Assessing Vaccine Confidence using the Vaccine Hesitancy Scale among Adolescent Girls and Young Women at risk of HIV acquisition living in Uganda, Zambia, and South Africa

Background: Vaccine hesitancy (VH) remains a major threat to global health and can reverse the progress in tackling vaccine-preventable diseases. Vaccine uptake among adolescents and young women (AGYW) is often low. We assessed VH using a validated scale among AGYW in Uganda, Zambia, and South Africa. Methods: From June 2023 to February 2024, we recruited AGYW from fishing communities in Uganda, as well as urban and peri-urban locations in Lusaka and Ndola, Zambia, and mining communities in Rustenburg, South Africa. Eligible participants were aged 15-24 years, sexually active, and HIV-negative but at-risk for HIV acquisition. We collected demographic, HIV-related behavioral data, and vaccine hesitancy data using a structured questionnaire. Vaccine confidence was assessed using the 10-question Vaccine Hesitancy Scale that describes two factors, i.e., “vaccine confidence” and “risk tolerance’’. Exploratory and confirmatory factor analyses were done to assess scale validity and internal consistency. Logistic regression was used to determine associations between demographics and VH. Results: A total of 1,213 AGYW participated in the study, with a mean age of 19.4 (SD ± 2.6) years. More than half (54%) were aged between 15-19 years. The majority of AGYW (94%) strongly believed that vaccines were important for their health and the community and that getting vaccinated is a good way to protect them from diseases. About two-thirds of the AGYW (66%) indicated that they were concerned about the adverse effects of vaccines, while 30% responded that they did not need vaccines for diseases that were not common. We observed that 951 (78%) of the AGYW reported high vaccine confidence, while 494 (41%) reported low concerns over risks. Vaccine confidence varied across countries, with Zambia and Uganda showing lower vaccine confidence (adjusted Odds Ratios of 0.28 and 0.45, respectively, p< 0.005) in comparison to South Africa. Conclusion: A high level of vaccine confidence was observed among AGYW at risk of HIV acquisition. Vaccine confidence among AGYW was driven more by the trust in vaccine safety and the need to protect communities against diseases. These findings suggest the potential for acceptance of vaccines, including future HIV vaccines, among AGYW. Despite high levels of vaccine confidence, concerns over vaccine risks remain substantial and must be addressed.