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Beydoun HA, Szymkowiak D, Kinney R, Beydoun MA, Zonderman AB, Tsai J. Is the Risk of Alzheimer's Disease and Related Dementias Among U.S. Veterans Influenced by the Intersectionality of Housing Status, HIV/AIDS, Hepatitis C, and Psychiatric Disorders? J Gerontol A Biol Sci Med Sci 2024; 79:glae153. [PMID: 38869510 DOI: 10.1093/gerona/glae153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Homelessness and housing instability disproportionately affect U.S. veterans with psychiatric disorders, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis C, and Alzheimer's disease and related disorders (ADRD). We examined housing status and/or HIV/AIDS in relation to ADRD risk and evaluated hepatitis C, substance use, and mental health disorders as mediators and/or moderators of hypothesized relationships, among U.S. veterans ≥50 years of age seeking Department of Veterans Affairs (VA) healthcare services. METHODS A retrospective cohort study was conducted using linked VA Homeless Operations Management and Evaluation System and Corporate Data Warehouse databases (2017-2023) on 3 275 098 eligible veterans yielding 133 388 ADRD cases over 5 years of follow-up. Multivariable regression and causal mediation analyses were performed, controlling for demographic and clinical characteristics. RESULTS Taking stably housed veterans without HIV/AIDS as referent, ADRD risk was higher among veterans with homelessness/housing instability alone (adjusted hazard ratio [aHR] = 1.67, 95% confidence interval [CI]: 1.63,1.72), lower among veterans with HIV/AIDS alone (aHR = 0.65, 95% CI: 0.58,0.73), but similar to veterans with homelessness/housing instability and HIV/AIDS (aHR = 1.01, 95% CI: 0.79,1.29). In adjusted models, hepatitis C and psychiatric disorders were positively related to homelessness/housing instability and ADRD risk, but negatively related to HIV/AIDS. Statistically significant mediation and/or moderation of hepatitis C and psychiatric disorders were observed, although <10% of total effects were explained by these characteristics, controlling for confounders. CONCLUSIONS Among older veterans, ADRD diagnoses over 5 years were less among those with HIV/AIDS, but more among those with homelessness/housing instability, and these relationships were partly explained by hepatitis C and psychiatric disorders.
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Affiliation(s)
- Hind A Beydoun
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, District of Columba, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Dorota Szymkowiak
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, District of Columba, USA
| | - Rebecca Kinney
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, District of Columba, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, Maryland, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, Maryland, USA
| | - Jack Tsai
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, District of Columba, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
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McCosker LK, Ware RS, Seale H, Hooshmand D, O'Leary R, Downes MJ. The effect of a financial incentive on COVID-19 vaccination uptake, and predictors of uptake, in people experiencing homelessness: A randomized controlled trial. Vaccine 2024; 42:2578-2584. [PMID: 38485641 DOI: 10.1016/j.vaccine.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 04/06/2024]
Abstract
People who are homeless are at increased risk of COVID-19 infection, and of poorer associated outcomes. Delivering vaccinations to, and ensuring uptake of multiple doses in, people who are homeless is complex. Financial incentives may improve vaccination uptake, particularly in people who have not received routine vaccinations previously, though evidence about the effect of incentives is limited and variable. This randomized controlled trial (ANZCTR 383156) assessed the effect of a financial incentive (an A$10 grocery voucher) on uptake of the second COVID-19 vaccination in Australian adults who were homeless, and who had received their first dose. Participants were recruited through a vaccination program for people experiencing homelessness between September 2021 and January 2022. They were followed-up for a minimum of 6.5 months. Uptake was measured 'on-time' at 6 weeks, and at any time during the trial period. Vaccination status was checked on the Australian Immunisation Register. Demographic and vaccination program characteristics associated with uptake were also investigated. Eighty-six people consented to participate, and 43 were randomly allocated to each of the 'incentive' and 'no incentive' groups. The incentive slightly increased the likelihood of a participant receiving a second vaccination on-time (risk difference (RD), 11.6 % [95 %CI, -9.0, 32.2 %]; p = 0.27), and at any time during the trial (RD, 14.0 % [95 %CI, -2.2, 30.1 %], p = 0.09). The incentive had a significant positive effect on uptake in people with no previous vaccination history, increasing their likelihood of receiving a second vaccination on-time (RD, 42.3 % [95 %CI, 15.7, 68.8 %]; p = 0.002) and at any time during the trial (RD, 38.7 % [95 %CI, 16.1, 61.3 %], p < 0.001). Financial incentives may increase COVID-19 vaccination uptake in people who are homeless, and particularly those who have no previous vaccination history. Future research should consider alternative incentive values, types, and cost-effectiveness.
