iris/handle/10665/40062 (accessed on 24 April 2023).
- Martin, L.R.; Petrie, K.J. Understanding the Dimensions of Anti-Vaccination Attitudes: The Vaccination Attitudes Examination (VAX) Scale. Ann. Behav. Med. 2017, 51, 652–660. [Google Scholar] [CrossRef]
- Yendewa, S.A.; Ghazzawi, M.; James, P.B.; Smith, M.; Massaquoi, S.P.; Babawo, L.S.; Deen, G.F.; Russell, J.B.W.; Samai, M.; Sahr, F.; et al. COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone: A Cross-Sectional Study. Vaccines 2022, 10, 757. [Google Scholar] [CrossRef]
- Oke, O.O.; Akinboro, A.O.; Olanrewaju, F.O.; Oke, O.A.; Omololu, A.S. Assessment of HIV-related stigma and determinants among people living with HIV/AIDS in Abeokuta, Nigeria: A cross-sectional study. SAGE Open Med. 2019, 7, 2050312119869109. [Google Scholar] [CrossRef] [PubMed]
- Barton, B.; Peat, J. Medical Statistics: A Guide to SPSS, Data Analysis and Clinical Appraisal, 2nd ed.; BMJ Books; Wiley Blackwell: Sydney, Australia, 2014. [Google Scholar]
- Govere-Hwenje, S.; Jarolimova, J.; Yan, J.; Khumalo, A.; Zondi, G.; Ngcobo, M.; Wara, N.J.; Zionts, D.; Bogart, L.M.; Parker, R.A.; et al. Willingness to accept COVID-19 vaccination among people living with HIV in a high HIV prevalence community. BMC Public Health 2022, 22, 1239. [Google Scholar] [CrossRef] [PubMed]
- Kabir Sulaiman, S.; Sale Musa, M.; Isma’il Tsiga-Ahmed, F.; Dayyab, F.M.; Sulaiman, A.K.; Dabo, B.; Ahmad, S.I.; Haruna, S.A.; Zubair, A.A.; Hussein, A.; et al. COVID-19 vaccine hesitancy among people living with HIV in a low-resource setting: A multi-center study of prevalence, correlates and reasons. Vaccine 2023, 41, 2476–2484. [Google Scholar] [CrossRef] [PubMed]
- Muhindo, R.; Okoboi, S.; Kiragga, A.; King, R.; Arinaitwe, W.J.; Castelnuovo, B. COVID-19 vaccine acceptability, and uptake among people living with HIV in Uganda. PLoS ONE 2022, 17, e0278692. [Google Scholar] [CrossRef]
- Iliyasu, Z.; Kwaku, A.A.; Umar, A.A.; Tsiga-Ahmed, F.; Nass, N.S.; Abdullahi, H.M.; Amole, T.G.; Salihu, H.M.; Aliyu, M.H. Predictors of COVID-19 Vaccine Acceptability among Patients Living with HIV in Northern Nigeria: A Mixed Methods Study. Curr. HIV Res. 2022, 20, 82–90. [Google Scholar] [CrossRef]
- Mohamed, R.; White, T.M.; Lazarus, J.V.; Salem, A.; Kaki, R.; Marrakchi, W.; Kheir, S.G.M.; Amer, I.; Ahmed, F.M.; A Khayat, M.; et al. COVID-19 vaccine acceptance and associated factors among people living with HIV in the Middle East and North Africa region. S. Afr. J. HIV Med. 2022, 23, 1391. [Google Scholar] [CrossRef]
- Turan, J.M.; Elafros, M.A.; Logie, C.H.; Banik, S.; Turan, B.; Crockett, K.B.; Pescosolido, B.; Murray, S.M. Challenges and opportunities in examining and addressing intersectional stigma and health. BMC Med. 2019, 17, 7. [Google Scholar] [CrossRef]
- Maragh-Bass, A.C.; Aimone, E.V.; Aikhuele, E.O.; Macqueen, K. Exploring intersectional stigma and COVID-19 impact on human immunodeficiency virus service provision for African Americans in a Southern city. J. Clin. Nurs. 2022, 32, 7822–7833. [Google Scholar] [CrossRef]
- Balaji, J.N.; Prakash, S.; Joshi, A.; Surapaneni, K.M. A Scoping Review on COVID-19 Vaccine Hesitancy among the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) Community and Factors Fostering Its Refusal. Healthcare 2023, 11, 245. [Google Scholar] [CrossRef]
- Faye, S.L.B.; Krumkamp, R.; Doumbia, S.; Tounkara, M.; Strauss, R.; Ouedraogo, H.G.; Sagna, T.; Barry, A.M.; Mbawah, A.K.; Doumbia, C.O.; et al. Factors influencing hesitancy towards adult and child COVID-19 vaccines in rural and urban West Africa: A cross-sectional study. BMJ Open 2022, 12, e059138. [Google Scholar] [CrossRef]
