AI Insight
A survey of HIV clinicians across 120 countries revealed substantial global disparities in vaccine access for adults living with HIV, with only 37% of countries having HIV-specific vaccination guidelines and just 30% providing full public reimbursement for recommended vaccines. Low- and lower-middle-income countries showed markedly lower rates of routine vaccine recommendations (52.6% versus 77.6% in high-income countries) and full reimbursement, with over 94% of influenza, pneumococcal, and hepatitis B vaccinations lacking funding in these settings. Even in high-income countries, significant reimbursement gaps persisted for HPV and herpes zoster vaccines, indicating that financial barriers to vaccine access affect this vulnerable population worldwide.
Why it matters
Adults with HIV face elevated risks of vaccine-preventable infections, yet this study demonstrates that most do not have adequate financial access to recommended vaccines, particularly in lower-income settings. These findings highlight the urgent need for policy reforms to integrate vaccination into routine HIV care and expand public funding, which could prevent significant morbidity and mortality in this immunocompromised population.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Objective: Adults living with HIV are at increased risk of vaccine-preventable infections, yet access to recommended vaccines varies globally. We evaluated national vaccination guidelines, public reimbursement, and on-site vaccination availability across countries with different income levels. Methods: We conducted a cross-sectional survey of HIV clinicians and experts representing 120 countries. The 26-item questionnaire assessed vaccination guidelines, recommendations, public reimbursement, and on-site vaccination availability. Countries were classified according to World Bank income group. Generalized linear mixed-effects models assessed routine recommendations, full reimbursement, and recommendation-reimbursement gaps by vaccine type and income group. Results: A total of 124 responses representing 120 countries were analyzed, including 38 low-/lower-middle-income (LIC/LMIC), 36 upper-middle-income (UMIC), and 50 high-income countries (HIC). HIV-specific national vaccination guidelines were reported by 37% of respondents, increasing from 18% in LIC/LMIC to 52% in HIC (p=0.026). Only 30% reported full public reimbursement for all recommended vaccines (13% LIC/LMIC, 28% UMIC, 44% HIC;p=0.007). Mixed-effects analyses showed significant differences in routine recommendations and full reimbursement by vaccine type and income group. The adjusted probability of routine recommendation was lower in LIC/LMIC than HIC countries (52.6% vs 77.6%; adjusted p=0.0013). Among recommended vaccines, more than 94% of influenza, pneumococcal, and hepatitis B vaccinations lacked full reimbursement in LIC/LMIC, based on adjusted estimates. Reimbursement gaps for HPV and herpes zoster vaccines remained substantial even in HIC. On-site vaccination was also less available in LIC/LMIC than in HIC (55% vs 78%; p=0.020). Conclusions: Significant income-related disparities persist in vaccination policy and implementation for adults living with HIV. Gaps between recommendations and financial access are particularly pronounced in lower-income settings, while HPV and herpes zoster reimbursement remains limited across all income groups. Expanding HIV-specific vaccination policies, improving public reimbursement, and integrating vaccination into routine HIV services are essential to improve access to recommended vaccines for this population.