Vaccination uptake and associated factors among HIV pre-exposure prophylaxis (PrEP) users: insights from a...

Vaccinationcoverage among individuals prescribed pre-exposure prophylaxis (PrEP) for HIV prevention is crucial for comprehensive healthcare. This study aims to evaluate vaccine uptake, characterize the vaccinated population, and identify factors influencing vaccination coverage among PrEP users in Israel.

A retrospective cross-sectional study was conducted in a large outpatient setting. Patients who purchased FTC/TDF for PrEP at least once during the study period were included. Data on vaccinations, PrEP adherence, socioeconomic status, sexually transmitted infections, and prescribing physicians were extracted from electronic medical records. Vaccine coverage was assessed for hepatitis A, B, Mpox, Human Papillomavirus (HPV), and influenza. Patients were considered fully vaccinated if they had completed the recommended dose series for each vaccine or had a positive serology for hepatitis A or B. High adherence to PrEP was defined as adherence rates of over 80%. Descriptive and multivariable analyses were performed to identify factors associated with vaccine uptake.  RESULTS: In 2023, a total of 2,668 patients purchased at least one PrEP prescription. All were men, with a median age of 36 years (range: 18-86). STIs occurred in 1043 (39.1%) patients, and 1222 (45.9%) had high adherence to PrEP. Fully vaccinated coverage was relatively high for hepatitis A (60.9%) and hepatitis B (58.2%), while lower rates were observed for Mpox (22.4%), HPV (27.7%), and influenza (27.6%). High adherence to PrEP was the most significant predictor of vaccination against hepatitis A, B, and Mpox (OR = 1.97, 95% CI = 1.57-2.57, p< 0.001) and for HPV (OR = 1.68, 95% CI = 1.37-2.06, p < 0.001). Family physician prescribing was also a significant predictor for vaccination against hepatitis A, B, and Mpox (OR = 1.68, 95% CI = 1.22-2.32, p = 0.001) and for HPV (OR = 1.54, 95% CI = 1.21-1.96, p < 0.001).

Vaccination coverage among PrEP users is suboptimal. High PrEP adherence and prescriptions by family physicians are strong predictors of vaccination. These findings highlight the need for targeted interventions to enhance vaccine uptake within PrEP care settings, emphasizing the importance of continuity of care and a patient-centered approach.