People's Uptake Research Articles

Developing a Theory-Based Instrument for Pre-Exposure Prophylaxis (PrEP) Uptake in People of Color Using a Qualitative Approach.

There is a large disparity in Pre-exposure Prophylaxis (PrEP) utilization among communities of color compared to White Americans. There is also a lack of theory-based survey instruments to measure the underlying reasons for the disparity among communities of color. The purpose of this study was to create an instrument based on a qualitative approach involving community interviews. Semi-structured interviews guided by the Multi-theory Model (MTM) of health behavior change were performed in a sample of 12 members from communities of color. The analysis entailed a directed content analysis along the themes of MTM constructs to develop a survey instrument. The barriers to PrEP that emerged included the cost of PrEP, lack of protection from other sexually transmitted diseases, reduced trust between partners, and the stigma associated with PrEP. The perceived disadvantages included the potential cost of PrEP, partner mistrust when taking PrEP, discussion of sexual behaviors with a provider, and unclear process of acquiring the PrEP prescription. The results guided the development of a survey tool to further investigate aspects of cost, partner relations, stigma, reassurance of safety, and other factors. The tool can be used for future studies as part of guided interventions to increase PrEP uptake.

Advancing Vaccine Uptake in People With HIV: A Call for Research on Trust and Intellectual Humility in Health Care.

This article addresses the challenge of vaccine hesitancy among people with HIV (PWH), emphasizing the need for research on the potential impact of trust and intellectual humility in health care. It underscores the complexity of vaccine acceptance in PWH and the urgency of addressing hesitancy in PWH ahead of a future HIV vaccine. The article identifies trust in health care providers as a critical factor influencing vaccine uptake and proposes that providers who demonstrate intellectual humility-openly recognizing the limits of their knowledge-might enhance patient trust. The role of nurses is spotlighted because of their social positioning in the patient experience. The article advocates for interventions tailored to PWH's unique experiences and attitudes. Such strategies are essential for improving vaccine uptake and, consequently, public health outcomes.

Health and Financial Literacy and the Acquisition of COVID-19 Knowledge in Older Adults.

Knowledge about COVID-19 enters into many aspects of decision making, especially for older people who are at increased risk of severe disease or death. Yet little is known about the resources that supported older people's uptake of COVID-19 knowledge. Here, we hypothesized that higher pre-pandemic health and financial literacy was associated with higher COVID-19 knowledge. Participants were 434 community-based older people without dementia. COVID-19 knowledge was assessed via a 5-item measure, and health and financial literacy was assessed via a 32-item measure. In an ordinal regression model adjusted for age, gender, and education, higher literacy was associated with higher COVID-19 knowledge (p < .0001), and this association persisted after further adjusting for robust measures of global cognition or one of five specific cognitive domains (all p's ≤ .0001). These findings suggest that literacy plays a key role in supporting older people's acquisition of impactful knowledge in the real world.

COVID-19 Vaccine Acceptance, Hesitancy, and Uptake in People with Diabetes in Australia.

Background: This study explored vaccination hesitancy, diabetes-specific COVID-19 vaccination concerns, and whether they predicted vaccination uptake in people with diabetes. Methods: Quantitative, cross-sectional, and predictive approaches were used. An online survey was conducted with people with diabetes attending four Australian health services, using convenience sampling (n = 842). The survey data collected included clinico-demographic characteristics, COVID-19 vaccine hesitancy, and attitudes around COVID-19 vaccine confidence and complacency. Clinico-demographic characteristics that predicted vaccination status, vaccine hesitancy, and vaccine-related attitudes were identified using regression analyses. Results: Most participants received at least one COVID-19 vaccine dose. Younger age and type 1 diabetes were associated with lower vaccination status, and they were partially mediated through higher vaccine hesitancy. Younger age and English as a dominant language were associated with higher negative attitudes towards speed of vaccine development. Conclusions: Despite an overall high vaccination rate, general and diabetes-specific COVID-19 vaccine concerns are a barrier to uptake for some people with diabetes, particularly in those who are younger or have type 1 diabetes. A detailed understanding of concerns for particular subgroups can help tailor information to increase vaccine acceptance, particularly in the context of requiring booster doses.

Low COVID-19 vaccine uptake in people living with HIV and those with hypertension and diabetes without HIV at Mbarara and Masaka regional referral hospitals: A cross-sectional survey.

