# Pneumococcal Vaccination Uptake Among People with HIV Following the Implementation of an On-Site Vaccination Service in an Italian Specialist Out-Patient Clinic

## TL;DR

Providing pneumococcal vaccines directly at an HIV clinic in Italy significantly increased vaccination rates among people with HIV, but disparities remain.

## Contribution

Demonstrates that on-site vaccination services in HIV clinics can improve pneumococcal vaccine uptake among people with HIV.

## Key findings

- Vaccination uptake increased six-fold after implementing on-site services.
- Men who have sex with men had higher vaccine acceptance compared to other groups.
- Immigrants showed significantly lower vaccination rates than Italian nationals.

## Abstract

Background: People with HIV (PWH) face elevated risk of pneumococcal disease despite optimal antiretroviral therapy. In Italy, pneumococcal vaccination coverage in adults remains suboptimal. For PWH, access barriers may be amplified because adult vaccinations are primarily delivered in primary care, whereas HIV care is mostly hospital-based. Methods: We conducted a retrospective, observational study at an HIV clinic in Milan, Italy, evaluating the impact of an on-site vaccination service implemented in January 2019. At baseline, 1854 PWH were in active follow-up; 135 (7.3%) had previously received pneumococcal vaccination. We assessed vaccination uptake (PCV13-PPSV23 sequential schedule or PCV20) among the remaining 1719 unvaccinated individuals through December 2023. A logistic regression analysis was used to identify factors associated with vaccine acceptance. Results: Over five years, 745/1719 individuals (43.3%) either initiated PCV13 + PPSV23 or received PCV20, representing a six-fold increase from baseline. Of 639 individuals receiving PCV13, 80.1% completed the sequence with PPSV23. Most vaccinations (80.8%) were administered on-site. In multivariable analysis, men who have sex with men showed higher uptake (aOR 1.56, 95% CI 1.25–1.95), while regular and irregular immigrants had significantly lower uptake (aOR 0.70 and 0.24, respectively) compared to Italian nationals. Conclusions: Integration of vaccination services into routine HIV care substantially improved pneumococcal vaccination uptake. However, with nearly half of eligible patients remaining unvaccinated, additional strategies are required to address vaccine hesitancy and inequities, particularly among immigrants, to achieve optimal pneumococcal coverage in PWH.