Ryan White Participation Increased the Prevalence of COVID-19 Vaccination Among People Living with HIV in Michigan

Introduction: People living with HIV (PLWH) have higher prevalence of adverse COVID-19 outcomes, and many reside in socially vulnerable communities. Our aim was to evaluate how engagement in HIV care may increase vaccination likelihood.Methods: Michigan HIV surveillance data were extracted from the Enhanced HIV/AIDS Reporting System and matched at the person-level to COVID-19 vaccination records from the Michigan Care Improvement Registry (through December 31, 2021 [n = 15,537]). Based on residential census tract, we classified PLWH into quartiles (<25th percentile [least vulnerable], 25th to <50th, 50th to <75th, >= 75th [most vulnerable]) of the 2018 CDC Social Vulnerability Index. Using log binomial regression, we estimated the relative prevalence of COVID-19 vaccine series initiation among PLWH by quartile of social vulnerability and Ryan White participation; models were adjusted for covariates.Results: By December 31, 2021, 67% of PLWH in Michigan had initiated a COVID-19 vaccine series; 47% resided in an area deemed most vulnerable and 54% had participated in Ryan White services. Compared with PLWH in the most vulnerable quartile, those who resided in least vulnerable quartiles had higher prevalence of vaccine initiation (Prevalence Ratio [95% Confidence Interval]: 1.67 [1.50 to 1.86]). Participants in Ryan White had greater prevalence of initiation (1.52 [1.42 to 1.62]) compared with those who were not participants; initiation remained higher when adjusted for covariates including social vulnerability quartile.Conclusions: Ryan White participation was associated with increased COVID-19 vaccine initiation regardless of community-level vulnerability. Wraparound services may be key in vaccine promotion interventions in this vulnerable population.