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Bolstering Influenza Vaccination in People With HIV During COVID-19

One HIV clinical care program in Delaware looked into strategies to increase immunization rates to decrease severe disease as well as minimize hospital capacity.


The upcoming influenza season in the northern hemisphere is expected to be worse than last year, especially after a difficult season in the southern hemisphere.

Typically, annual influenza vaccinations hover around 50% for the general public. In addition to protecting individuals from severe respiratory illness, another benefit is it can help keep hospitalizations down especially as respiratory seasonal viruses peak in the winter months. RSV in the pediatric population has already been especially challenging in parts of the country and issues around finding hospitals for kids in need. Add in COVID-19 into this mix, and this is enough to cause great concerns for hospital administrators and public health officials who may grapple with overcapacity in the coming months.

Although everyone is recommended to get influenza vaccines, certain populations, such as people with HIV (PWH), are at an increased risk for severe flu and possible hospitalization.

The William J Holloway Community Program in Delaware is the only Ryan White-funded program in the state, and they care for approximately 70% of the adults with HIV in the state.

“Historically, within our program about 65% of our patients do receive the annual flu vaccination, which is above national averages as well as Ryan White benchmarks,” said HIV provider Deborah Kahal, MD, MPH, FACP, FIDSA, ChristianaCare/Thomas Jefferson University who practices at Holloway. “But starting in 2020, we really wanted to do better not knowing what the flu season would look like in the setting of the COVID pandemic.”

In the 2020-2021 flu season, Kahal said they created a pilot project that used interventions and change levers in their flagship program in Wilmington, DE, that saw an increase in influenza vaccination from 65% to 85%. After that success, they decided to expand the project statewide throughout their program to look at the 2021-2022 flu season and study it.

Their findings from the project was developed into a study and Kahal presented the subsequent poster from the study, “Expanding and Sustaining Influenza Vaccination Acceptance amongst Adults with HIV in Delaware during the COVID-19 Pandemic,” at ID Week 2022 recently.

Kahal says they applied changes learned from the first flu season and added them to the project for the follow-up flu season.

In their subsequent statewide project looking at the three counties within Delaware, they achieved an 84.9% vaccination coverage with county level rates ranging from 79.1 to 89.7%, Kahal and her contributors reported.

In speaking with Contagion, Kahal offered some insights into their specific change levers and interventions they employed, as well as the results of the initiative.