Substance use and other factors associated with COVID-19 vaccine uptake among people at risk for or living with HIV: Findings from the C3PNO consortium

Marjan Javanbakht; Lamia Khan; Brian Mustanski; Steve Shoptaw; Marianna K Baum; Shruti H Mehta; Gregory D Kirk; Shenghan Lai; Richard Moore; M-J Milloy; Michele Kipke; Kanna Hayashi; Kora DeBeck; Suzanne Siminski; Lisa M White; Pamina Gorbach

doi:10.1016/j.pmedr.2023.102300

Substance use and other factors associated with COVID-19 vaccine uptake among people at risk for or living with HIV: Findings from the C3PNO consortium

Prev Med Rep. 2023 Jun 24:35:102300. doi: 10.1016/j.pmedr.2023.102300. eCollection 2023 Oct.

Authors

Marjan Javanbakht¹, Lamia Khan¹, Brian Mustanski², Steve Shoptaw³, Marianna K Baum⁴, Shruti H Mehta⁵, Gregory D Kirk^{5

6}, Shenghan Lai⁷, Richard Moore⁶, M-J Milloy⁸, Michele Kipke⁹, Kanna Hayashi¹⁰, Kora DeBeck¹¹, Suzanne Siminski¹², Lisa M White¹, Pamina Gorbach¹

Affiliations

¹ Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
² Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
³ Department of Family Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
⁴ Department of Dietetics and Nutrition, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.
⁵ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁶ Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁷ Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA.
⁸ Department of Medicine, University of British Columbia, Vancouver, Canada.
⁹ Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹⁰ Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
¹¹ School of Public Policy, Simon Fraser University, Vancouver, Canada.
¹² Frontier Science Foundation, Amherst, NY, USA.

Abstract

Objective: We describe the prevalence of COVID-19 vaccine uptake, substance use, and other factors associated with vaccine hesitancy among participants from nine North American cohort studies following a diverse group of individuals at risk for or living with HIV.

Methods: Between May 2021 and January 2022, participants completed a survey related to COVID-19 vaccination. Participants included those with and without substance use. Those responding as 'no' or 'undecided' to the question "Do you plan on getting the COVID-19 vaccine?" were categorized as vaccine hesitant. Differences between groups were evaluated using chi-square methods and multivariable log-binomial models were used to calculate prevalence ratios (PR) of COVID-19 vaccine hesitancy with separate models for each substance.

Results: Among 1,696 participants, COVID-19 vaccination was deferred or declined by 16%. Vaccine hesitant participants were younger, with a greater proportion unstably housed (14.8% vs. 10.0%; p = 0.02), and not living with HIV (48.% vs. 36.6%; p <.01). Vaccine hesitant participants were also more likely to report cannabis (50.0% vs. 42.4%; p = 0.03), methamphetamine (14.0% vs. 8.2%; p <.01), or fentanyl use (5.5% vs. 2.8%; p = 0.03). Based on multivariable analyses methamphetamine or fentanyl use remained associated with COVID-19 vaccine hesitancy (Adjusted PR = 1.4; 95% CI 1.1-1.9 and Adjusted PR = 1.6; 95% CI 1.0-2.6, respectively).

Conclusion: As new COVID-19 vaccines and booster schedules become necessary, people who use drugs (PWUD) may remain vaccine hesitant. Strategies to engage hesitant populations such as PWUD will need to be tailored to include special types of outreach such as integration with substance use programs such as safe injection sites or recovery programs.

Keywords: COVID-19; Substance Use; Vaccine hesitancy.

Abstract

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