Chronic diseases such as HIV, hypertension, and diabetes increase the risk of severe coronavirus disease 2019 (COVID-19) and death. Thus, COVID-19 vaccine uptake data among these priority populations are needed to inform immunization programs. We assessed COVID-19 vaccine uptake among people living with HIV (PLWH) and those with hypertension/diabetes without HIV (PWoH) in Southwestern and Southcentral Uganda and determined factors influencing vaccination. We conducted a cross-sectional study from January to April 2023. We enrolled a random sample of participants aged 18 years and older seeking HIV, hypertension, or diabetes care at two regional referral hospitals (RRHs) in Mbarara and Masaka in Uganda. Using vaccination records abstraction and interviewer-administered questionnaires, we collected data on COVID-19 vaccine uptake, sociodemographic data, and reasons for non-uptake in unvaccinated persons. We compared COVID-19 vaccination uptake between PLWH and PWoH and applied modified Poisson regression to determine sociodemographic factors associated with vaccine uptake. The reasons for non-vaccine uptake were presented as percentages. Of the 1,376 enrolled participants, 65.6% were fully vaccinated against COVID-19. Vaccination coverage was 65% among PWLH versus 67% among PWoH. Higher education attainment and older age were associated with COVID vaccination. Participants with secondary education and those aged ≥50 years achieved >70% coverage. Fear of side effects was the most cited reason (67%) for non-vaccination among 330 unvaccinated participants, followed by vaccine mistrust (24.5%). People with chronic diseases in Southwestern Uganda had slightly lower than 70% COVID-19 vaccine coverage as recommended by WHO. Higher educational attainment and older age were linked to increased vaccine uptake. However, mistrust and fear of vaccine side effects were the main reasons for non-vaccination. To increase COVID-19 vaccine uptake, programs must reach those with lower educational attainment and younger age groups, and address the fear of vaccine side effects and mistrust among persons with underlying diseases in Uganda.

The effect of a financial incentive on COVID-19 vaccination uptake, and predictors of uptake, in people experiencing homelessness: A randomized controlled trial

People who are homeless are at increased risk of COVID-19 infection, and of poorer associated outcomes. Delivering vaccinations to, and ensuring uptake of multiple doses in, people who are homeless is complex. Financial incentives may improve vaccination uptake, particularly in people who have not received routine vaccinations previously, though evidence about the effect of incentives is limited and variable.This randomized controlled trial (ANZCTR 383156) assessed the effect of a financial incentive (an A$10 grocery voucher) on uptake of the second COVID-19 vaccination in Australian adults who were homeless, and who had received their first dose. Participants were recruited through a vaccination program for people experiencing homelessness between September 2021 and January 2022. They were followed-up for a minimum of 6.5 months. Uptake was measured ‘on-time’ at 6 weeks, and at any time during the trial period. Vaccination status was checked on the Australian Immunisation Register. Demographic and vaccination program characteristics associated with uptake were also investigated.Eighty-six people consented to participate, and 43 were randomly allocated to each of the ‘incentive’ and ‘no incentive’ groups. The incentive slightly increased the likelihood of a participant receiving a second vaccination on-time (risk difference (RD), 11.6 % [95 %CI, −9.0, 32.2 %]; p = 0.27), and at any time during the trial (RD, 14.0 % [95 %CI, –2.2, 30.1 %], p = 0.09). The incentive had a significant positive effect on uptake in people with no previous vaccination history, increasing their likelihood of receiving a second vaccination on-time (RD, 42.3 % [95 %CI, 15.7, 68.8 %]; p = 0.002) and at any time during the trial (RD, 38.7 % [95 %CI, 16.1, 61.3 %], p < 0.001).Financial incentives may increase COVID-19 vaccination uptake in people who are homeless, and particularly those who have no previous vaccination history. Future research should consider alternative incentive values, types, and cost-effectiveness.

