Factors associated with full COVID-19 vaccination among persons living with diabetes mellitus in Uganda – A Cross-sectional Study

Background: Diabetes mellitus (DM) is associated with severe coronavirus disease (COVID-19) outcomes, including death. COVID-19 vaccination is the mainstay for preventing infection and severe disease in the general population, but most importantly, among high-risk populations such as persons with DM. However, while COVID-19 vaccination uptake in the general population is regularly tracked, information on vaccination behavior specific to persons with DM is scarce. This study sought to identify factors associated with the uptake of full COVID-19 vaccination among persons living with DM at Kiruddu National Referral Hospital (KRH). Methods: We used a cross-sectional study design to identify factors associated with receiving a full COVID-19 vaccination among persons with DM attending Kiruddu National Referral Hospital between March 08 and May 25, 2023. We used a systematic sampling technique to select a random sample of 340 participants for whom an interviewer-administered questionnaire was administered. We used a modified Poisson regression model to identify the factors associated with full COVID-19 vaccination and adjusted prevalence ratios with their 95% confidence intervals are presented. The data were analyzed in STATA version 14.0. Results: A total of 340 participants, 75% (255/340) of whom were female, completed the interview. The mean age of the participants was 52 years (±12 years) and the median duration of diabetes mellitus was 5 years (±7.3 years). Overall, 195/340 participants (57.35%) completed the last dose in the primary series of a COVID-19 vaccine. The likelihood of receiving full vaccination was higher when a health provider advised one to receive a vaccine [aPR=1.91 (95% CI 1.2-3.02)] when one reported having a comorbidity [aPR=1.26 (95% CI: 1.06-1.53)], and when one had a strong perceived benefit of vaccination [aPR=1.76 (95% CI: 1.23-2.53)]. However, having a strong perceived barrier to vaccination was negatively associated with the likelihood of being fully vaccinated [aPR=0.71 (95% CI: 0.6-0.84)]. Conclusion: Approximately 43% of persons living with DM in Uganda have incomplete COVID-19 vaccination. The Ugandan Ministry of Health (MoH) needs to implement a provider-initiated vaccination strategy in diabetic clinics using the healthcare providers who regularly attend to DM patients to boost their uptake of full COVID-19 vaccination.