Determinants of influenza, HBV, and pneumococcal vaccination uptake in people living with HIV: a multilevel and expert survey study

초록

Purpose: The aim of this study was to assess clinical, institutional, and expert-level factors affecting the uptake of influenza, hepatitis B virus (HBV), and pneumococcal vaccines among people living with HIV (PLWH). Method: We analyzed data from the Korea HIV/AIDS Cohort Study (KoCosHIV, 2006–2017), including 1,485 PLWH. Uptake of influenza, HBV, and pneumococcal vaccines was analyzed using multilevel logistic regression. Intraclass correlation coefficient (ICC) values were used to quantify institutional effects. We also analyzed survey responses from 70 HIV care experts to assess clinician-level variability. Results: Vaccination uptake varied: HBV increased markedly (21.7% in 2008 to 75.4% in 2017), pneumococcal rose modestly (3.0% in 2015 to 9.7% in 2017), and influenza remained stable (33–36%). In multilevel models, HBV uptake was associated with higher CD4 counts, pneumococcal with lower viral load, and influenza with male sex and ART changes. Influenza uptake was significantly associated with eGFR stage (p=0.002); PLWH with mildly reduced kidney function (stage 2) had the highest vaccination rates, while those with normal function (stage 1) were less likely to be vaccinated. Institutional factors explained up to 32% of total variance, indicating substantial differences in practices across institutions. The expert survey revealed variability in practices. For HBV, 36.9% of experts administer the vaccine for CD4 ≥200, 18.5% for ≥350, and 44.6% regardless of CD4 count. Only 1.5% administer a high-dose vaccine, while 89.2% check for antibody production. For pneumococcal vaccination, 42.3% administer PCV13 for CD4 ≥200, 19.6% for ≥350, and 38.1% regardless. For PPSV23, 45.3% administer it for CD4 ≥200, 17.0% for ≥350, and 37.7% for all PLWH regardless of CD4 count. For influenza, all experts (100%) reported administering it annually to people living with HIV. Conclusions: Vaccine uptake among PLWH is influenced by clinical, institutional, and expert-level factors. Reducing variation through standardized guidelines and improved coordination may enhance vaccination coverage.