Patients with tuberculosis (TB) are at increased risk of developing severe forms of novel coronavirus 2019 (COVID-19), and COVID-19 coinfection aggravates active TB progression through immunosuppression. Despite the availability of COVID-19 vaccines to prevent and reduce COVID-19 transmission, COVID-19 vaccine uptake levels remain low worldwide. In Kenya, an African country with high TB prevalence and TB-HIV coinfection, 47% of the population had received the COVID-19 vaccine by 2023. This study determined health-system enablers and barriers to the COVID-19 vaccine among adult TB patients across Nairobi County TB clinics in Kenya. An analytical cross-sectional study was used. Three hundred eighty-eight TB patients from six TB clinics across six sub-counties in Nairobi were recruited. The participants completed the study questionnaire. After confounding for age, employment status perceived COVID-19 susceptibility, and perceived COVID-19 seriousness, health system enablers of COVID-19 vaccine uptake were consistent and positive messaging on COVID-19 (adjusted odds ratio (aOR) = 4.498; 95% CI: 1.953 - 10.36, p < 0.001), the feeling that the vaccination had significant social benefits was (aOR = 2.632; 95% CI: 1.108 - 6.257, p = 0.028), and enough public awareness about the vaccine (aOR = 2.619; 95% CI: 1.099 - 6.239, p = 0.03). A significant barrier was vaccine preference (aOR = 0.387, 95% CI: 0.179 - 0.838, p = 0.016). This study confirmed health facility factors that enable and hinder COVID-19 vaccine uptake among TB patients. We recommend policy actions to improve TB clinics’ infrastructure and resources to support the enablers and address the barriers.
References
[1]
Falzon, D., Zignol, M., Bastard, M., Floyd, K. and Kasaeva, T. (2023) The Impact of the COVID-19 Pandemic on the Global Tuberculosis Epidemic. FrontiersinImmunology, 14, Article 1234785. https://doi.org/10.3389/fimmu.2023.1234785
[2]
Zimmer, A.J., Klinton, J.S., Oga-Omenka, C., Heitkamp, P., Nawina Nyirenda, C., Furin, J., etal. (2021) Tuberculosis in Times of Covid-19. JournalofEpidemiologyandCommunityHealth, 76, 310-316. https://doi.org/10.1136/jech-2021-217529
[3]
Stochino, C., Villa, S., Zucchi, P., Parravicini, P., Gori, A. and Raviglione, M.C. (2020) Clinical Characteristics of COVID-19 and Active Tuberculosis Co-Infection in an Italian Reference Hospital. EuropeanRespiratoryJournal, 56, Article 2001708. https://doi.org/10.1183/13993003.01708-2020
[4]
Thekkur, P., Takarinda, K.C., Timire, C., Sandy, C., Apollo, T., Kumar, A.M.V., et al. (2021) Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe. Tropical Medicine and Infectious Disease, 6, Article 94. https://doi.org/10.3390/tropicalmed6020094
[5]
World Health Organization (2022) Global Tuberculosis Report 2022. https://iris.who.int/bitstream/handle/10665/363752/9789240061729-eng.pdf?sequence=1
[6]
World Health Organization (2023) Vulnerable? Vaccinate. Protecting the Unprotected from COVID-19 and Influenza. https://www.who.int/europe/news/item/09-10-2023-vulnerable--vaccinate.-protecting-the-unprotected-from-covid-19-and-influenza
[7]
Azanaw, J., Endalew, M., Zenbaba, D., Abera, E. and Chattu, V.K. (2023) COVID-19 Vaccine Acceptance and Associated Factors in 13 African Countries: A Systematic Review and Meta-Analysis. Frontiers in Public Health, 10, Article 1001423. https://doi.org/10.3389/fpubh.2022.1001423
[8]
Sharma, A., Jain, M. and Vigarniya, M. (2022) Acceptance and Adverse Effects Following COVID-19 Vaccination among the Health Care Workers at a Health Care Centre in the Most Backward District of India. JournalofFamilyMedicineandPrimaryCare, 11, 3224-3229. https://doi.org/10.4103/jfmpc.jfmpc_2370_21
[9]
Nabia, S., Wonodi, C.B., Vilajeliu, A., Sussman, S., Olson, K., Cooke, R., etal. (2023) Experiences, Enablers, and Challenges in Service Delivery and Integration of COVID-19 Vaccines: A Rapid Systematic Review. Vaccines, 11, Article 974. https://doi.org/10.3390/vaccines11050974
[10]
Enos, M., Sitienei, J., Ong’ang’o, J., Mungai, B., Kamene, M., Wambugu, J., et al. (2018) Kenya Tuberculosis Prevalence Survey 2016: Challenges and Opportunities of Ending TB in Kenya. PLOSONE, 13, e0209098. https://doi.org/10.1371/journal.pone.0209098
[11]
