COVID-19 vaccine hesitancy among pregnant and postpartum women enrolled in a PrEP study in Western Kenya


BACKGROUND: COVID-19 is associated with increased maternal morbidity and mortality, making preventive measures in pregnancy critical. COVID-19 vaccines lower the risk of severe illness and death. However, vaccine hesitancy can hamper uptake of COVID-19 vaccination. Evaluating current COVID-19 vaccine hesitancy among pregnant and postpartum Kenyan women could help guide vaccine introduction strategies for this population.
METHODS: We utilized data from HIV-negative pregnant and postpartum women enrolled in an ongoing evaluation of perinatal PrEP use at 4 public sector maternal child health (MCH) clinics in Western Kenya. From October 2020-January 2022, study nurses assessed COVID-19 experiences, including vaccine hesitancy, defined as reporting 'unlikely' or 'very unlikely' to the question, 'If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?'. We identified correlates of vaccine hesitancy using Poisson regression models, clustered by facility.
RESULTS: Among 790 women (140 pregnant, 650 postpartum), median age was 28 years (IQR: 24-33 years), 94% were married, and 60% had '¥12 years of education. Overall, 21% of women were currently on PrEP; among those 25% reported interruptions to PrEP access related to COVID-19. Over half (57%) of women reported vaccine hesitancy. Women who perceived worsened MCH services during the pandemic had higher frequency of vaccine hesitancy than women reporting no change in quality (83% vs. 47%, prevalence ratio [PR]=1.79: 95% CI:1.68-2.73, p=0.0071). Women who did not perceive masks as effective protection against COVID-19 had higher frequency of vaccine hesitancy than those who did (69% vs. 48%, PR=1.44, 95% CI:1.09-1.92, p=0.011). Vaccine hesitancy was similar among pregnant and postpartum women (59% vs. 57%, p=0.536) and among women on PrEP and those not on PrEP (55% vs. 57%, p=0.37). Vaccine hesitancy was not associated with age, education, marital status, or perceived risk of COVID-19.
CONCLUSIONS: Among Kenyan pregnant and postpartum women, COVID-19 vaccine hesitancy was common and more frequent among those reporting worsened MCH care quality during the pandemic and those who felt masks were not effective for prevention. It will be important to optimize vaccine information within MCH and to address vaccine hesitancy among pregnant and postpartum women attending MCH services.

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