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Ahillan T, Emmerson M, Swift B, Golamgouse H, Song K, Roxas A, Mendha SB, Avramović E, Rastogi J, Sultan B. COVID-19 in the homeless population: a scoping review and meta-analysis examining differences in prevalence, presentation, vaccine hesitancy and government response in the first year of the pandemic. BMC Infect Dis 2023; 23:155. [PMID: 36918758 PMCID: PMC10012317 DOI: 10.1186/s12879-023-08037-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023] Open
Abstract
AIMS People experiencing homelessness (PEH) have been identified as being increasingly susceptible to Coronavirus disease (COVID-19), with policies enacted to test, isolate, increase hygiene practices and prioritise vaccines among this population. Here, we conduct a scoping review of the current evidence-base pertaining to the prevalence and presentation of COVID-19 in PEH, COVID-vaccine hesitancy rates and government interventions enacted within the first year of the pandemic for PEH. MATERIALS AND METHODS A systematic search was conducted on Pubmed, Cochrane, Embase and MedRxiv databases for studies reporting primary data on COVID-19 prevalence and clinical characteristics in PEH, vaccine uptake for PEH and policies enacted targeting PEH. Study qualities were assessed with The National Heart, Lung and Blood Institute's set of Study Quality. RESULTS Eighty-three studies were included in our final analysis. The overall prevalence of symptomatic COVID-19 infection in PEH is estimated at 35%. The most common symptoms found were cough and shortness of breath, followed by fever. Concerns regarding vaccine hesitancy amongst PEH related to thoroughness of COVID-19 vaccine clinical trials, side effects and mistrust of the government. The main strategies implemented by governments were mass testing, adaption of healthcare service provision, provision of alternative housing, encouraging personal hygiene (hand sanitation and mask wearing), and inter-organisational communication. DISCUSSION In our meta-analysis, 35% of PEH with a COVID-19 infection presented symptomatically; the low prevalence of symptomatic COVID-19 infection suggests widespread testing following outbreaks would be beneficial for this group of individuals. Temporary recuperation units and measures for housing stability in the pandemic, namely provision of alternative housing and stopping evictions, were found to be highly effective. High rates of vaccine hesitancy means that education and encouragement towards vaccination would be beneficial for this vulnerable population, where comorbidities are common. Finally increased focus in research should be placed on the mental health burden of COVID-19 and the pandemic on PEH moving forwards.
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Affiliation(s)
| | | | - Bethan Swift
- Wellcome Centre for Human Genetics, Oxford, UK.,Nuffield Department of Women's and Reproductive Health, Oxford, UK
| | | | | | | | | | | | | | - Binta Sultan
- Institute of Global Health, University College London, London, UK
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Torres-Leguizamon M, Favaro J, Coello D, Reynaud EG, Néfau T, Duplessy C. Remote harm reduction services are key solutions to reduce the impact of COVID-19-like crises on people who use drugs: evidence from two independent structures in France and in the USA. Harm Reduct J 2023; 20:1. [PMID: 36611167 PMCID: PMC9823260 DOI: 10.1186/s12954-023-00732-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Harm Reduction (HR) policies for People Who Use Drugs (PWUD) have a significant positive impact on their health. Such approaches limit the spread of infections and reduce opioid overdose mortality. These policies have led to the opening of specialized structures located mainly in big cities and urbanized zones. The COVID-19 pandemic reduced access to HR structures in locations undergoing lockdown. Before the pandemic, HR services in France and in the USA were complemented by the development of remote HR programs: HaRePo (Harm Reduction by Post) for France, implemented in 2011, and NEXT Distro for the USA founded in 2017. These programs are free and specifically designed for people who have difficulties accessing HR tools and counseling in-person. PWUD can access HaRePo program by phone and/or email. NEXT Distro users can access the program through its dedicated website. The aim of the study is to test if and possibly how COVID-19 pandemic and the associated lockdowns have impacted the HR services in both countries. METHODS By using t-test comparing the year 2019 with the year 2020, we analyzed how lockdowns impacted the number of new users entering the programs, as well as the numbers of parcels sent and naloxone distributed, by using records of both structures. RESULTS We showed that the activity of both programs was significantly impacted by the pandemic. Both show an increase in the number of new users joining the programs (+ 77.6% for HaRePo and + 247.7% for NEXT Distro) as well as for the number of parcels sent per month (+ 42.7% for HaRePo and + 211.3% for NEXT Distro). It shows that remote HR was able to partially compensate for the reduced HR activities due to COVID-19. We also observed that the distribution of naloxone per parcel tends to increase for both structures. CONCLUSION With the ability to reach PWUD remotely, HaRePo and NEXT Distro were particularly effective at maintaining service continuity and scaling up services to meet the needs of PWUD during the COVID-19 pandemic. By studying two independent structures in France and in the USA sharing similar objectives (remote HR), we showed that this approach can be a key solution to crises that impact classical HR structures despite various differences in operating procedures between countries.
