Influenza Vaccination Uptake and Associated Factors Among Adults With and Without Human Immunodeficiency Virus in a Large, Integrated Healthcare System

Abstract

Background Influenza vaccination is recommended for adults regardless of HIV status. There may be facilitators or barriers to vaccinating people with HIV (PWH) that differ from people without HIV (PWoH). We sought to describe the uptake of influenza vaccination by HIV status and identify factors associated with vaccination. Methods We abstracted data from the electronic health records of PWH and PWoH in Kaiser Permanente Northern California during six influenza seasons (2013-2018). We determined vaccination uptake and used Poisson regression models to evaluate factors associated with vaccination in PWH and PWoH. Results 9,272 PWH and 194,393 PWoH matched by age, sex, and race/ethnicity were included (mean age: 48 vs 49 years; men: 91% vs 90%; white race: 53%). PWH were more likely to receive the influenza vaccine (65%-69% across years for PWH and 37%-41% for PWoH) with an adjusted risk ratio for all years of 1.48 (95% CI: 1.46-1.50). For PWH, lower vaccination uptake was associated with several factors that suggested more complex health needs, such as lower CD4 cell counts, higher HIV viral loads, prior depression diagnoses, having Medicare insurance, and having a higher number of comorbidities. Associations with vaccination uptake were attenuated in PWH, compared with PWoH, for smoking, alcohol, and demographic factors. Conclusions PWH had an almost 50% higher uptake of influenza vaccination than PWoH, possibly reflecting greater engagement with the healthcare system. We also found that PWH with more complex health needs had reduced vaccination uptake. Findings may inform outreach strategies to increase influenza vaccination in PWH.

Assessment of Disease Burden and Immunization Rates for Vaccine-Preventable Diseases in People Living with HIV: The Korea HIV/AIDS Cohort Study

“…In this study, the vaccination rates for HBV and pneumococcus increased annually, which is encouraging, whereas the influenza vaccination rate remained low despite the recommendations for high-priority annual immunization. A study conducted in the US showed that the influenza vaccination rate was almost 50.0% higher among people with HIV than among those without HIV, reflecting greater engagement with the healthcare system [ 14 ]. Therefore, integrated care may play a role in improving vaccination rates in this population.…”

Routine Vaccination During Pregnancy Among People Living With HIV in the United States

“…Data on other vaccinations among PLHIV are limited but suggest receipt of other vaccines, such as the human papillomavirus (HPV) vaccine, which is recommended to be administered post partum, is similarly low . Influenza vaccination rates for the general population of people living with HIV is also suboptimal, with data from a large health system in California from 2013 to 2018 revealing influenza vaccination uptake at 65% to 69% for PLHIV . Given the paucity of data on the topic of routine vaccination in PLHIV, our objective was to estimate the prevalence of and identify factors associated with receiving influenza and/or Tdap vaccinations among pregnant PLHIV participating in a large multisite prospective cohort in the United States.…”

“…24 Influenza vaccination rates for the general population of people living with HIV is also suboptimal, with data from a large health system in California from 2013 to 2018 revealing influenza vaccination uptake at 65% to 69% for PLHIV. 25 Given the paucity of data on the topic of routine vaccination in PLHIV, our objective was to estimate the prevalence of and identify factors associated with receiving influenza and/or Tdap vaccinations among pregnant PLHIV participating in a large multisite prospective cohort in the United States. The study population for this analysis was derived from participants in the WHS (Figure).…”