Latent class and time-to-event analyses of social determinants of health and COVID-19 vaccine uptake among Black women living with HIV.

Publication date: Sep 05, 2025

Existing inequities are exacerbated during the COVID-19 pandemic. Similar to HIV, COVID-19 disproportionately affects Black and other communities of color. Among Black women living with HIV (BWLWH) this study examined the relationship between community level and individual level social determinants of health and time to COVID-19 vaccine uptake. Utilizing longitudinal data collected between February 2021 and May 2023, pre-pandemic experiences of microaggressions, economic stability, health behaviors, resilience, self-efficacy and trauma/violence were modeled using latent class (LCA) and time-to-event (TTE) analyses methods to identify which classes emerge and how these determinants may influence COVID-19 vaccination uptake. Among 152 BWLWH, 75 % were vaccinated by 232 days (95 %CI: 202-441 days) after vaccine availability. A total of 25 women did not get vaccinated or were lost to follow up by the end of the study period. The primary reason for not getting a vaccine (endorsed by 76 % of unvaccinated women) was lack of trust in the government and institutions developing the vaccine. The LCA resulted in a 2-class solution. Class 1 exhibited lower scores for microaggressions and trauma/violence while reporting slightly higher economic stability, higher self-efficacy, resilience, self-care, and medication adherence. Women in Class 2 had higher probabilities for experiencing more microaggressions, trauma/violence, slightly less economic stability, and less resilience, self-efficacy, self-care, and medication adherence. The TTE analysis included 134 women, no significant difference was found between classes for COVID-19 vaccine uptake, but a pattern was observed with Class 2 taking longer to get the vaccine. Efforts to promote vaccine uptake must take into account and address community level and individual level social determinants of health.

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