Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: A Nationwide Online Survey

Background: People living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. There is a dearth of evidence on willingness to receive COVID-19 vaccination (WTR) among PLWHA. Methods: The study is a multicenter cross-sectional online survey conducted in eight conveniently selected Chinese metropolitan cities between January and February 2021. Participants were PLWHA aged 18-65 years and living in the study cities. Eight community-based organizations (CBO) providing services to PLWHA, one in each city, facilitated the recruitment through their networks. Eligible PLWHA completed an online survey developed using Golden Data, a widely used encrypted web-based survey platform in China. Logistic regression models and path analysis were used in data analysis. Findings: Out of 10,845 PLWHA approached by the CBO, 2740 completed the survey. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported WTR (57·2%, 1470/2570). After adjusting for potential confounders, all four constructs of the Theory of Planned Behavior (TPB) were significantly associated with WTR, including positive attitudes (adjusted odds ratio, aOR: 1·11, 95%CI: 1·09, 1·12), negative attitudes (aOR: 0·96, 95%CI: 0·94, 0.97), perceived support from significant others (perceived subjective norm) (aOR: 1·53, 95%CI: 1·46, 1·61), and perceived higher behavioral control (aOR: 1·13, 95%CI: 1·11, 1·14). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR: 1·99, 95%CI: 1·65, 2·40), CBO staff (aOR: 1·89, 95%CI: 1·51, 2·36), friends and/or family members (aOR: 3·22, 95%CI: 1·93, 5·35), and PLWHA peers (aOR: 2.38, 95%CI: 1·85, 3·08) were associated with higher WTR. Overall opinion supporting COVID-19 vaccination for PLWHA on Internet or social media was also positively associated with WTR (aOR: 1·59, 95%CI: 1·31, 1·94). Path analysis indicated that interpersonal-level variables was indirectly associated with WTR through TPB-related perceptions (β=0·43, 95% CI=0·37, 0·51). Interpretation: PLWHA in China reported a relatively low WTR. Interpersonal communication and Internet/social media may be the major sources to convey information and promote COVID-19 vaccination in the population. Funding Statement: This work was supported by the Academic technology leader project of Changzhi Medical College (Grant No. XSQ201902), he Beijing Excellent Talent Plan (2018000021223ZK04) and the National Institute of Mental Health of the National Institutes of Health under Award Numbers R34MH119963. Declaration of Interests: The authors have no conflicts of interest to disclose. Ethics Approval Statement: The Institutional Review Boards of Changzhi Medical College (RT2021003) approved this study.