title: Development of an HIV vaccine attitudes scale to predict HIV vaccine acceptability among vulnerable populations: L.A. VOICES.
abstract: BACKGROUND
  Decade-long delays in successful implementation of Hepatitis B vaccines and ongoing obstacles in HPV vaccine roll-out suggest the importance of an implementation science approach to prepare for the effective translation of future HIV vaccines from clinical trials into routine practice. The objective of this study was to test HIV vaccine attitude items to develop reliable scales and to examine their association with HIV vaccine acceptability.
  
  
  METHODS
  HIV vaccine attitude items were assessed as part of the L.A. VOICES survey, a large-scale study conducted among underserved residents of Los Angeles, to identify factors that may influence HIV vaccine acceptability. Participants (n=1225) were randomly selected from public STD clinics, needle exchange sites and Latino community clinics using three-stage, venue-based time space sampling.
  
  
  RESULTS
  Exploratory factor analysis across 20 items revealed four distinct factors - mistrust, HIV vaccine social concerns, risk compensation, and altruistic vaccination - with acceptable reliability coefficients for each subscale (Cronbach's α range 0.61-0.84). We found no significant differences in reliability by gender or by vaccine acceptability. Risk compensation (odds ratio (OR)=1.49; 95% CI=[1.18, 1.89]; p=0.001) and altruistic vaccination (OR=1.40; 95% CI=[1.14, 1.71]; p=0.001) were significantly and positively associated with HIV vaccine acceptability.
  
  
  CONCLUSIONS
  We identified four HIV vaccine attitude scales with sound internal reliability parameters. In the aftermath of the first candidate vaccine to demonstrate efficacy against HIV infection, these scales may be helpful in bridging expectable research-to-practice gaps in future HIV vaccine dissemination among populations at risk. As HIV vaccine trials progress in the United States and globally, these measures also may be useful as a tool to assess and facilitate effective responses to community concerns about HIV vaccine trials and to target interventions to support recruitment and mitigate risk compensation.
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute, Center for Community Health, University of California, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA 90024-6521, USA. Electronic address: sjlee@mednet.ucla.edu.
authors.forename: Sung-Jae
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1V4. Electronic address: p.newman@utoronto.ca.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Newman
authors.affiliation: Department of Psychiatry, Columbia University Medical Center, Room Old PI R209, Unit/Box: Biostatistics Division, 1051 Riverside Drive, New York, NY 10032, USA. Electronic address: naihua.duan@columbia.edu.
authors.forename: Naihua
authors.initials: N
authors.lastname: Duan
authors.affiliation: Department of Health Policy and Management, UCLA Fielding School of Public Health; Division of General Internal Medicine & Health Services Research, UCLA David Geffen School of Medicine, University of California, 640 Charles E Young Dr S, Los Angeles, CA 90024, USA. Electronic address: wcunningham@mednet.ucla.edu.
authors.forename: William E
authors.initials: WE
authors.lastname: Cunningham
mesh_terms: D016915:AIDS Vaccines / Q000627:therapeutic use*; D000328:Adult; D000533:Altruism; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015141:Los Angeles; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D035502:Trust; D014611:Vaccination / Q000523:psychology*; D035862:Vulnerable Populations
chemical_list: D016915:AIDS Vaccines
keywords: AIDS vaccine; Acceptability of healthcare; Altruism; Attitudes; Risk compensation; Scale development