Using a theoretical framework of Intervention Mapping to inform public health communication messages designed to increase vaccination uptake; the example of mpox in the Netherlands

IntroductionDuring an infectious disease outbreak, primary preventive pre-exposure vaccination (PPV) could substantially increase the potential for its control, if uptake is sufficiently high. An important tool to increase PPV uptake, are communication strategies, with tailored messages targeted to modify determinants for PPV uptake. Here, we take the example of the 2022 mpox multicountry outbreak, as we inform the development of communication strategies by applying a theoretical framework for selecting effective communication strategies.MethodsThe theoretical framework Intervention Mapping (IM) was applied during the outbreak to inform communications [program]. Steps included: 1. Creating a logic model of the problem [not accepting PPV] by reviewing available literature, conducting an online survey among people at risk of mpox exposure, and consulting community-members, healthcare-and communication professionals; 2. Creating a matrix of change [from lower to higher PPV acceptance]; and 3. Selecting theory-based methods and practical applications for communication messages to achieve the intended behaviour change (getting vaccinated).ResultsThe program objective was to promote PPV uptake in people at risk of mpox exposure. Important changeable determinants identified included perceived risk and severity of mpox, importance to protect against mpox [attitude], experienced effectiveness of vaccination and side-effects [response efficacy], and social norm. Theory-based communication methods for optimizing these determinants include provision of facts [increasing knowledge], personalized risk and scenario-based risk information [addressing risk perception/severity], elaboration, arguments [stimulating a positive attitude], gain framing [increasing perceived response efficacy], guided practice [increasing skills/self-efficacy in overcoming barriers] and social norm approach [demonstrating positive norm]. Other key important factors include that communication delivery is uniform (across channels), clear, accessible, and with stigma-free messaging, and that is well-timed and repeated.ConclusionIM provided a valuable tool in selecting communication methods to promote mpox vaccination uptake. These methods can be used to (more quickly) produce and implement a communication program in the context of possible future, vaccine-preventable, infectious disease outbreaks.

2360. Factors Affecting COVID-19 Vaccine Uptake in People Living with HIV

Abstract Background There is a lack of available data regarding COVID-19 vaccination rates in people living with HIV (PLWH). We examined a group of PLWH to evaluate the association between specific demographics and COVID-19 vaccine uptake. Methods This is a retrospective observational study which included PLWH who were seen in an HIV clinic at an academic medical center in Memphis, TN. 300 randomly selected PLWH who had been seen at least once in the clinic within an 18-month study period during the COVID-19 pandemic were included. Univariate analysis using Chi Square and T tests followed by multivariable regression including significant results from univariate analysis identified factors associated with COVID-19 vaccine uptake. Results 300 PLWH between January 2021 to June 2022 were included in the study. 248 (82.67%) were Black, 27 (9%) were White, 2 (0.67%) were Asian, and 23 (7.67%) were of multiracial/other races. The average age was 47 years old. 243 (81%) were retained in care, defined as 3 visits within the 18-month period with 2 of them being at least 6 months apart. 239 (81.29%) of the participants had a suppressed HIV viral load, defined as HIV RNA &amp;lt; 200 copies/mL. The mean number of total vaccinations in the previous 3 years was 4.61, and the mean number of influenza vaccinations in the past 3 years was 1.64. 207 (69%) of the participants received at least 1 COVID-19 vaccine, with 187 (62.33%) being fully vaccinated, defined as 2 doses of mRNA or 1 adenovirus vector vaccine. Age, number of attended clinic visits, retention in care, viral suppression, and number of previous vaccinations were associated with receiving at least one COVID-19 vaccine in univariate analysis, while only age (odds ratio (OR) 1.07, p&amp;lt; 0.0001), number of influenza vaccinations in the past 3 years (OR 0.58, p=0.03), and total number of vaccinations in the prior 3 years (OR 2.29, p&amp;lt; 0.0001) were significant in multivariable analysis.Table 1.Demographics and COVID-19 vaccine uptake, N=300.Table 2.Multivariable analysis, N=294. Conclusion Age and total number of vaccinations in the past 3 years were positively correlated with having at least one COVID vaccine. Number of influenza vaccinations in the past 3 years was negatively correlated with having at least one COVID vaccine. Further study is needed to identify targeted interventions to improve vaccine uptake in this population. Disclosures All Authors: No reported disclosures

