Determinants of vaccine uptake in HIV-affected families from West Bengal

Figures & data

Table 1. Demographics and family organization of families who participated in the immunization study (N = 172)

	HIV infected children	HIV uninfected children	P value
N	125	47
Rural, n (%)	114 (91.2%)	46 (97.8%)	.126
Vaccination card, n (%)
No	27 (21.7%)	0	-
Religion, n (%)
Hindu	112 (89.6%)	45 (95.7%)	.2
Muslim	12 (9.6%)	1 (2.1%)	.099
Buddhist	1 (0.8%)	1 (2.1%)	.469
Male child, n (%)	77 (61%)	22 (46.8%)	.08
Where immunized, n (%)
Government	119 (95.2%)	47 (100%)	.162
Private	2 (1.6%)	0	-
NGO	2 (1.6%)	0	-
Hospital based government clinic	1 (0.8%)	0	-
Proximity to ART center, km median (IQR)	65 (52, 79)	NA	-
Time to ART center, hour median (IQR)	4 (4, 4)	NA	-
Father HIV, n (%)	65 (83%)	0	-
Mother HIV, n (%)	104 (89%)	0	-
Parent data
Mother living, n (%)	116 (92.8%)	47 (100%)	.059
Father living, n (%)	78 (62.4%)	47 (100%)	<.0001
Mother’s education (yrs) median, IQR	7 (4, 9)	9 (5, 10)	.0028
House
Brick/cement	44 (35.2%)	31 (66%)	.0002
Mud	78 (62%)	16 (34%)	.0008
Temporary hut	2 (1.6%)	0	-
Asbestos	1 (0.8%)	0	-
Family income, median (IQR25, IQR75) (INR)	9478 (9478, 11362)	9478 (7594, 9478)	.0001
Kuppuswamy socioeconomic index, n (%)
Upper-middle	49 (39.2%)	4 (8.5%)	.0001
Middle	68 (54%)	31 (66%)	.17
Upper-lower	7 (5.6%)	11 (23.4%)	.006
Lower	1 (0.8%)	1 (2.1%)	.47

Table 2. Immunization coverage in children living with and without HIV

	HIV infected children (2–14 years)	HIV uninfected children (2–5 years)	HIV infected children (2–5 years)	P^!	P^#
N	125	47	31
Fully immunized*	88 (70%)	47 (100%)	26 (84%)	<.0001	.008
Incompletely immunized**	17 (13.6%)	0	4 (13%)	.008	.022
Unimmunized***	20 (16%)	0	1 (3%)	.004	.397
Incompletely or unimmunized	37 (29.6%)	0	5 (16%)	.001	.008
Overall Immunization coverage, n (%)
Vaccines in first 12 months of life
BCG	104 (83.2%)	47 (100%)	30 (97%)	.01	.397
OPV 1–3	96 (76.8%)	47 (100%)	29 (93%)	.001	.15
DPT 1–3	100 (80%)	47 (100%)	28 (90%)	.004	.059
Measles 1	97 (77.6%)	47 (100%)	27 (87%)	.002	.022
Hepatitis B 1–3	27 (21.6%)	40 (85%)	11 (35%)	<.0001	<.0001
Vaccines in 12–24 months of life
OPV Booster	11 (8.8%)	37 (78.7%)	5 (16%)	<.0001	<.0001
DPT Booster-1	18 (14.4%)	41 (87.2%)	5 (16%)	<.0001	<.0001
Measles 2	1 (0.8%)	26 (55%)	1 (3%)	<.0001	<.0001

^!P-value comparing HIV-infected children (under 15 years) and HIV-uninfected children; ^#P value comparing HIV-infected children (under 5 years) and HIV-uninfected children; *Fully immunized is defined as the children who received one dose of BCG, three doses of DPT, three doses of OPV(excluding the 0 dose of OPV) and one dose of measles vaccine by 12 months of age; **Incomplete immunization is defined as the children who received at least one but not all recommended vaccines(excluding the 0 dose of OPC) by 12 months of age;***Unimmunized is defined as the children who did not receive any of the recommended vaccines by 12 months of age.

Table 3. Factors influencing the risk for incomplete or un-immunization in study children (n = 172)

	Risk Ratio (RR)	95% CI	P*
Child’s HIV	4.637	1.5, 14.3	.0013
Maternal HIV	4.82	1.5, 14.9	.001
Child’s male gender	0.814	.47, 1.4	.46
Child’s female gender	1.227	.71, 2.1	.46
Rural	1.425	.39, 5.2	.575
Urban	0.701	.19, 2.56	.575
Hindu religion	0.45	.24,.83	.0247
Islam religion	2.15	1.1, 4.16	.042
Buddhism religion	2.179	.53, 8.95	.368
Single parent	1.418	.81, 2.47	.224
Single mother	1.42	.79, 2.54	.244
Single father	1.258	.37, 4.2	.71
>1 child in family	1.295	.66, 2.51	.434
Maternal age
<18 years	0.886	.40, 1.9	.76
19–25 years	1.21	.67, 2.19	.522
26–35 years	0.564	.28, 1.12	.085
Maternal schooling
High school & above (> or = 9 years)	0.709	.37, 1.33	.28
Middle school (6–8 yr)	0.743	.36, 1.5	.398
Primary school (1–5 years)	1.15	.53, 2.4	.723
No schooling	1.859	1.03, 3.35	.048
Socioeconomic status, n
Upper-middle	1.081	.60, 1.92	.792
Middle	1.106	.63, 1.92	.721
Upper-lower	0.693	.237, 2.02	.484
Absence of vaccine card	5.428	3.4, 8.69	<.0001

