A total of 332 HIV-positive patients on ART participated, with a response rate of 89.5%. The respondent’s age range was 18–57 years. Out of 332 study participants, 61.4% were female (Table 1). The mean monthly income of the study participants was 2696.95 Birr. The minimum and maximum duration of diseases among the study participants was 1 year and 17 years respectively, with mean of 8.45 years.

One hundred and ten (33.1%) and 118(35.5%) of the study participants had poor knowledge and negative attitude about COVID-19 vaccine respectively while 31(9.3%) of the study participants perceive ART drugs can also prevent COVID-19 infection. Twenty-seven (8.1%) participants perceive COVID-19 vaccination had negative impact on HIV/AIDS progress (Table 2).

Two hundred and seven study participants got COVID-19 vaccine related information’s from health care workers, out of them about 85 study participants had willingness to accept COVID-19 vaccination (Figure 1).

Two hundred and twenty (66.3%) with 95% CI (60.9, 71.5) study participants were willing to take COVID-19 vaccination. Out of this, 141(64.1%), 177 (80.4%) and 78(35.4%) were female, urban resident and private worker. (Table 3)

In multivariable analysis, refusal to be vaccinated for COVID-19 vaccine was significantly associated with poor knowledge (AOR: 2.73; 95% CI (1.69, 4.4)) and negative attitude (AOR: 2.55; 95% CI (1.59, 4.09)) compared with their counters. PLWHA on ART who live in rural area were less likely (AOR: 0.12, 95% CI (0.07, 0.21) willing to be vaccinated compared to those who live in urban area.

Vaccination is an important approach for mitigating the COVID-19 pandemic by instilling herd immunity in the community. The effectiveness of this technique is dependent on vaccine uptake in the population. According to the most recent COVID-19 estimates, up to 60-75 percent of the population needs to be vaccinated in order to stop the disease's spread and achieve herd immunity 26.

The established risk factors for COVID-19 acquisition and consequences, such as heart disease, kidney disease, diabetes, chronic pulmonary disease, and obesity, may be more prevalent in PLWHA 27. Existing clinical data suggest that the risk of acquiring deadly COVID-19 in PLWHA was 30% higher than in those without HIV infection. All currently available vaccinations can be used safely in patients living with HIV, independent of CD4 count or viral load suppression status 28. 

The prevalence and parameters associated with PLWHA's willingness to receive COVID-19 immunization were investigated in this study. As a result, 66% of PLWHA expressed desire to get the COVID-19 vaccine. This study's findings agree with those of an Ethiopian study (62.6%) 25. Reports of willingness to receive COVID-19 vaccine among PLWHA in current study was higher than findings from study in Turkey (29.2%) 29, Ethiopia (31.4%)30 and Palestine (37.8%)31, Wolayta-Ethiopia (45.5%)32, Southern Ethiopia (46.1%)33, China (57.2%)34 and south India (60%)35. And the finding of this study is lower than findings from, China (72.5)36, France (71.3%)37. This disparity could be explained by geographical heterogeneity, the methodology used, and the socio-demographic and socioeconomic features of the research populations.

The novelty of the COVID-19 disease may have contributed to the lower magnitude of vaccine adoption. As a result of the vaccine's rapid development, there may be ambiguity and misguided ideas about it, which leads to the false notion that the vaccine has not been sufficiently proven for safety and effectiveness, as well as restricted access to information, particularly in LMICs38. Furthermore, this increased vaccine hesitation could be linked to widespread misinformation about the COVID-19 vaccine on social media39. Despite the increased risk of developing COVID-19, the low rate of vaccination uptake in PLWHA provides fertile ground for exacerbating health-related side effects 40.

In our study, PLWHA with secondary and college education levels were less likely to be willing to be vaccinated with COVID 19 vaccine than non-educated participants. This is confirmed by studies from Gondar, Ethiopia, which found that participants with a university degree were less likely to receive the vaccine than those with a college diploma 10. In contrary, this study was not in-line with findings from41, (Palestine)31, USA42 which reported willingness of receiving vaccine increases as educational status of an individual increases. This might be due increased concerns about the mistrust in efficacy and efficiency of the vaccine 35. In addition, for HIV infected individuals, they may worry that the vaccine would further worsen their immune system 43.

Negative claims about vaccine effectiveness can profoundly influence vaccine uptake 44. Rumors regarding vaccination efforts being utilized for political goals, assertions that the COVID-19 vaccine was designed to reduce the global population, affect vaccination campaigns in various nations, particularly among the educated portion of the public who likely have better access to information. The odds of a participant being classified as hesitant increased by 26% for each additional source of information they mistrusted 3545. In this situation, stakeholders such as the federal ministry of health, the regional health bureau, and media organizations should broadcast reliable information to the population, thereby developing confidence, ensuring widespread vaccine coverage, and ultimately ending the pandemic.

In present study, participants who had good knowledge towards COVID-19 vaccine were 3.7 more likely to accept the COVID-19 vaccine when compared to respondents with poor knowledge. This was consistent with the findings from Ethiopia46, Ethiopia47, Pakistan31, Ethiopia 25, and the USA48.It might be due to having good knowledge about a COVID-19 vaccine being a prerequisite for using it.

Respondents who had a positive attitude towards the COVID-19 vaccines had a significantly higher acceptance rate of the COVID-19 vaccine (AOR=4.3) which was supported by the findings from Ethiopia47, Ethiopia46, Ethiopia49, South Africa50, Ethiopia33 worldwide51. This could be due to those who have positive attitude towards the vaccine are highly compliant towards preventive measures against the pandemic including vaccination. Therefore, information campaigns should focus on providing more information about COVID-19 vaccine safety, reassuring the population in order to maintain this positive attitude towards the intention to accept the vaccine.

Even though this study had strengths, there were some limitations. This study was cross sectional survey. Therefore the limitation of this study is temporal relationship can t be determined. The other limitation is lack of control group (HIV negative persons)