COVID-19 mortality risk among people with HIV in Florida before and after the introduction of COVID-19 vaccines: A population-based study
- 1Robert Stempel School of Public Health and Social Work, Department of Epidemiology, Florida International University, Miami, Florida, United States of America
- 2Robert Stempel School of Public Health and Social Work, Department of Biostatistics, Florida International University, Miami, Florida, United States of America
- 3Ft. Lauderdale Research & Education Center, School of Forest, Fisheries and Geomatics Sciences, Geospatial Analytics, Technology, and Open Research (GATOR) Lab, University of Florida, Davie, Florida, United States of America
Abstract
Objective: Assess associations between COVID-19 vaccine availability and differences in COVID-19 mortality risk across subgroups among 122,527 people with HIV (PWH) in Florida. Methods: Analyzed HIV surveillance data, Social Vulnerability Index (SVI), and Rural-Urban Commuting Area Codes using a competing risks model to compare COVID-19 mortality among PWH before (3/1/2020–4/30/2021) and during (5/1/2021–12/31/2021) vaccine availability. Results: Overall COVID-19 mortality rates increased from before to during the vaccine availability period (22.3 vs. 27.5 per 100,000 person-months), driven in part by the Delta variant surge in mid-to-late 2021. Compared to Non-Hispanic White (NHW) PWH, adjusted COVID-19 mortality hazards remained elevated for Non-Hispanic Black (NHB) PWH both before (HR 2.06, 95% CI 1.45–2.91) and during (HR 1.60, 95% CI 1.13–2.27) vaccine availability. For Hispanic PWH, the relative hazard compared to NHW was elevated before (HR 2.24, 95% CI 1.55–3.23) and attenuated during vaccine availability (HR 1.03, 95% CI 0.68–1.57). In the final model, living in ZIP Code-level areas of high social vulnerability (overall SVI high vs. low) was associated with elevated hazard during vaccine availability (HR 1.75, 95% CI 1.04–2.97). Conclusions: Overall COVID-19 mortality rates were higher during the vaccine availability period (27.5 vs. 22.3 per 100,000 person-months); however, subgroup patterns varied substantially. Inequities persisted in key subgroups and were most pronounced among PWH living in more socially vulnerable areas. These observational comparisons do not estimate the causal effect of vaccination uptake. Public health implications: Tailored vaccination strategies and structural interventions remain essential to advancing equity in pandemic response among PWH.
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BibTeX
@article{gwanzura2026covid19,
title = {{COVID-19 mortality risk among people with HIV in Florida before and after the introduction of COVID-19 vaccines: A population-based study}},
author = {Tendai N.R. Gwanzura and Mary Jo Trepka and Tan Li and Levente Juhasz and Giselle A. Barreto and Shelbie Burchfield and Diana M. Sheehan},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358543},
url = {https://doi.org/10.1371/journal.pone.0358543},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - COVID-19 mortality risk among people with HIV in Florida before and after the introduction of COVID-19 vaccines: A population-based study
AU - Tendai N.R. Gwanzura
AU - Mary Jo Trepka
AU - Tan Li
AU - Levente Juhasz
AU - Giselle A. Barreto
AU - Shelbie Burchfield
AU - Diana M. Sheehan
PY - 2026
DA - 2026/09/18
JO - PLOS One
DO - 10.1371/journal.pone.0358543
UR - https://doi.org/10.1371/journal.pone.0358543
AB - Objective: Assess associations between COVID-19 vaccine availability and differences in COVID-19 mortality risk across subgroups among 122,527 people with HIV (PWH) in Florida. Methods: Analyzed HIV surveillance data, Social Vulnerability Index (SVI), and Rural-Urban Commuting Area Codes using a competing risks model to compare COVID-19 mortality among PWH before (3/1/2020–4/30/2021) and during (5/1/2021–12/31/2021) vaccine availability. Results: Overall COVID-19 mortality rates increased from before to during the vaccine availability period (22.3 vs. 27.5 per 100,000 person-months), driven in part by the Delta variant surge in mid-to-late 2021. Compared to Non-Hispanic White (NHW) PWH, adjusted COVID-19 mortality hazards remained elevated for Non-Hispanic Black (NHB) PWH both before (HR 2.06, 95% CI 1.45–2.91) and during (HR 1.60, 95% CI 1.13–2.27) vaccine availability. For Hispanic PWH, the relative hazard compared to NHW was elevated before (HR 2.24, 95% CI 1.55–3.23) and attenuated during vaccine availability (HR 1.03, 95% CI 0.68–1.57). In the final model, living in ZIP Code-level areas of high social vulnerability (overall SVI high vs. low) was associated with elevated hazard during vaccine availability (HR 1.75, 95% CI 1.04–2.97). Conclusions: Overall COVID-19 mortality rates were higher during the vaccine availability period (27.5 vs. 22.3 per 100,000 person-months); however, subgroup patterns varied substantially. Inequities persisted in key subgroups and were most pronounced among PWH living in more socially vulnerable areas. These observational comparisons do not estimate the causal effect of vaccination uptake. Public health implications: Tailored vaccination strategies and structural interventions remain essential to advancing equity in pandemic response among PWH.
SN - 1932-6203
ER -