- Lv, X.; Zhao, C.; Song, B.; Huang, H.; Song, S.; Long, H.; Liu, W.; Du, M.; Liu, M.; Liu, J. COVID-19 vaccination in people living with HIV and AIDS (PLWHA) in China: A cross-sectional study. Hum Vaccines Immunother. 2023, 19, 2151798. [Google Scholar] [CrossRef] [PubMed]
- Alsuwaidi, A.R.; Hammad, H.A.A.-K.; Elbarazi, I.; Sheek-Hussein, M. Vaccine hesitancy within the Muslim community: Islamic faith and public health perspectives. Hum. Vaccines Immunother. 2023, 19, 2190716. [Google Scholar] [CrossRef] [PubMed]
- Wonodi, C.; Obi-Jeff, C.; Adewumi, F.; Keluo-Udeke, S.C.; Gur-Arie, R.; Krubiner, C.; Jaffe, E.F.; Bamiduro, T.; Karron, R.; Faden, R. Conspiracy theories and misinformation about COVID-19 in Nigeria: Implications for vaccine demand generation communications. Vaccine 2022, 40, 2114–2121. [Google Scholar] [CrossRef] [PubMed]
- Yendewa, G.A.; James, P.B.; Mohareb, A.; Barrie, U.; Massaquoi, S.P.E.; Yendewa, S.A.; Ghazzawi, M.; Bockarie, T.; Cummings, P.E.; Diallo, I.S.; et al. Determinants of Incomplete Childhood Hepatitis B Vaccination in Sierra Leone, Liberia, and Guinea: Analysis of National Surveys (2018–2020). Epidemiol. Infect. 2023, 1–44. [Google Scholar] [CrossRef]
- Forster, A.S.; Rockliffe, L.; Chorley, A.J.; Marlow, L.A.V.; Bedford, H.; Smith, S.G.; Waller, J. Ethnicity-specific factors influencing childhood immunisation decisions among Black and Asian Minority Ethnic groups in the UK: A systematic review of qualitative research. J. Epidemiol. Community Health 2017, 71, 544–549. [Google Scholar] [CrossRef]
- Ansari, M.T.; Jamaluddin, N.N.; Ramlan, T.A.; Zamri, N.; Majeed, S.; Badgujar, V.; Sami, F.; Hasnain, M.S.; Singh, H.K.B. Knowledge, attitude, perception of Muslim parents towards vaccination in Malaysia. Hum. Vaccines Immunother. 2021, 17, 785–790. [Google Scholar] [CrossRef]
- Wong, L.P.; Wong, P.F.; AbuBakar, S. Vaccine hesitancy and the resurgence of vaccine preventable diseases: The way forward for Malaysia, a Southeast Asian country. Hum. Vaccines Immunother. 2020, 16, 1511–1520. [Google Scholar] [CrossRef]
- Nageeb, S.; Vu, M.; Malik, S.; Quinn, M.T.; Cursio, J.; Padela, A.I. Adapting a religious health fatalism measure for use in Muslim populations. PLoS ONE 2018, 13, e0206898. [Google Scholar] [CrossRef]
- Padela, A.I.; Nageeb, S.; Vu, M.; Quinn, M.T. The Development and Validation of a Modesty Measure for Diverse Muslim Populations. J. Relig. Health 2019, 58, 408–425. [Google Scholar] [CrossRef]
- Perry, S.L.; Whitehead, A.L.; Grubbs, J.B. Culture wars and COVID-19 conduct: Christian nationalism, religiosity, and Americans’ behavior during the coronavirus pandemic. J. Sci. Study Relig. 2020, 59, 405–416. [Google Scholar] [CrossRef]
- Corcoran, K.E.; Scheitle, C.P.; DiGregorio, B.D. Christian nationalism and COVID-19 vaccine hesitancy and uptake. Vaccine 2021, 39, 6614–6621. [Google Scholar] [CrossRef] [PubMed]
- Olagoke, A.A.; Olagoke, O.O.; Hughes, A.M. Intention to Vaccinate Against the Novel 2019 Coronavirus Disease: The Role of Health Locus of Control and Religiosity. J. Relig. Health 2021, 60, 65–80. [Google Scholar] [CrossRef] [PubMed]
- Mamani-Benito, O.; Farfán-Solís, R.; Huayta-Meza, M.; Tito-Betancur, M.; Morales-García, W.C.; Tarqui, E.E.A. Effect of religious fatalism and concern about new variants on the acceptance of COVID-19 vaccines. Front. Psychiatry 2023, 14, 1071543. [Google Scholar] [CrossRef] [PubMed]