2379. An Urban Detroit Clinic’s Experience in Bivalent COVID-19 Booster Uptake in People Living with HIV

Abstract Background Both HIV and COVID-19 disproportionately affect vulnerable communities. People living with HIV (PLWH) are a priority population for COVID-19 vaccination. Bivalent COVID-19 boosters (BCB) were granted emergency use authorization on August 31, 2022. We assessed onsite BCB uptake amongst PLWH enrolled at our HIV clinic in Detroit, Michigan. Methods HIV care data was obtained from CareWare collected as part of Ryan White program quality initiatives. BCB (Pfizer/BioNTech and Moderna) administration data from September 1, 2022 to March 20, 2023 was pulled using Current Procedural Terminology codes from our Athena electronic medical record. We excluded patients &amp;lt; 18 years old. A deterministic match was done using name and date of birth. Of 2268 PLWH, 1,921 (84.7%) had complete care data. The outcome of interest was the percentage of patients who received the BCB. Covariates examined were gender, age (years), race, CDC transmission risk factor, year of HIV diagnosis, insurance type, HIV viral load measurement after Sep. 1, 2022, and most recent HIV viral load value (&amp;lt; or &amp;gt; 200 copies/mL). Bivariate analysis was done using Wilcoxon rank sum test and Pearson's Chi-squared test. Statistical significance was defined as P &amp;lt; 0.05. We used R 4.3.0 for all analyses. Results Of 1,921 PLHW, 519 (27%) received the BCB. Compared to PLWH 18-29, those 50 years and older were more likely to receive the BCB (P &amp;lt; 0.001). Although not statistically significant, Black PLWH (26%) were less likely to have been vaccinated with the BCB compared to white PLWH (32%, P &amp;lt; 0.30). BCB uptake was higher in PLWH diagnosed with HIV prior to 2010 (P &amp;lt; 0.001). PLWH enrolled in Medicare were more likely to receive the BCB than those with other or no insurance (P &amp;lt; 0.001). No statistically significant trends were found based on CDC HIV transmission risk factor. Only 5% of PLWH who underwent HIV viral load testing before Sep. 1, 2022 received the BCB compared to 33% with testing after Sep. 1, 2022 (P &amp;lt; 0.001). Patients with viral load &amp;lt; 200 copies/mL (28%) had a higher BCB vaccination rate compared to those with viral load &amp;gt; 200 copies/mL (16%, P &amp;lt; 0.001). Conclusion Vaccine surveillance studies such as this one are critical to equitable vaccine distribution to PLWH by identifying subpopulations that may benefit from more intensive outreach. Disclosures All Authors: No reported disclosures

Conceptualizing Health-Seeking Behavior among Adolescents and Youth with Substance Use Disorder in Urban KwaZulu-Natal

In a setting where substance use is rife, understanding contextual factors that influence an individual’s perceived eligibility to seek rehabilitation is paramount. The study explores how situational factors influence an individual’s perceived eligibility for healthcare uptake in people with substance use disorder (SUD). Using qualitative methods, the study draws on in-depth interviews with 20 substance users and 20 family members to unpack how individuals with SUD negotiate their eligibility for health services. Findings show that substance users are aware of their substance use habits and acknowledge their eligibility for health services with information on the navigation of health services is shared by peers and family members. Access and use of health services is hindered by individual determinants and the availability of health services for substance users, such as rehabilitation centers. The hunt for drugs and long waiting queues for health service acquisition overshadows substance users’ claim to health services. Future research should prioritize understanding substance use and health seeking behavior at a context specific level in community settings so that, even in the absence of substance use health facilities, substance use is addressed at least from a harm reduction perspective which can improve health outcomes.

A systematic review and meta-analysis of the global prevalence and determinants of COVID-19 vaccine acceptance and uptake in people living with HIV

People living with HIV (PLHIV) are at higher risk of poor outcomes of SARS-CoV-2 infection. Here we report the pooled prevalence of COVID-19 vaccine acceptance/uptake and determinants among this vulnerable population of PLHIV based on a systematic review and meta-analysis of studies published by 25 August 2023. Among the 54 included studies (N = 167,485 participants), 53 (N = 166,455) provided data on vaccine acceptance rate, while 27 (N = 150,926) provided uptake data. The global prevalences of COVID-19 vaccine acceptance and uptake were 67.0% and 56.6%, respectively. Acceptance and uptake rates were 86.6% and 90.1% for the European Region, 74.9% and 71.6% for the Region of the Americas, 62.3% and 78.9% for the South-East Asian Region, 64.6% and 19.3% for the Eastern Mediterranean Region, 58.0% and 35.5% for the African Region, and 57.4% and 44.0% for the Western Pacific Region. The acceptance rate increased from 65.9% in 2020 to 71.0% in 2022, and the uptake rate increased from 55.9% in 2021 to 58.1% in 2022. Men, PLHIV aged ≥40 years and those who had recently received the influenza vaccine were more likely to accept and receive the COVID-19 vaccine. Factors associated with lower uptake included Black race, other races (Latinx/Hispanic/mixed race), low education level and being unemployed. Vaccine-related factors associated with higher acceptance included belief in vaccine effectiveness, vaccine trust, perceived high susceptibility to SARS-CoV-2 infection and fear of potential COVID-19 effect in PLHIV. Sustained efforts and targeted interventions are needed to reduce regional disparities in COVID-19 vaccine uptake among PLHIV.

