Predictors of COVID-19 Vaccine Hesitancy and Adverse Events following COVID-19 vaccination among People on Anti-retroviral therapy in Nigeria

BackgroundCOVID-19 vaccination is critical among people living with HIV (PLHIV) given the risk of severe COVID-19 disease and hospitalization, due to their immunocompromised state. However, COVID-19 vaccine hesitancy among PLHIV globally has been increasing, thus presenting a risk of continued transmission of the disease. We sought to investigate the rate of, and predictors of COVID-19 vaccine hesitancy among people living with HIV in FCT, Nigeria. Additionally, we sought to investigate adverse events following immunization among PLHIV who were already vaccinated. MethodsA facility-based cross-sectional study was conducted among 164 unvaccinated PLHIV across two-large ART clinics in 2023. An interviewer administered data collection tool was utilized to collect data on socio-demographic information, vaccine hesitancy and barriers to vaccine uptake. Among the unvaccinated individuals, we adapted the WHO-SAGE definition to measure vaccine hesitancy, by asking "Do you still want to take the vaccine?". Descriptive statistics, chi-squares and binary logistic regressions were used to analyse the data in Stata version 18. ResultsMajority of the unvaccinated individuals were female (79.3%), and aged 35-49 years (62.8%). Over half (62.2%, 104) were hesitant to receive a COVID-19 vaccine. On multi-variable logistic regression, the odds of vaccine hesitancy was 5 times higher among participants without pre-existing co-morbidities (AOR: 4.858, 95%CI: 1.109,21.285, p=0.036). Barriers to vaccination among unvaccinated, non-hesitant participants included not knowing available vaccination centers (40.7%, 24/59), and lack of transportation to a vaccination center (22%, 13/59). Among participants who were vaccinated, 45 (52.9%) reported at least one adverse event (AE). Most common AEs reported were local reactions (15, 32.6%), muscle pain (13, 28.2%), fever (10, 21.7%) and malaise (7, 15.2%). The odds of AE were higher among females (OR=3.978, p=0.004). Age, viral load, antiretroviral regimen and presence of other comorbidities did not affect AE occurrence (p-value for all >0.05). No serious AE was reported. ConclusionCOVID-19 Vaccine hesitancy rate was high among our study population. Measures to address vaccine hesitancy among PLHIV should be prioritized by immunization and HIV programs.