- Franklin, M.D.; Schlundt, D.G.; Wallston, K.A. Development and validation of a religious health fatalism measure for the African-American faith community. J. Health Psychol. 2008, 13, 323–335. [Google Scholar] [CrossRef] [PubMed]
- Noar, S.M.; Zimmerman, R.S. Health Behavior Theory and cumulative knowledge regarding health behaviors: Are we moving in the right direction? Health Educ. Res. 2005, 20, 275–290. [Google Scholar] [CrossRef]
- Janz, N.K.; Becker, M.H. The health belief model—A decade later. Health Ed. Quart. 1984, 11, 1–47. [Google Scholar] [CrossRef]
- Rejeski, W.J.; Fanning, J. Models and theories of health behavior and clinical interventions in aging: A contemporary, integrative approach. Clin. Interv. Aging 2019, 14, 1007–1019. [Google Scholar] [CrossRef]
- Wickersham, J.A.; Meyer, J.P.; Shenoi, S.; Altice, F.L.; Barakat, L.A.; Virata, M.; Olivares, M.; Maviglia, F.; Khati, A.; Shrestha, R. Willingness to Be Vaccinated Against COVID-19 Among People with HIV in the United States: Results From a National Survey. Front. Med. 2022, 9, 886936. [Google Scholar] [CrossRef]
- Kricorian, K.; Civen, R.; Equils, O. COVID-19 vaccine hesitancy: Misinformation and perceptions of vaccine safety. Hum. Vaccines Immunother. 2022, 18, 1950504. [Google Scholar] [CrossRef]
- Sergi, C.M.; Leung, A.K.C. Vaccination: A question of social responsibility. J. Prev. Med. Hyg. 2021, 62, E46–E47. [Google Scholar]
Characteristics | N (%) |
---|---|
Gender | |
Male | 140 (28.6) |
Female | 350 (71.4) |
Age, years | |
Median (IQR) | 38 (32–49) |
<25 | 16 (3.3) |
25–34 | 144 (29.4) |
35–44 | 167 (34.1) |
45–54 | 99 (20.2) |
≥55 | 64 (13.1) |
Relationship status | |
Single | 297 (60.6) |
Married | 155 (31.6) |
Widowed/separated | 38 (7.8) |
Highest education level attained | |
None | 98 (20.0) |
Primary | 111 (22.7) |
Secondary | 225 (45.9) |
Tertiary | 56 (11.4) |
Occupation | |
Unemployed | 109 (22.2) |
Informal | 340 (69.4) |
Formal | 41 (8.4) |
Religion | |
Christian | 151 (30.8) |
Muslim | 339 (69.2) |
Time living with HIV, years | |
Median (IQR) | 5 (3–11) |
≤2 | 69 (14.1) |
3–5 | 180 (36.7) |
6–10 | 109 (22.2) |
≥11 | 132 (26.9) |
Current CD4 count, cells/mm3 | |
Median | 412 (256–508) |
<200 | 79 (16.1) |
≥200 | 405 (82.7) |
Viral load, copies/mL | |
<1000 | 411 (83.9) |
≥1000 | 79 (16.1) |
Current ART | |
Dolutegravir-based | 283 (57.8) |
Efavirenz-based | 146 (29.8) |
Lopinavir-based | 61 (12.4) |
History of chronic illness | |
Yes | 24 (4.9) |
No | 466 (95.1) |
Tested for COVID-19 | |
Yes | 28 (5.7) |
No | 462 (94.3) |
Received any COVID-19 vaccine | |
Yes | 85 (17.3) |
No | 405 (82.7) |
COVID-19 vaccine doses received (n = 85) | |
1 (partial dose) | 54 (63.5) |
2 (full dose) | 31 (36.5) |
COVID-19 vaccine types (n = 85) | |
Janssen (Johnson & Johnson) | 33 (38.8) |
AstraZeneca | 28 (32.9) |
Sinopharm | 24 (28.2) |
Experienced adverse COVID-19 vaccine effects (n = 85) | |
Yes | 37 (44.6) |
No | 46 (55.4) |
Type of vaccine adverse effects (not mutually exclusive) (n = 85) | |
Pain at injection site | 33 (38.8) |
Bodyaches | 8 (9.4) |
Fever | 3 (3.5) |
COVID-19 Vaccine Attitude Statements | Vaccine Hesitancy Level | Mean Inter-Item Correlation | Domain Cronbach’s Alpha | ||
---|---|---|---|---|---|
Low | Moderate | High | |||
Mistrust of vaccine benefits | |||||
I feel that the COVID-19 vaccine is very safe | 37.9 | 12.0 | 50.1 | ||
I can rely on the COVID-19 vaccine to prevent serious infection of COVID-19 | 38.1 | 11.8 | 49.8 | 0.892 | 0.94 |
I feel fully protected from the COVID-19 infection in the future after receiving the COVID-19 vaccine | 31.6 | 16.7 | 51.7 | ||
Worries about unforeseen future effects | |||||