Ministry of Health (2022) Kenya COVID-19 Vaccination Program-Daily Situation Report. https://www.health.go.ke/sites/default/files/2023-05/MINISTRY-OF-HEALTH-KENYA-COVID-19-IMMUNIZATION-STATUS-REPORT-15TH-MAY-2022.pdf
[12]
Sallam, M. (2021) COVID-19 Vaccine Hesitancy Worldwide: A Concise Systematic Review of Vaccine Acceptance Rates. Vaccines, 9, Article 160. https://doi.org/10.3390/vaccines9020160
[13]
Naidoo, D., Meyer-Weitz, A. and Govender, K. (2023) Factors Influencing the Intention and Uptake of COVID-19 Vaccines on the African Continent: A Scoping Review. Vaccines, 11, Article 873. https://doi.org/10.3390/vaccines11040873
[14]
Shah, J., Abeid, A., Sharma, K., Manji, S., Nambafu, J., Korom, R., et al. (2022) Perceptions and Knowledge Towards COVID-19 Vaccine Hesitancy among a Subpopulation of Adults in Kenya: An English Survey at Six Healthcare Facilities. Vaccines, 10, Article 705. https://doi.org/10.3390/vaccines10050705
[15]
Muchangi, J.M., Mturi, J., Mukasa, H., Kithuki, K., Kosgei, S.J., Kanyangi, L.M., etal. (2024) Enablers and Barriers to Vaccine Uptake and Handwashing Practices to Prevent and Control COVID-19 in Kenya, Uganda, and Tanzania: A Systematic Review. FrontiersinPublicHealth, 12, Article 1352787. https://doi.org/10.3389/fpubh.2024.1352787
[16]
Orangi, S., Mbuthia, D., Chondo, E., Ngunu, C., Kabia, E., Ojal, J., etal. (2024) A Qualitative Inquiry on Drivers of COVID-19 Vaccine Hesitancy among Adults in Kenya. PLOSGlobalPublicHealth, 4, e0002986. https://doi.org/10.1371/journal.pgph.0002986
[17]
Ocholla, B.A., Nyangena, O., Murayi, H.K., Mwangi, J.W., Belle, S.K., Ondeko, P., etal. (2021) Association of Demographic and Occupational Factors with SARS-CoV-2 Vaccine Uptake in Kenya. OALib, 8, e7424. https://doi.org/10.4236/oalib.1107424
[18]
Charan, J. and Biswas, T. (2013) How to Calculate Sample Size for Different Study Designs in Medical Research? IndianJournalofPsychologicalMedicine, 35, 121-126. https://doi.org/10.4103/0253-7176.116232
[19]
Palupi, S., Pambudi, I., Surya, A., Bramanthi, R., Arfi, M., Suyanto, S., et al. (2023) Sequence of COVID-19 Vaccination and COVID-19 Infection and Their Association with the Development of Active Tuberculosis: A Case-Control Study. Cureus, 15, e46353. https://doi.org/10.7759/cureus.46353
[20]
Wang, Y., Chen, Y.P., Gu, L., Lou, L.X., Zhang, J. and Zhang, K.Y. (2022) The Clinical Characteristics and Risk Factors for Severe COVID-19 in Patients with COVID-19 and Tuberculosis Coinfection. FrontiersinMicrobiology, 13, 1061879. https://doi.org/10.3389/fmicb.2022.1061879
[21]
World Health Organization (2021) Monitoring COVID-19 Vaccination: Considerations for the Collection and Use of Vaccination Data, Interim Guidance. https://www.who.int/publications/i/item/monitoring-covid-19-vaccination-interim-guidance?cfchlmanagedtk=EodgaZSVnUfrBh6HVwCuHngo57MAqcZaMDyQ333dm4-1639551661-0-gaNycGzNCT0
[22]
Rajshekhar, N., Pinchoff, J., Boyer, C.B., Barasa, E., Abuya, T., Muluve, E., etal. (2023) Exploring COVID-19 Vaccine Hesitancy and Uptake in Nairobi’s Urban Informal Settlements: An Unsupervised Machine Learning Analysis of a Longitudinal Prospective Cohort Study from 2021 to 2022. BMJOpen, 13, e071032. https://doi.org/10.1136/bmjopen-2022-071032
[23]
Bono, S.A., Faria de Moura Villela, E., Siau, C.S., Chen, W.S., Pengpid, S., Hasan, M.T., et al. (2021) Factors Affecting COVID-19 Vaccine Acceptance: An International Survey among Low-and Middle-Income Countries. Vaccines, 9, Article 515. https://doi.org/10.3390/vaccines9050515
[24]
James, E.K., Bokemper, S.E., Gerber, A.S., Omer, S.B. and Huber, G.A. (2021) Persuasive Messaging to Increase COVID-19 Vaccine Uptake Intentions. Vaccine, 39, 7158-7165. https://doi.org/10.1016/j.vaccine.2021.10.039
[25]
Abraham, S.A.A., Amoah, J.O., Agyare, D.F., Sekimpi, D.K., Bosomtwe-Duker, D., Druye, A.A., etal. (2023) Health Service Factors Affecting the COVID-19 Vaccination Campaign in a Ghanaian Metropolis: A Qualitative Exploratory Study. BMJOpen, 13, e076184. https://doi.org/10.1136/bmjopen-2023-076184
[26]
Levy, J., Maroney, J. and Kashem, M.A. (2023) Introduction to Clinical Research: What Is It? Why Is It Needed? In: Eltorai, A.E.M., Bakal, J.A., Newell, P.C. and Osband, A.J., Eds., TranslationalSurgery, Elsevier, 105-110. https://doi.org/10.1016/b978-0-323-90300-4.00040-9