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Affiliation(s)
- Laura K McCosker
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia; School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Robert S Ware
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
| | - Holly Seale
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Dona Hooshmand
- Ashben Medical Centre, Gold Coast, Queensland, Australia.
| | - Ryan O'Leary
- Queensland Council of Social Service, Brisbane, Queensland, Australia; Gold Coast Homelessness Network, Australia.
| | - Martin J Downes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
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Gin JL, Balut MD, Dobalian A. COVID-19 vaccination uptake and receptivity among veterans enrolled in homelessness-tailored primary health care clinics: provider trust vs. misinformation. BMC PRIMARY CARE 2024; 25:24. [PMID: 38216894 PMCID: PMC10785369 DOI: 10.1186/s12875-023-02251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Compared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)'s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care. METHODS This study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic). RESULTS Four themes emerged from the interviews: (1) Vaccination uptake and timing- While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing- Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care- Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers' Conspiracy Theories and Objectivity Claims- Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources. CONCLUSIONS These findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans' beliefs, are also key to effectively delivering vaccine messaging to this population.
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Affiliation(s)
- June L Gin
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA.
| | - Michelle D Balut
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, 202 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
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Nguyen DA, Alagbo HO, Hassan TA, Mera-Lojano LD, Abdelaziz EO, The NPN, Makram AM, Makram OM, Elsheikh R, Huy NT. Vaccine acceptance, determinants, and attitudes toward vaccine among people experiencing homelessness: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:880. [PMID: 38102542 PMCID: PMC10724884 DOI: 10.1186/s12879-023-08878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND COVID-19 has caused millions of deaths globally, with vulnerable populations such as people experiencing homelessness (PEH) at higher risk. This systematic review and meta-analysis aims to identify the prevalence and key factors contributing to vaccine acceptance experienced by PEH. METHODS The protocol of this study was registered in PROSPERO (CRD42023391659). We included studies that reported relevant information about vaccine acceptance or vaccine hesitant/refusal among PEH. Eight databases were systematically searched in January 2023. Meta-analysis was conducted for the prevalence of vaccine acceptance, vaccine uptake, and factors associated with vaccine acceptance. Attitudes toward vaccines were combined into bar charts. RESULT A total of 29 papers were included in this systematic review and 19 papers were included for meta-analysis. The pooled prevalence of COVID-19 vaccine acceptance among PEH was 66% (95%CI: 58%-73%). Our meta-regression showed vaccine acceptance was significantly increased over time. Moreover, subgroup meta-analysis showed that PEH were more likely to accept the COVID-19 vaccine after June 2021 (78%, 95%CI: 65%-86%) compared with earlier period (56%, 95%CI: 54%-59%). Subgroup meta-analysis also revealed that women and participants without underlying medical condition (chronic diseases) were significantly less likely to accept the COVID-19 vaccine, compared to men and those with medical conditions, respectively. CONCLUSION The study emphasizes the need for targeted public health interventions aimed at increasing vaccine acceptance among PEH, especially at the early stage of the pandemic, among females, those without underlying medical conditions, being Black (in Canada and the USA), and young people. These interventions should address the common concerns of vaccine safety, adverse effects, effectiveness, and distrust in health care systems. In addition to offering vaccinations in different areas convenient to them, education programs could be established to increase vaccine acceptance among PEH.
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Affiliation(s)
- Dung Anh Nguyen
- Health Science Department, University of The People, Pasadena, CA, USA
- Online Research Club, Nagasaki, Japan
| | - Habib Olatunji Alagbo
- Online Research Club, Nagasaki, Japan.
