Health Disparities
Changes in COVID-19 mortality disparities among people with HIV in Florida after introduction of COVID-19 vaccine. Tendai Gwanzura* Tendai Gwanzura Mary Jo Trepka Diana Sheehan Tan Li Levente Juhasz Giselle Barreto Shelbie Burchfield
Previous studies have identified sociodemographic variations in COVID-19 mortality rates, including factors such as age, race/ethnicity, and geographic location, both before and after the availability of the COVID-19 vaccine. However, there is limited research on this relationship among people with HIV (PWH). This study therefore aimed to compare sociodemographic disparities in COVID-19 mortality among PWH before (January 1, 2020 – April 30, 2021) and after (May 1, 2021 – December 31, 2021) the introduction of COVID-19 vaccines. Using 2020-2021 Florida HIV surveillance data and ZIP Code-level Social Vulnerability Index (SVI), a multilevel competing risks model estimated risk of COVID-19 death among PWH, before and after vaccine availability. The adjusted hazard ratio (aHR) decreased post-vaccine for individuals aged 50 to 65 (after vaccine: aHR 4.23, 95% confidence interval [CI] 2.23–7.98; before vaccine: aHR 5.39, 95% CI 2.66–10.93) and those over 65 (after vaccine: aHR 9.19, 95% CI 4.83–17.47; before vaccine: aHR 17.15, 95% CI 8.45–37.49) compared to those aged 18 to 34. Post vaccine, disparities in the hazard of death from COVID-19 were eliminated for Hispanics (after vaccine: aHR 0.99, 95% CI 0.66–1.49; before vaccine: aHR 2.23, 95% CI, 1.57–3.16), but not for Non-Hispanic Blacks (after vaccine: aHR 1.43, 95% CI, 1.02–2.0; before vaccine: aHR 1.81, 95% CI, 1.30–2.52) compared to Non-Hispanic Whites (NHW). PWH who resided in areas of high social vulnerability had a higher risk of death post-vaccine (aHR 1.70, 95% CI 1.03–2.80), but not pre-vaccine availability (aHR 1.36, 95% CI 0.89–2.07). Potential reductions in age and race/ethnic disparities in COVID-19 mortality were observed following the availability of the COVID-19 vaccine. However, PWH in the most socially vulnerable areas did not show improvements, suggesting a need for targeted interventions to boost vaccine uptake and eliminate disparities in these communities.