'It's a fragile open door'-enhancing COVID-19 vaccination rates in people receiving treatment for substance use disorder.

People with substance use disorder are at high risk of harms from COVID-19 infection. Vaccine hesitancy is common in this population and compounds pre-existing barriers to accessing health care. A drug and alcohol service in Sydney, Australia introduced strategies to enhance COVID-19 vaccination in people receiving opioid agonist treatment (OAT). We report vaccination outcomes and staff experiences of this. This mixed methods study (i) retrospectively evaluated vaccine uptake in people accessing OAT and (ii) explored perceptions of staff who delivered vaccination interventions through surveys and semi-structured interviews. Of the 984 patients receiving OAT on 9 December 2021, 90.9% had received the first COVID-19 vaccination and 86.7% the second. Australia wide vaccination rates on that date were 93.1% and 88.7% for first and second doses, respectively. Staff commented that having a deep knowledge, understanding and connection with the patient group drove implementation and success of vaccination interventions. This was further supported by staff engagement with the vaccination interventions, and communication and sharing information, both between staff and with patients. High rates of COVID-19 vaccination can be achieved in a vulnerable population. Engaged staff providing information and facilitating access to healthcare underpin this success.

Optimising recruitment to a lung cancer screening trial: A comparison of general practitioner and community-based recruitment.

Pre-trial focus groups of the Early detection of Cancer of the Lung Scotland (ECLS) trial indicated that those at high risk of lung cancer are more likely to engage with community-based recruitment methods. The current study aimed to understand if general practitioner (GP) and community-based recruitment might attract different groups of people, and to quantitatively explore the demographic and psychosocial differences between people responding to GP or community-based recruitment. Secondary data analysis of ECLS trial baseline data. Adults (n = 11,164) aged 50 to 75 years completed a baseline questionnaire as part of their participation in the ECLS trial. The questionnaire assessed smoking behaviour, health state, health anxiety and illness perception. Alongside demographic characteristics, how participants were made aware of the study/participant recruitment method (GP recruitment/community recruitment) was also obtained via trial records. The likelihood of being recruited via community-based methods increased as deprivation level decreased. Those recruited via the community had higher levels of perceived personal control of developing lung cancer and were more likely to understand their own risk of developing lung cancer, compared to those who were recruited to the trial via their GP. Health state and health anxiety did not predict recruitment methods in multivariable analysis. Community and opportunistic screening invitations were associated with uptake in people from less-deprived backgrounds, and therefore might not be the optimal method to reach those at high risk of lung cancer and living in more deprived areas.

COVID-19 vaccination uptake in people with multiple sclerosis compared to the general population.

To determine the COVID-19 vaccine uptake among people with multiple sclerosis (pwMS) compared to the general population in Croatia. Data from all pwMS entered in the MS Base register until March 24th, 2022 were extracted including age, sex, MS phenotype, disease-modifying therapy (DMT), and date of COVID-19 vaccination. Data on the general population of Croatia were obtained from the vaccination register of the Croatian Institute of Public Health. 64.4% pwMS were fully COVID-19 vaccinated which was comparable to 66.3% of the general population. More pwMS were fully vaccinated in the age group 20-24 (74.1% vs 51.7%), and fewer pwMS were fully vaccinated in the age group 65-69 (33.3% vs 80.4%) compared to the general population of the same age group, respectively. PwMS who received at least one dose of any COVID-19 vaccine were older (40.5 vs 37.6years, p = 0.01), had higher EDSS (2.0 vs 1.0, p = 0.025), and had longer disease duration (6.39 vs 5.35years, p = 0.02), were more likely to have progressive disease course (p = 0.049) and were on high efficacy DMTs (p = 0.045) compared to unvaccinated pwMS. Longer disease duration positively predicted vaccine uptake. Croatia has suboptimal COVID-19 vaccination uptake without a significant difference between the general population and pwMS.

