Abstract
BACKGROUND: Chicago sustained substantial COVID-19 morbidity and mortality with greatest burdens among low-income communities of color. We sought to determine the prevalence and predictors of vaccine uptake and refusal over 3 years among a long-term cohort of Chicago women with/without HIV (WWH/WWoH). METHODS: Research staff provided outreach and collected data on COVID-19 knowledge, vaccine intent, uptake, and refusal quarterly during 2020 and then semiannually through 2023. 146 women (102 WWH and 44 WWoH) participated. RESULTS: Among 146 women, mean age was 54.4 years, 70% were WWH; predominantly Black (63%), unemployed (73%), 58% had ≤$18,000 annual household income, 63% had a high school education or less, and 65% had one or more comorbidities. Initially, 46% of women reported no intent to be vaccinated and were more likely to be employed, report medical mistrust and not living with HIV. By September 2023, 88% of women received at least one vaccination and 86% received the full series of doses. Vaccine uptake was lowest among those who were younger, less educated, heavier drinkers and marijuana users, and had fewer comorbidities including lower BMI and diabetes. CONCLUSIONS: While initial vaccination non-intent was high, we observed higher-than-expected and more rapid COVID-19 vaccine uptake among vulnerable women of color engaged in a long-term research initiative relative to Chicago residents overall. Lower education, higher alcohol and marijuana use, and lower COVID morbidity and mortality risks were predictors of not receiving COVID vaccination. Understanding and addressing factors associated with vaccine refusal should be a key component of future pandemic preparedness initiatives.