- V.N, Karazin National University, Kharkiv, Ukraine.
| | - Toka Adel Hassan
- Online Research Club, Nagasaki, Japan
- Faculty of Medicine, October 6 University, Giza, Egypt
| | - Leonardo D Mera-Lojano
- Online Research Club, Nagasaki, Japan
- ASOCEM UCE - Scientific Association of Students of Medicine, School of Medicine, Faculty of Medical Science, Central University of Ecuador, Quito, Ecuador
| | - Esraa Osama Abdelaziz
- Online Research Club, Nagasaki, Japan
- Faculty of Pharmacy and Biotechnology, German University in Cairo, Cairo, Egypt
| | - Nguyen Pham Nguyen The
- Online Research Club, Nagasaki, Japan
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Abdelrahman M Makram
- Online Research Club, Nagasaki, Japan
- School of Public Health, Imperial College London, London, UK
| | - Omar M Makram
- Online Research Club, Nagasaki, Japan
- Center for Health & Nature, Houston Methodist Hospital, Houston, Texas, 77030, USA
| | - Randa Elsheikh
- Online Research Club, Nagasaki, Japan
- Deanery of Biomedical Sciences at Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Nguyen Tien Huy
- Online Research Club, Nagasaki, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Gin JL, Balut MD, Dobalian A. COVID-19 Vaccine Hesitancy among U.S. Veterans Experiencing Homelessness in Transitional Housing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15863. [PMID: 36497937 PMCID: PMC9735876 DOI: 10.3390/ijerph192315863] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
Little is known about COVID-19 vaccine hesitancy and acceptance among individuals experiencing homelessness, despite their higher risk for morbidity and mortality from SARS-CoV-2. This study examines COVID-19 vaccination attitudes and uptake among U.S. military Veterans experiencing homelessness enrolled in transitional housing programs funded by the U.S. Department of Veterans Affairs (VA). Telephone interviews were conducted with 20 Veterans in California, Florida, Iowa, Kentucky, and Massachusetts, USA (January-April 2021). A rapid analysis approach was used to identify and enumerate commonly occurring themes. Although 60% of interviewed Veterans either received the COVID-19 vaccine or were willing to do so, one-third expressed hesitancy to get vaccinated. COVID-19 vaccination attitudes (e.g., belief that the vaccines were inadequately tested), military experience, beliefs about influenza and other vaccines, and sources of information emerged as influential factors for COVID-19 vaccination uptake or hesitancy. Veterans in VA-funded homeless transitional housing programs are generally willing to be vaccinated. However, a substantial minority is reluctant to take the vaccine due to concerns about the COVID-19 vaccine and distrust of authority. Recommendations for increasing uptake include utilizing Veteran peers, homeless service providers, and healthcare providers as trusted messengers to improve confidence in the vaccine.
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Affiliation(s)
- June L. Gin
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA 91343, USA
| | - Michelle D. Balut
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA 91343, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA 91343, USA
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH 43210, USA
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Allen EM, Smither B, Barranco L, Reynolds J, Bursey K, Mattson K, Mosites E. Communicating Effectively With People Experiencing Homelessness to Prevent Infectious Diseases. J Infect Dis 2022; 226:S340-S345. [PMID: 36208164 PMCID: PMC9619659 DOI: 10.1093/infdis/jiac336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background People experiencing homelessness (PEH) are disproportionately affected by many infectious diseases, including coronavirus disease 2019 (COVID-19). However, communication efforts during public health emergencies like the COVID-19 pandemic often do not consider the unique needs of PEH. We examined how PEH seek and receive health information and how traditional health communication methods resonate with them. Methods We conducted in-person focus groups with PEH in 4 jurisdictions (Cincinnati, Ohio; Denver, Colorado; Sacramento, California; and the Bronx, New York) during July 2021. Results Findings from 15 focus groups with PEH (n = 53) revealed the need for trusted messengers and consistent messaging across local organizations, as PEH seek to verify information they receive from multiple sources. PEH overwhelmingly preferred to receive health information through face-to-face conversations, especially with healthcare providers with whom they had an established relationship, but they also cited news media, the internet, and social media as their main sources for obtaining health information. PEH reported that effective communication products pair a recommended action with instructions and resources about how to take that action within their community. Conclusions These findings support healthcare providers collaborating with public health agencies to ensure that infectious disease prevention messages for PEH are provided by trusted messengers, multimodal, paired with resources, and consistent.