Patient characteristics and prediction of CoViD-19 in-hospital mortality: a retrospective cohort study in Crete, Greece before and after the onset of a targeted vaccination strategy in 2021

Background: CoviD-19 in-hospital mortality rates show variations across time, setting, patient populations and health-systems. Aim: The aim of the present study was to explore the association of patient characteristics with in-hospital mortality taking into consideration temporal changes of CoViD-19 prevention and treatment, focusing on the negative predictive value of specific biomarker thresholds for death and oxygen requirements. Methods: This retrospective study included a sample of 425 vaccine-naive patients hospitalized for CoViD-19 in Crete, Greece. Time-specific mortality rates and negative predictive values of biomarkers on admission were calculated. The association of patient characteristics with mortality was assessed using multivariate logistic regression models. Results: The overall in hospital case fatality rate (CFR) was 19.53%. The in-hospital CFR [95% CI] dropped from 22.74% [17.96-27.52] to 11.9% [6.17-17.63] before and after 31/03/2021, as did the mean age of hospitalized patients. LDH &amp; D-dimers ≥240 or ≥0.5), CRP &amp; D-dimers (≥3 or ≥0.5), CRP &amp; Ferritin (≥3 or ≥205) had negative predictive values [95% CI] for mortality of 100% [86.7-100], 96.1% [80.3-99.9] and 95.4% [84.5-99.4] %, but the respective negative predictive values for oxygen requirements were 19.2% [6.5-39.3], 19.2% [6.5-39.3] and 27.2% [14.9-42.7] . Conclusion: A decreasing trend of in-hospital case fatality rates over the course of our study was associated with a decreasing age of hospitalized patients, which could be associated with community vaccination uptake in people over 60 in Greece through reduction of persons “susceptible” to severe disease. Mortality prediction formulas incorporating biomarkers should be used cautiously for the risk stratification of patients with CoViD-19 in the setting of the emergency department assessment.

COVID-19 vaccination uptake in people with epilepsy in wales

PurposePeople with epilepsy (PWE) are at increased risk of severe COVID-19. Assessing COVID-19 vaccine uptake is therefore important. We compared COVID-19 vaccination uptake for PWE in Wales with a matched control cohort. MethodsWe performed a retrospective, population, cohort study using linked, anonymised, Welsh electronic health records within the Secure Anonymised Information Linkage (SAIL) Databank (Welsh population=3.1 million).We identified PWE in Wales between 1st March 2020 and 31st December 2021 and created a control cohort using exact 5:1 matching (sex, age and socioeconomic status). We recorded 1st, 2nd and booster COVID-19 vaccinations. ResultsThere were 25,404 adults with epilepsy (127,020 controls). 23,454 (92.3%) had a first vaccination, 22,826 (89.9%) a second, and 17,797 (70.1%) a booster. Comparative figures for controls were: 112,334 (87.8%), 109,057 (85.2%) and 79,980 (62.4%).PWE had higher vaccination rates in all age, sex and socioeconomic subgroups apart from booster uptake in older subgroups. Vaccination rates were higher in older subgroups, women and less deprived areas for both cohorts. People with intellectual disability and epilepsy had higher vaccination rates when compared with controls with intellectual disability. ConclusionsCOVID-19 vaccination uptake for PWE in Wales was higher than that for a matched control group.

Uptake of COVID-19 vaccination in people with blood cancer: Population-level cohort study of 12 million patients in England

BackgroundPeople with blood cancers have increased risk of severe outcomes from COVID-19 and were prioritised for vaccination. MethodsIndividuals in the QResearch database aged 12 years and above on 1st December 2020 were included in the analysis. Kaplan–Meier analysis described time to COVID-19 vaccine uptake in people with blood cancer and other high-risk disorders. Cox regression was used to identify factors associated with vaccine uptake in people with blood cancer. ResultsThe analysis included 12,274,948 individuals, of whom 97,707 had a blood cancer diagnosis. 92% of people with blood cancer received at least one dose of vaccine, compared to 80% of the general population, but there was lower uptake of each subsequent vaccine dose (31% for fourth dose). Vaccine uptake decreased with social deprivation (HR 0.72, 95% CI 0.70, 0.74 for most deprived versus most affluent quintile for first vaccine). Compared with White groups, uptake of all vaccine doses was significantly lower in people of Pakistani and Black ethnicity, and more people in these groups remain unvaccinated. ConclusionsCOVID-19 vaccine uptake declines following second dose and there are ethnic and social disparities in uptake in blood cancer populations. Enhanced communication of benefits of vaccination to these groups is needed.

