Behavioural and Structural Determinants of Mpox Vaccine Awareness and Uptake Among People With HIV in the Dominican Republic: A Cross-Sectional Study.
Paulino-Ramirez Robert R, Matias Wilfredo R WR, Chaumette Alexandre A, Lora-Rodríguez Hector H et al.
Mpox disproportionately affects people with HIV (PWH), yet little is known about mpox vaccine awareness and uptake in low- and middle-income countries. We evaluated mpox-related knowledge, attitudes and practices (KAP) among PWH in the Dominican Republic to identify determinants of vaccine awareness and uptake. We conducted a cross-sectional online survey of 98 PWH recruited through HIV clinics, community-based organizations and social networks (January-May 2025). The questionnaire assessed sociodemographic characteristics, mpox-related KAP, structural barriers and vaccination status. Univariable and multivariable logistic regression were used to examine factors associated with mpox vaccine awareness. Half of the participants (49/98) were aware of the mpox vaccine. Individuals aged 31-40 years had significantly lower odds of awareness compared with those aged 21-30 years. Despite high levels of formal education, 79% rated their mpox knowledge as low, and most perceived minimal personal risk. Among participants aware of the vaccine, 71% had been vaccinated. Structural barriers, including inconvenient site locations and logistical challenges, were frequently reported, even among vaccinated individuals, indicating that access limitations rather than hesitancy were the dominant constraints. Trust in vaccinating organizations was high overall, and healthcare providers and community organizations were the primary sources of vaccine information. Peer and community influence emerged as notable facilitators of uptake, while lack of reliable information and concerns about vaccine safety contributed to hesitancy. Mpox vaccine awareness among PWH in the Dominican Republic was low, but willingness to vaccinate was high when individuals were informed and able to access services. Strengthening mpox preparedness will require expanding accessible vaccination sites, improving disease-specific health literacy, and leveraging trusted community and clinical networks. Integrating mpox vaccination into routine HIV care delivery and enhancing community-led outreach may substantially improve uptake in this and similar low-middle income countries (LMIC) settings.