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Affiliation(s)
- Elizabeth M Allen
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Betsy Smither
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Lindsey Barranco
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Reynolds
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Kelli Bursey
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Kristin Mattson
- Public Health and Healthcare Program, Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Emily Mosites
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Agaku IT, Adeoye C, Long TG. Geographic, Occupational, and Sociodemographic Variations in Uptake of COVID-19 Booster Doses Among Fully Vaccinated US Adults, December 1, 2021, to January 10, 2022. JAMA Netw Open 2022; 5:e2227680. [PMID: 35984657 PMCID: PMC9391956 DOI: 10.1001/jamanetworkopen.2022.27680] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE COVID-19 booster vaccine can strengthen waning immunity and widen the range of immunity against new variants. OBJECTIVE To describe geographic, occupational, and sociodemographic variations in uptake of COVID-19 booster doses among fully vaccinated US adults. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study used data from the Household Pulse Survey conducted from December 1, 2021, to January 10, 2022. Household Pulse Survey is an online, probability-based survey conducted by the US Census Bureau and is designed to yield estimates nationally, by state, and across selected metropolitan areas. MAIN OUTCOMES AND MEASURES Receipt of a booster dose was defined as taking 2 or more doses of COVID-19 vaccines with the first one being the Johnson and Johnson (Janssen) vaccine, or taking 3 or more doses of any of the other COVID-19 vaccines. Weighted prevalence estimates (percentages) were computed overall and among subgroups. Adjusted prevalence ratios (APRs) were calculated in a multivariable Poisson regression model to explore correlates of receiving a booster dose among those fully vaccinated. RESULTS A total of 135 821 adults completed the survey. Overall, 51.0% were female and 41.5% were aged 18 to 44 years (mean [SD] age, 48.07 [17.18] years). Of fully vaccinated adults, the percentage who reported being boosted was 48.5% (state-specific range, from 39.1% in Mississippi to 66.5% in Vermont). Nationally, the proportion of boosted adults was highest among non-Hispanic Asian individuals (54.1%); those aged 65 years or older (71.4%); those with a doctoral, professional, or master's degree (68.1%); those who were married with no children in the household (61.2%); those with annual household income of $200 000 or higher (69.3%); those enrolled in Medicare (70.9%); and those working in hospitals (60.5%) or in deathcare facilities (eg, funeral homes; 60.5%). Conversely, only one-third of those who ever received a diagnosis of COVID-19, were enrolled in Medicaid, working in pharmacies, with less than a high school education, and aged 18 to 24 years old were boosted. Multivariable analysis of pooled national data revealed that compared with those who did not work outside their home, the likelihood of being boosted was higher among adults working in hospitals (APR, 1.23; 95% CI, 1.17-1.30), ambulatory health care centers (APR, 1.16; 95% CI, 1.09-1.24), and social service settings (APR, 1.08; 95% CI, 1.01-1.15), whereas lower likelihood was seen among those working in food or beverage stores (APR, 0.85; 95% CI, 0.74-0.96) and the agriculture, forestry, fishing, or hunting industries (APR, 0.83; 95% CI, 0.72-0.97). CONCLUSIONS AND RELEVANCE These findings suggest continuing disparities in receipt of booster vaccine doses among US adults. Targeted efforts at populations with low uptake may be needed to improve booster vaccine coverage in the US.
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Affiliation(s)
- Israel T. Agaku
- NYC Test and Trace Corps, NYC Health + Hospitals, New York, New York
| | - Caleb Adeoye
- NYC Test and Trace Corps, NYC Health + Hospitals, New York, New York
| | - Theodore G. Long
- NYC Test and Trace Corps, NYC Health + Hospitals, New York, New York
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