Factors associated with hesitancy toward a future tuberculosis vaccine among people living with HIV: A cross-sectional study in Indonesia

Abstract

Evidence regarding factors associated with tuberculosis (TB) vaccine hesitancy among people living with HIV (PLHIV) in Indonesia remains limited. This study aimed to identify sociodemographic and clinical factors associated with hesitancy toward a future TB vaccine among PLHIV. This cross-sectional study included 346 PLHIV attending the Intermediate Care Unit and Infectious Disease Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from January to February 2026. Participants were recruited using consecutive sampling. Data were collected using a structured questionnaire and verified through electronic medical records. Associations were assessed using the Chi-square test, followed by multivariable logistic regression for variables with p<0.25 in the bivariate analysis. Of the 346 participants, 33.2% were hesitant, and 66.8% were willing to receive a future effective TB vaccine. In the bivariate analysis, female sex (OR: 3.04; 95%CI: 1.91–4.86; p<0.001), age 26–39 years (OR: 1.59; 95%CI: 1.00–2.52; p=0.046), unemployment (OR: 1.71; 95%CI: 1.07–2.73; p=0.024), and income below the regional minimum wage (OR: 1.85; 95%CI: 1.14–2.98; p=0.011) were associated with greater vaccine hesitancy. After adjustment, income below the regional minimum wage remained independently associated with hesitancy (adjusted OR: 2.14; 95%CI: 1.11–4.24; p=0.025). Socioeconomic disadvantage, particularly low income, may represent an important barrier to the acceptance of future TB vaccines among PLHIV. Socioeconomically tailored education and vaccination strategies should be considered for this population.