Global Disparities in Vaccine Reimbursement for Adults Living with HIV: A Cross-Sectional Survey of 120 Countries

In a survey covering 120 countries, routine recommendation for adult vaccines in HIV care is lower in LIC/LMIC than HIC (52.6% vs 77.6%; adjusted p=0.0013).

• Why it matters: Adults living with HIV face higher risk from vaccine-preventable infections, but global differences in policy and reimbursement can limit access to recommended vaccines.
• What they did: Clinicians and experts completed a 26-item questionnaire on national guidelines, public reimbursement, and on-site availability; generalized linear mixed-effects models estimated recommendation and reimbursement gaps by vaccine type and World Bank income group.
• The result: Full public reimbursement for all recommended vaccines was reported by only 30% overall (13% LIC/LMIC, 28% UMIC, 44% HIC; p=0.007), implying major recommendation-to-access gaps, especially in lower-income settings.

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