Assessing acceptability of and confidence in a potential TB vaccine in South African adults living with HIV

Abstract

Objective: Although several TB vaccines are in late-stage clinical trials, there is limited understanding of TB vaccine attitudes among persons likely to be eligible for a new TB vaccine, particularly in the context of rising vaccine hesitancy following the COVID-19 pandemic. Acceptability of a potential TB vaccine and associated socio-behavioral factors were assessed among people with HIV (PWH) in South Africa to inform strategies for successful TB vaccine implementation. Methods: A cross-sectional survey assessing vaccine acceptability and confidence was conducted in 2024 at two South African public health clinics serving PWH. Surveys were administered at follow-up visits of a study of PWH initiating ART and undergoing TB screening. Exploratory analyses were performed using Kruskal-Wallis testing to examine the relationship between vaccine acceptability and sociodemographic factors. Results: A total of 225 PWH (57% female) were surveyed of median age 34 years (IQR 27-42), median baseline CD4 count 338 (IQR: 179-514). Of these, 64 (28%) had a personal TB history, 216 (96%) had ever lived with someone with TB, 92 (41%) were currently living with someone with TB. Acceptability of a potential TB vaccine was 112 (50%) responding “Definitely yes, as soon as available”, 86 (38%) “Definitely yes, but wait ≥6months to receive it” and 27 (12%) “Unsure, leaning yes, any timeline” with nobody responding “leaning no” or “definitely no.” Acceptability was observed to be higher among participants who perceived TB as an extremely important community health issue (P=0.003), were extremely concerned about contracting TB (P=0.005), had a history of TB (P=0.044), were not living with someone with TB (P=0.044), and were unemployed (P=0.009). For vaccine confidence, 210 (93%) tended to or strongly agreed a TB vaccine would be safe and 218 (98%) that it would be effective. For TB information, most participants sourced government, community, and health entities, or internet (>70%), and rarely sourced family or friends (<6%) or social media (<1%). Participants widely preferred to receive a TB vaccine in a community space (191, 85%). Conclusions: TB vaccine acceptability and confidence among South African adult PWH was high and observed to be associated with greater risk perception for TB disease, greater perceived importance of TB in the community, and unemployment. Community spaces were widely preferred settings for TB vaccine receipt and government, health, and community entities were preferred sources for TB information. These findings may inform strategies for successful, future TB vaccine campaigns.