Predictors of vaccination rates in people living with HIV followed at a specialty care clinic

Figures & data

Table 1. Vaccinations analyzed per the CDC’s 2018 immunization guidelines for PLWH

1. HepA (Hepatitis A)

2. HepB (Hepatitis B)

3. HPV (Human Papillomavirus)

4. Influenza

5. PCV13 (Pneumococcal Conjugate)

6. PPSV23 (Pneumococcal Polysaccharide)

7. Tdap/Td (Tetanus and Diptheria, with or without acellular pertussis)

8. ZVL (Zoster Vaccine Live)

CDC = Centers for Disease Control and Prevention, PLWH = People Living with HIV

Table 2. Study population demographics

Variable	Value	Total Population n = 502; n (%)	Adherent n = 206; n (%)	Non-Adherent n = 296; n (%)	P Value
Age, years	< 49	245 (48.8)	100 (48.5)	145 (49.0)	.59
	≥ 49	257 (51.2)	106 (51.5)	151 (51.0)
Sex/gender	Female	112 (22.3)	50 (24.3)	62 (20.9)	.37
	Male	381 (75.9)	154 (74.8)	227 (76.7)
	Transgender MTF	9 (1.8)	2 (1.0)	7 (2.4)
Race/ethnicity	White	268 (53.4)	105 (51.0)	163 (55.1)	<.01^a
	Hispanic/Latino	70 (13.9)	32 (15.5)	38 (12.8)
	Black/African American	143 (28.5)	52 (25.2)	91 (30.7)
	American Indian/Alaskan Native	4 (0.8)	2 (1.0)	2 (0.7)
	Asian	17 (3.4)	15 (7.3)	2 (0.7)
MSM status^b	Non-MSM	231 (46.0)	110 (53.4)	121 (40.9)	.01
	MSM	271 (54.0)	96 (46.4)	175 (59.1)
Distance from clinic, miles	< 15	402 (80.1)	171 (83.0)	231 (78.0)	.30
	15–70	62 (12.4)	20 (9.7)	42 (14.2)
	> 70	38 (7.6)	15 (7.3)	23 (7.8)
Number of clinic visits/year	< 3	255 (50.8)	105 (51.0)	150 (50.7)	.95
	≥ 3	247 (49.2)	101 (49.0)	146 (49.3)
Percentage of missed clinic appointments	≤ 10%	264 (52.6)	131 (63.6)	133 (44.9)	<.01
	> 10%	238 (47.4)	75 (36.4)	163 (55.1)
Employment status	Unemployed	174 (34.7)	63 (30.6)	111 (37.5)	.11
	Employed/Retired	328 (65.3)	143 (69.4)	185 (62.5)
Insurance status and assistance programs	Uninsured	37 (7.4)	17 (8.3)	20 (6.8)	.25
	Ever received Medicare/Medicaid	173 (34.5)	61 (29.6)	112 (37.8)
	Ryan White/ADAP	204 (40.6)	87 (42.2)	117 (39.5)
	Private Insurance Only	88 (17.5)	41 (19.9)	47 (15.9)
Primary care clinic	UNMC HIV Clinic	152 (30.3)	63 (30.6)	89 (30.1)	.61
	Other UNMC Clinic	112 (22.3)	50 (24.3)	62 (20.9)
	Non-UNMC Clinic	238 (47.4)	93 (45.1)	145 (49.0)
Most recent CD4 count, cells/mm^3	> 200	471 (93.8)	204 (99.0)	267 (90.2)	<.01
	≤ 200	31 (6.2)	2 (1.0)	29 (9.8)
Most recent HIV RNA level, copies/mL	≤ 50	437 (87.1)	187 (90.8)	250 (84.5)	.04
	> 50	65 (12.9)	19 (9.2)	46 (15.5)

Data are presented as n (%). P-values are based on univariate analysis.

Abbreviations: Transgender MTF = Transgender Male to Female; MSM = Men who have sex with men

^aP-value indicates a higher percentage of Asian population in the Adherent cohort.

^bMSM was used to delineate eligibility for vaccination with HepA as defined in the 2018 CDC Immunization Guidelines.

Table 3. Adjusted odds ratios of non-adherence by predictor variable

Variable	Adjusted Odds Ratio (95% CI)	P Value
Age ≥ 49 years	1.28 (0.86–1.92)	.23
Male sex at birth	0.78 (0.45–1.36)	.38
Nonwhite race	0.87 (0.58–1.31)	.50
MSM	2.03 (1.26–3.27)	<.01
Distance ≥ 15 miles	1.57 (0.95–2.58)	.08
Office visits ≥ 3 per year	1.12 (0.76–1.65)	.56
Missed appointments > 10%	2.21 (1.48–3.29)	<.01
Currently employed	0.78 (0.51–1.19)	.25
Currently insured/receiving assistance^a	1.18 (0.55–2.53)	.67
PCP outside of HIV clinic	1.13 (0.90–1.41)	.29
CD4 ≤ 200 cells/mm^Citation3*	9.44 (2.14–41.57)	<.01
HIV RNA > 50 copies/mL	1.30 (0.70–2.41)	.40

P-values are based on multivariable logistic regression. Abbreviations: MSM = men who have sex with men; PCP = primary care provider

^aDefined as private health insurance, Medicare or Medicaid, Ryan White or ADAP assistance, or ADAP-facilitated health insurance.

Figure 1. Percentage of eligible patients that received each vaccine. All patients (n = 502) were eligible for vaccination with Hepatitis B (HepB), Influenza, Pneumococcal Conjugate (PCV13), and Tetanus, Diptheria, with/without acellular pertussis (TDaP/TD) vaccines. The number of eligible patients for other vaccines is as follows: Hepatitis A (HepA): 271; Human Papillomavirus (HPV): 48; Pneumococcal Polysaccharide (PPSV23): 452; Zoster Vaccine Live (ZVL): 70

Tengan FM, Abdala E, Nascimento M, Bernardo WM, Barone AA. Prevalence of hepatitis B in people living with HIV/AIDS in Latin America and the Caribbean: a systematic review and meta-analysis. BMC Infect Dis. 2017;17(1):587. doi:10.1186/s12879-017-2695-z.

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