Baker Pieter, Cepeda Javier A, Schluth Catherine, Astemborski Jacquie, Feder Kenneth A, Rudolph Jacqueline, Sun Jing, Kirk Gregory D, Mehta Shruti H, Genberg Becky L
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States.
Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States.
Prev Med Rep. 2023 Sep 28;36:102448. doi: 10.1016/j.pmedr.2023.102448. eCollection 2023 Dec.
People who inject drugs (PWID) may have diminished access to essential preventive services like COVID-19 vaccination given structural and substance use barriers. We aimed to assess the role of HIV on COVID-19 vaccination uptake among adult PWID participating in the ALIVE cohort study in Baltimore, Maryland who were alive as of April 2021. We abstracted COVID-19 vaccination data from electronic medical records via the regional health information exchange. We used Kaplan-Meier method to estimate time from universal vaccine eligibility (April 6, 2021) to completion of the COVID-19 vaccination primary series (1 dose J&J or 2 doses mRNA) by HIV viral load status (uninfected, PWH [HIV-RNA < 400 copies/mL], PWH [HIV-RNA ≥ 400 copies/mL]) and Cox Proportional Hazards regression to adjust for potential confounders. Our sample (N = 960) was primarily black (77%) and male (65%) with 31% reporting recent injection drug use. Among 265 (27%) people living with HIV (PWH) in our sample, 84% were virally suppressed. As of February 22, 2022, 539 (56%) completed the primary series, 131 (14%) received a single dose of mRNA vaccine and 290 (30%) remained unvaccinated. Compared to PWID without HIV, virally suppressed PWH were more likely to complete the primary series (Adjusted Hazard Ratio [aHR]:1.23,95% Confidence Interval [95 %CI]:1.07,1.50), while PWH who were not virally suppressed were less likely (aHR:0.72,95 %CI:0.45,1.16), although this was not statistically significant. We conclude that among PWID, HIV infection and viral suppression is associated with quicker vaccination uptake, likely due to HIV care engagement. Targeted improvements along the HIV care continuum may bolster vaccine uptake.
由于结构和药物使用方面的障碍，注射毒品者（PWID）获得新冠疫苗等基本预防服务的机会可能会减少。我们旨在评估艾滋病毒对参与马里兰州巴尔的摩市ALIVE队列研究的成年注射毒品者新冠疫苗接种情况的影响，这些研究对象截至2021年4月仍然存活。我们通过区域健康信息交换从电子病历中提取了新冠疫苗接种数据。我们使用Kaplan-Meier方法估计从普遍符合疫苗接种条件（2021年4月6日）到按艾滋病毒病毒载量状态（未感染、艾滋病毒感染者[HIV-RNA＜400拷贝/mL]、艾滋病毒感染者[HIV-RNA≥400拷贝/mL]）完成新冠疫苗基础系列接种（1剂强生疫苗或2剂mRNA疫苗）的时间，并使用Cox比例风险回归来调整潜在的混杂因素。我们的样本（N = 960）主要为黑人（77%）和男性（65%），31%的人报告近期有注射毒品行为。在我们样本中的265名（27%）艾滋病毒感染者（PWH）中，84%的人病毒得到抑制。截至2022年2月22日，539人（56%）完成了基础系列接种，131人（14%）接种了单剂mRNA疫苗，290人（30%）仍未接种。与未感染艾滋病毒的注射毒品者相比，病毒得到抑制的艾滋病毒感染者更有可能完成基础系列接种（调整后风险比[aHR]：1.23，95%置信区间[95%CI]：1.07，1.50），而病毒未得到抑制的艾滋病毒感染者完成接种的可能性较小（aHR：0.72，95%CI：0.45，1.16），尽管这在统计学上不显著。我们得出结论，在注射毒品者中，艾滋病毒感染和病毒抑制与更快的疫苗接种相关，这可能是由于参与了艾滋病毒护理。在艾滋病毒护理连续过程中进行有针对性的改进可能会促进疫苗接种。