Table 4. Responses of HIV-affected families and HIV-unaffected families on the reasons for uptake of study vaccines (HibCV and PCV13)

	HIV affected	HIV unaffected
N	64	35
Access
Vaccination card available, n (%)	58 (90.6%)	35 (100%)
Time to travel to ART/Immunization center, hours (Median)	3 h	0.27 h (16 min)
Geographical factors prevented from taking UIP vaccines? n (%)	1 (1.5%)
Affordability
Travel expenses to visit treatment center, (Median) (INR)	120
Ready to pay for three doses of study vaccines, n (%)	57 (89%)	32 (91.4%)
Ready to pay for HibCV and PCV13, n (%)	57 (89%)	32 (91.4%)
The amount you can pay for HibCV (Median, IQR) (INR)	300 (50, 300)	300 (200, 300)
The amount you can pay for 3 doses of PCV(Median, IQR) (INR)	500 (300, 1000)	750 (500, 2000)
Awareness
Were you aware of pneumonia before participating in the study, n (%)
No	53 (83%)	32 (91%)
Do you think pneumonia is a potentially important health problem for children, n (%)
Yes	56 (87.5%)	33 (94.3)
How did you come to know about this study, n (%)
Medical officer	2 (3.12%)	0
Study staff	3 (4.7%)	0
Outreach worker/Health center staff	52 (81.2%)	29 (83%)
Study participants	2 (3.12%)	1 (2.8%)
Others	5 (7.8%)	5 (14.3%)
Who took decision to participate in the study, n (%)
Own decision	59 (92%)	29 (83%)
How difficult was it for you to decide if you should participate in the study, n (%)
Scale 1, Not at all difficult	49 (76%)	28 (80%)
Scale 2, Not difficult	5 (7.8%)	3 (8.5)
Scale 3, Neutral	4 (6.25%)	3 (8.5)
Scale 4, Difficult	4 (6.25%)	1 (2.8%)
Scale 5, Highly difficult	1 (1.5%)	0
What was most important for your decision to participate and continue the follow-up, n (%)
Information through audiovisual and discussion	25 (39%)	7 (20%)
Given at ART center where we could attend other ART services due in that week along with study visit	1 (1.5%)
Recommended by health care provider or friends	1 (1.5%)	1 (2.8%)
Other	37 (57.8%)	27 (77%)
For good health and wellbeing of my child	33 (89%)	26 (96%)
Acceptance
How likely will you consider immunization with Hib/PCV to your unvaccinated child or other children in your family, if given free through government? You have to come to hospital 3 times for schedule, n (%).
Scale 1, Strongly disagree	1 (1.5%)	-
Scale 2, Disagree	1 (1.5%)	-
Scale 3, Neutral	-	1 (3%)
Scale 4, Agree	7 (11%)	1(3%)
Scale 5, Strongly agree	55 (86%)	33(94%)
How likely will you recommend these vaccines to other friends or relatives, n (%)
Scale 1, Strongly disagree	3 (4.6%)	1 (2.8%)
Scale 2, Disagree	1 (1.5%)	-
Scale 3, Neutral	3 (4.6%)	-
Scale 4, Agree	8 (12.5%)	-
Scale 5, Strongly agree	49 (77%)	34 (97%)
How strongly do you feel that the study vaccines has impacted on your child’s health, n (%)
Yes	44 (69%)	21 (60%)
Scale 1, Strongly disagree	2 (3.1%)
Scale 2, Disagree
Scale 3 Neutral	13 (26.6%)	14 (40%)
Scale 4, Agree	35 (55%)	16 (46%)
Scale 5, Strongly agree	9 (14%)	5 (14%)
Did you had concern of adverse events from the vaccine, before participating in the study, n (%)
Yes	26 (40.6%)	12 (34.3%)
Scale 1, Strongly disagree
Scale 2, Disagree
Scale 3, Neutral	15 (57.7%)	5 (42%)
Scale 4, Agree	6 (23%)	6 (50%)
Scale 5, Strongly agree	5 (19%)	1 (8%)
Activation
Was the audiovisual presentation and the discussion before consent process understandable to you?
Yes	64 (100%)	35 (100%)
Scale 1, Strongly disagree	0	5 (14%)
Scale 2, Disagree	9 (14)	1 (2.8%)
Scale 3, Neutral	25 (39%)	18 (51%)
Scale 4, Agree	13 (20%)	4 (11%)
Scale 5, Strongly agree	17 (26%)	7 (20%)
Did you have enough opportunity to ask questions before participating in the study?
Yes	64 (100%)	35 (100%)