Global Disparities in Vaccine Reimbursement for Adults Living with HIV: A Cross-Sectional Survey of 120 Countries
- 1Medical University of Warsaw, Medical Faculty English Division, Warsaw, Poland
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.
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BibTeX
@misc{burzynski2026global,
title = {{Global Disparities in Vaccine Reimbursement for Adults Living with HIV: A Cross-Sectional Survey of 120 Countries}},
author = {E. Burzynski and O. Turkmen Recen and P. Velikov and A. Cordie and G. Zambrano and A. J. Rodriguez-Morales and M. Krone and O. Epaulard and Z. B. Harboe and J. Kowalska},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.30.26366946},
url = {https://www.medrxiv.org/content/10.64898/2026.10.30.26366946v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Global Disparities in Vaccine Reimbursement for Adults Living with HIV: A Cross-Sectional Survey of 120 Countries
AU - E. Burzynski
AU - O. Turkmen Recen
AU - P. Velikov
AU - A. Cordie
AU - G. Zambrano
AU - A. J. Rodriguez-Morales
AU - M. Krone
AU - O. Epaulard
AU - Z. B. Harboe
AU - J. Kowalska
PY - 2026
DA - 2026/10/30
PB - medRxiv
DO - 10.64898/2026.10.30.26366946
UR - https://www.medrxiv.org/content/10.64898/2026.10.30.26366946v1
AB - 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.
ER -