Improving influenza vaccination among African-American HIV-positive patients through ‘Tele-flucation’

From the 2018 HVPAA National Conference

Titilope Olanipekun (Morehouse School of Medicine), Mesfin Fransua (Morehouse School of Medicine)


People with HIV and AIDS are at a higher risk of influenza infection and related complications due to immune suppression. Therefore, the CDC recommends annual influenza vaccination for HIV infected persons. There is limited data about national vaccination rates in HIV infected patients. Influenza vaccination rate is generally low


The project was conducted in one of the HIV out-patient clinics of Grady Memorial Hospital – a public hospital in Atlanta with more than 600,000 general outpatient visits annually. The objectives of the project were to:

  • Identify reasons why HIV infected patients visiting the clinic during the 2017-2018 influenza season decline influenza vaccination.
  • Improve vaccine uptake among HIV infected patients visiting the clinic during the 2017-2018 influenza season through ‘Tele-flucation’

‘Tele – flucation’ for the purpose of this project is the process of educating patients on the importance of influenza vaccination to improve vaccine uptake.


The project was found to be exempt from the human subjects’ research regulations by the institutional review board. HIV infected African-Americanpatients who had consultation appointments between October 1, 2017 and February 28, 2018 who had not received flu vaccine was enrolled in the study. Their telephone contacts were obtained from the medical record charts and they were contacted within 2 – 4 weeks of their scheduled appointments. After explaining the objectives of the project to the patients, the reasons for declining flu vaccination in the past were discussed and ‘Tele-flucation’ was provided over the phone by resident physicians directly involved with the care of HIV infected patients in the outpatient clinic. Telephone services were already available at the clinic to contact patients about appointments, results and generally ease communications in patient care. Therefore, there was no additional direct cost to the hospital from the project.


232 patients (78% male) of 268 scheduled were successfully interviewed and provided ‘Tele-flucation’. 165 (75% male) accepted to get vaccinated during their clinic appointments. 197 patients showed up for their clinic appointments and 122 (72% male) received the flu shot.  The average age of the study participants was 42 years. The overall vaccination rate following ‘Tele-flucation’ was 61%. The influenza vaccination rate from the previous flu season (2016-2017) was 15.2%The main reasons cited by participants for declining flu vaccine were fear of side effects and perception of flu as a mild illness


‘Tele-flucation’ uses telephone technology which is universally available, relatively cost effective and readily accessible. This study suggests that inadequate health education of patients on flu vaccine during routine outpatient visits contribute to low vaccination rates. Our project shows that ‘Tele-flucation’ can be used to improve vaccination coverage among HIV infected patients. It should be focused on addressing concerns about vaccine side effects and correcting the wrong perception of flu as a minor disease.

Implications for the Patient

Tele-flucation’ intervention led to about 46% improvement (15% in 2016-2017 season – 61% in 2017-2018 season) in flu vaccination rates in our HIV outpatient clinic. Next step is to conduct this project on non – HIV infected patients in other outpatient departments to improve overall influenza vaccine coverage

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