{
  "abstract": "Objective: Adults living with HIV are at increased risk of vaccine-preventable infections, yet access to recommended vaccines varies globally. We evaluated national vaccination guidelines, public reimbursement, and on-site vaccination availability across countries with different income levels. Methods: We conducted a cross-sectional survey of HIV clinicians and experts representing 120 countries. The 26-item questionnaire assessed vaccination guidelines, recommendations, public reimbursement, and on-site vaccination availability. Countries were classified according to World Bank income group. Generalized linear mixed-effects models assessed routine recommendations, full reimbursement, and recommendation-reimbursement gaps by vaccine type and income group. Results: A total of 124 responses representing 120 countries were analyzed, including 38 low-/lower-middle-income (LIC/LMIC), 36 upper-middle-income (UMIC), and 50 high-income countries (HIC). HIV-specific national vaccination guidelines were reported by 37% of respondents, increasing from 18% in LIC/LMIC to 52% in HIC (p=0.026). Only 30% reported full public reimbursement for all recommended vaccines (13% LIC/LMIC, 28% UMIC, 44% HIC;p=0.007). Mixed-effects analyses showed significant differences in routine recommendations and full reimbursement by vaccine type and income group. The adjusted probability of routine recommendation was lower in LIC/LMIC than HIC countries (52.6% vs 77.6%; adjusted p=0.0013). Among recommended vaccines, more than 94% of influenza, pneumococcal, and hepatitis B vaccinations lacked full reimbursement in LIC/LMIC, based on adjusted estimates. Reimbursement gaps for HPV and herpes zoster vaccines remained substantial even in HIC. On-site vaccination was also less available in LIC/LMIC than in HIC (55% vs 78%; p=0.020). Conclusions: Significant income-related disparities persist in vaccination policy and implementation for adults living with HIV. Gaps between recommendations and financial access are particularly pronounced in lower-income settings, while HPV and herpes zoster reimbursement remains limited across all income groups. Expanding HIV-specific vaccination policies, improving public reimbursement, and integrating vaccination into routine HIV services are essential to improve access to recommended vaccines for this population.",
  "abstract_shown": true,
  "affiliations": [
    "Medical University of Warsaw, Medical Faculty English Division, Warsaw, Poland"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "E. Burzynski"
    },
    {
      "name": "O. Turkmen Recen"
    },
    {
      "name": "P. Velikov"
    },
    {
      "name": "A. Cordie"
    },
    {
      "name": "G. Zambrano"
    },
    {
      "name": "A. J. Rodriguez-Morales"
    },
    {
      "name": "M. Krone"
    },
    {
      "name": "O. Epaulard"
    },
    {
      "name": "Z. B. Harboe"
    },
    {
      "name": "J. Kowalska"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/74rasd9xxk7a4.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.30.26366946",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366946v1.full",
  "id": "74rasd9xxk7a4",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366946v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "hiv aids"
    ],
    [
      "openalex",
      "3306|Vaccine Coverage and Hesitancy"
    ]
  ],
  "openalex": "W7225048583",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366946v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/74rasd9xxk7a4.ris",
  "sources": [
    {
      "first_seen": "2026-11-02T12:20:44Z",
      "native_id": "10.64898/2026.10.30.26366946",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366946v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:hiv aids",
      "subfield": "infectious-disease"
    }
  ],
  "title": "Global Disparities in Vaccine Reimbursement for Adults Living with HIV: A Cross-Sectional Survey of 120 Countries",
  "title_text": "Global Disparities in Vaccine Reimbursement for Adults Living with HIV: A Cross-Sectional Survey of 120 Countries",
  "type": "preprint",
  "updated_at": "2026-11-03T00:20:20Z",
  "url": "https://research.draconitic.com/paper/74rasd9xxk7a4",
  "venue": "medRxiv",
  "versions": []
}