Factors Influencing COVID-19 Vaccine Hesitancy among Patients with Serious Chronic Illnesses during the Initial Australian Vaccine Rollout: A Multi-Centre Qualitative Analysis Using the Health Belief Model.

Background: People with chronic illnesses have increased morbidity and mortality associated with COVID-19 infection. The influence of a person's serious and/or comorbid chronic illness on COVID-19 vaccine uptake is not well understood. Aim: To undertake an in-depth exploration of factors influencing COVID-19 vaccine uptake among those with various serious and/or chronic diseases in the Australian context, using secondary data analysis of a survey study. Methods: Adults with cancer, diabetes and multiple sclerosis (MS) were recruited from 10 Australian health services to undertake a cross-sectional online survey (30 June to 5 October 2021) about COVID-19 vaccine uptake, vaccine hesitancy, confidence and complacency and disease-related decision-making impact. Free-text responses were invited regarding thoughts and feelings about the interaction between the participant's disease, COVID-19, and vaccination. Qualitative thematic analysis was undertaken using an iterative process and representative verbatim quotes were chosen to illustrate the themes. Results: Of 4683 survey responses (cancer 3560, diabetes 842, and MS 281), 1604 (34.3%) included free-text comments for qualitative analysis. Participants who provided these were significantly less likely to have received a COVID-19 vaccination than those who did not comment (72.4% and 86.2%, respectively). People with diabetes were significantly less likely to provide free-text comments than those with cancer or MS (29.0%, 35.1% and 39.9%, respectively). Four key themes were identified from qualitative analysis, which were similar across disease states: (1) having a chronic disease heightened perceived susceptibility to and perceived severity of COVID-19; (2) perceived impact of vaccination on chronic disease management and disease-related safety; (3) uncertain benefits of COVID-19 vaccine; and (4) overwhelming information overload disempowering patients. Conclusions: This qualitative analysis highlights an additional layer of complexity related to COVID-19 vaccination decision making in people with underlying health conditions. Appreciation of higher susceptibility to severe COVID-19 outcomes appears to be weighed against uncertain impacts of the vaccine on the progression and management of the comorbid disease. Interactions by clinicians addressing individual factors may alleviate concerns and maximise vaccine uptake in people with significant underlying health conditions.

Exploring the impact of mental health conditions on vaccine uptake in high-income countries: a systematic review

BackgroundVaccination is an essential public health intervention to reduce morbidity and mortality from infectious diseases. Despite being at higher at risk of infectious diseases, health inequalities towards vaccine uptake in people with mental health issues have not been systematically appraised.MethodsWe searched 7 databases from 1994 to 26/03/2021. We included all studies with a relative measure of effect comparing a group with a mental health issue to a control group. All studies covering any mental health issue were eligible with no constraints to study population, vaccine type or region, provided in a high-income country for comparability of health care systems. The study outcomes were synthesised by study population, mental health issue and type of vaccine.ResultsFrom 4,069 titles, 23 eligible studies from 12 different countries were identified, focusing on adults (n = 13) or children (n = 4) with mental health issues, siblings of children with mental health issues (n = 2), and mothers with mental health issue and vaccine uptake in their children (n = 6). Most studies focused on depression (n = 12), autism, anxiety, or alcoholism (n = 4 respectively). Many studies were at high risk of selection bias.DiscussionMental health issues were associated with considerably lower vaccine uptake in some contexts such as substance use disorder, but findings were heterogeneous overall and by age, mental health issue or types of vaccine. Only individuals with mental health issues and physical comorbidities had consistently higher uptake in comparison to other adults.Mental health should be considered as a health inequality for vaccine uptake but more context specific research is needed focusing more on specific mental health issues and subgroups of the population to understand who misses vaccination and why.

The effects of 4 mA cerebellar transcranial direct current stimulation on gait and cerebral glucose uptake in people with multiple sclerosis

The effects of 4 mA cerebellar transcranial direct current stimulation on gait and cerebral glucose uptake in people with multiple sclerosis