Although the COVID-19 vaccine appears to be safe, there may be problems with the vaccine that we have not yet discovered (r) | 56.3 | 17.0 | 26.7 | ||
The COVID-19 vaccine can cause unforeseen problems in the future (r) | 54.7 | 17.8 | 27.1 | 0.823 | 0.90 |
I worry about the unknown future effects of the COVID-19 vaccine (r) | 68.8 | 6.7 | 24.5 | ||
Concerns about commercial profiteering | |||||
The COVID-19 vaccine will make a lot of money for pharmaceutical companies but will not bring much benefit to common people (r) | 37.7 | 13.9 | 48.4 | ||
Authorities promote the COVID-19 vaccine for financial gain, not for people’s health (r) | 32.0 | 12.6 | 55.4 | 0.745 | 0.88 |
COVID-19 vaccination programs are a fraud (r) | 29.4 | 6.8 | 63.8 | ||
Preference for natural immunity | |||||
Natural immunity will last longer than immunity from the COVID-19 vaccine (r) | 31.8 | 18.2 | 50.0 | ||
Natural exposure to the virus provides the safest protection against COVID-19 (r) | 24.3 | 29.8 | 45.9 | 0.846 | 0.93 |
Being exposed to COVID-19 naturally is safer for the immune system than being exposed through a vaccination (r) | 23.3 | 19.2 | 57.5 |
Variables | Expected Range of VAX Score | Median (Min–Max) | VAX Score or N | % Participants With VAX Score |
---|---|---|---|---|
Overall hesitancy | ||||
Mean (SD) | 12–72 | 44 (27–60) | 43.14 ± 7.05 | 59.9 |
Hesitancy domains | ||||
Mistrust of vaccine benefits | 3–18 | 12 (3–18) | 11.06 ± 4.59 | 61.4 |
Worries about unforeseen future effects | 3–18 | 6 (3–18) | 8.62 ± 4.05 | 48.0 |
Concerns about commercial profiteering | 3–18 | 13 (3–18) | 11.62 ± 4.11 | 64.4 |
Preference for natural immunity | 3–18 | 13 (3–18) | 11.84 ± 3.89 | 65.8 |
Categories of hesitancy | ||||
Low | 12–32 | 33 | 33 | 6.7 |
Moderate | 33–52 | 446 | 446 | 91.0 |
High | >52 | 11 | 11 | 2.3 |
Variables | Univariate | Multivariable | ||||
---|---|---|---|---|---|---|
β | S.E. | p-Value | β | S.E. | p-Value | |
Sociodemographic information | ||||||
Sex: male | −0.896 | 0.702 | 0.202 | |||
Age (years) | 0.040 | 0.030 | 0.179 | |||
Relationship status: single | −0.010 | 0.648 | 0.988 | |||
Education: none | 0.661 | 0.791 | 0.403 | |||
Religion: Muslim | 2.511 | 0.676 | <0.001 | 2.563 | 0.674 | <0.001 |
Unemployed | 0.552 | 0.761 | 0.469 | |||
Residence: urban | 1.476 | 0.671 | 0.028 | 1.709 | 0.661 | 0.010 |
HIV-related factors | ||||||
Time living with HIV | 0.119 | 0.074 | 0.107 | |||
CD4 count | 0.001 | 0.001 | 0.293 | |||
Viral load: suppressed | 0.474 | 0.861 | 0.582 | |||
ART class: dolutegravir-based | 1.179 | 0.640 | 0.065 | |||
COVID-19 and other health information | ||||||
Tested for COVID-19 | −3.417 | 1.355 | 0.012 | −2.943 | 1.334 | 0.027 |
History of chronic illness | 0.356 | 1.467 | 0.808 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Cummings, P.E.; Lakoh, S.; Yendewa, S.A.; Massaquoi, S.P.E.; James, P.B.; Sahr, F.; Deen, G.F.; Salata, R.A.; Gevao, P.; Yendewa, G.A. Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study. Vaccines 2023, 11, 1685. https://doi.org/10.3390/vaccines11111685
Cummings PE, Lakoh S, Yendewa SA, Massaquoi SPE, James PB, Sahr F, Deen GF, Salata RA, Gevao P, Yendewa GA. Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study. Vaccines. 2023; 11(11):1685. https://doi.org/10.3390/vaccines11111685
Chicago/Turabian StyleCummings, Peterlyn E., Sulaiman Lakoh, Sahr A. Yendewa, Samuel P. E. Massaquoi, Peter B. James, Foday Sahr, Gibrilla F. Deen, Robert A. Salata, Pelema Gevao, and George A. Yendewa. 2023. "Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study" Vaccines 11, no. 11: 1685. https://doi.org/10.3390/vaccines11111685