Sexually Transmitted and Bloodborne Infections, Methamphetamine Use, and COVID-19 Vaccination in Manitoba, Canada: A Retrospective Matched Cohort Analysis Using Population-Based Administrative Healthcare Data (2020-2022)
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Objectives
To examine COVID-19 vaccine uptake among people diagnosed with sexually transmitted and bloodborne infections (STBBI) and reported methamphetamine users in Manitoba, Canada, during the acute phase of the COVID-19 pandemic.
Methods
We conducted a retrospective matched-cohort study using linked population-based administrative healthcare, laboratory, and vaccination databases in Manitoba. Individuals aged ≥16 years with laboratory-confirmed chlamydia/gonorrhea (CT/NG), syphilis, HIV, and/or documented methamphetamine use during the four years prior to March 1, 2020 were included in eight exposed cohorts. Each cohort was matched to unexposed comparators on age, sex, geographic region, and income quintile. The primary outcome was receipt of ≥2 COVID-19 vaccine doses between December 1, 2020 and March 31, 2022. Poisson regression models estimated adjusted rate ratios (aRRs) and 95% confidence intervals (95% CIs) for vaccine uptake.
Results
Compared with matched comparators, most exposed cohorts were less likely to complete the COVID-19 primary vaccine series. Individuals in the Syphilis Only (aRR: 0.87, 95% CI: 0.85–0.90), Syphilis Plus (aRR: 0.84, 95% CI: 0.81–0.86), CT/NG Only (aRR: 0.95, 95% CI: 0.94–0.96), CT/NG Plus (aRR: 0.82, 95% CI: 0.80–0.85), Methamphetamine Only (aRR: 0.78, 95% CI: 0.76–0.80), and Methamphetamine + STBBI cohorts (aRR: 0.74, 95% CI: 0.72–0.77) had significantly lower vaccine uptake. The HIV Only cohort did not differ significantly from matched comparators (aRR: 0.98, 95% CI: 0.95–1.01). Lower uptake was concentrated among individuals living in lower-income areas.
Conclusions
People diagnosed with STBBI and methamphetamine users in Manitoba experienced significant inequities in COVID-19 vaccine uptake, particularly those with STBBI co-infections and concurrent substance use. Integrated vaccination approaches linked with HIV, harm reduction, and addiction services may improve vaccine equity during future public health emergencies.
What is already known on this topic
Previous studies have shown lower COVID-19 vaccine uptake among marginalized populations, including people who inject drugs, and some people living with HIV, but little research has examined vaccination coverage among people diagnosed with other sexually transmitted or bloodborne infections (STBBI) or those with co-infections and methamphetamine use.
What this study adds
Using linked population-based administrative healthcare data from Manitoba, we found that people diagnosed with STBBI and methamphetamine users were generally less likely to complete the COVID-19 primary vaccine series than matched comparators from the general population. The lowest uptake was observed among methamphetamine users with concurrent STBBI, while people living with HIV without evidence of other STBBI had vaccine uptake comparable to matched controls.
How this study might affect research, practice or policy
These findings demonstrate how intersecting social and structural vulnerabilities contribute to inequities in vaccine uptake during public health emergencies. Integrated vaccination strategies linked with HIV, harm reduction, and addiction services may improve vaccine equity in future pandemics.