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Affiliation(s)
| | | | | | - Emmanuel G. Reynaud
- grid.7886.10000 0001 0768 2743School of Biomolecular and Biomedical Science, University College Dublin, Dublin, Ireland
| | - Thomas Néfau
- SAFE, 11 Avenue de la Porte de la Plaine, 75015 Paris, France
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Aronowitz SV, Carroll JJ, Hansen H, Jauffret-Roustide M, Parker CM, Suhail-Sindhu S, Albizu-Garcia C, Alegria M, Arrendondo J, Baldacchino A, Bluthenthal R, Bourgois P, Burraway J, Chen JS, Ekhtiari H, Elkhoy H, Farhoudian A, Friedman J, Jordan A, Kato L, Knight K, Martinez C, McNeil R, Murray H, Namirembe S, Radfar R, Roe L, Sarang A, Scherz C, Tay Wee Teck J, Textor L, Thi Hai Oanh K. Substance use policy and practice in the COVID-19 pandemic: Learning from early pandemic responses through internationally comparative field data. Glob Public Health 2022; 17:3654-3669. [PMID: 36692903 DOI: 10.1080/17441692.2022.2129720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 pandemic has created an unprecedented natural experiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures and social safety nets around the world. Using qualitative data including ethnographic methods, questionnaires, and semi-structured interviews with people who use drugs (PWUD) and Delphi-method with experts from field sites spanning 13 different countries, this paper compares national responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of social scientists, public health scientists, and community health practitioners convened to identify and contextualise health service delivery models and social protections that influence the health and wellbeing of PWUD during COVID-19. Findings suggest that countries with stronger social welfare systems pre-COVID introduced durable interventions targeting structural drivers of health. Countries with fragmented social service infrastructures implemented temporary initiatives for PWUD led by non-governmental organisations. The paper summarises the most successful early pandemic responses seen across countries and ends by calling for greater systemic investments in social protections for PWUD, diversion away from criminal-legal systems toward health interventions, and integrated harm reduction, treatment and recovery supports for PWUD.
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Affiliation(s)
- Shoshana V Aronowitz
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, United States
| | - Jennifer J Carroll
- Department of Anthropology, North Carolina State University, Raleigh, United States
| | - Helena Hansen
- UCLA Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles, United States
| | - Marie Jauffret-Roustide
- Centre d'étude des mouvements sociaux (Inserm U12/76/CNRS UMR 8044/EHESS), Paris, France.,Baldy Center for Law and Social Policy, Buffalo University of Social Science, NY, USA
| | - Caroline Mary Parker
- The University of Manchester, Manchester University, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Selena Suhail-Sindhu
- University of California Los Angeles, UCLA Center for Social Medicine and Humanities, Los Angeles, United States
| | - Carmen Albizu-Garcia
- Universidad de Puerto Rico, Graduate School of Public Health, San Juan, Puerto Rico
| | - Margarita Alegria
- Massachusetts General Hospital, Disparities Research Unit, Boston, United States
| | - Jaimie Arrendondo
- Center for Research and Economic Teaching, Drug Policy Program, Aguascalientes, MX, Mexico
| | - Alexander Baldacchino
- Medicine, University of St Andrews, St Andrews, United Kingdom of Great Britain and Northern Ireland
| | - Ricky Bluthenthal
- Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, United States
| | - Philippe Bourgois
- Center for Social Medicine and Humanities, University of California Los Angeles, Los Angeles, United States
| | - Joshua Burraway
- Institute for Advanced Studies, University of Virginia, Charlottesville, United States
| | - Jia-Shin Chen
- Institute of Science, Technology and Society, National Yang-Ming University, Hsinchu, Taiwan
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, The University of Oklahoma, Norman, United States
| | - Hussien Elkhoy
- Neurology and Psychiatry, Ain Shams University, Cairo, Egypt
| | - Ali Farhoudian
- University of Social Welfare and Rehabilitation Sciences, Substance Abuse and Dependence Research Center, Tehran, Iran (the Islamic Republic of)
| | - Joseph Friedman
- David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, United States
| | - Ayana Jordan
- Psychiary, Yale University, New Haven, United States
| | - Lindsey Kato
- Centers for Disease Control and Prevention, Overdose Response Strategy, Atlanta, United States
| | - Kelly Knight
- Humanities and Social Sciences, University of California San Francisco, San Francisco, United States
| | - Carlos Martinez
- Medical Anthropology, University of California at Berkeley, Berkeley, USA
| | - Ryan McNeil
- Addiction Medicine, Yale University, New Haven, United States
| | - Hayley Murray
- Anthropology, Universiteit van Amsterdam, Amsterdam, Netherlands
| | | | - Ramin Radfar
- Isfahan University of Medical Sciences, Thought, Culture and Health Institute, Isfahan, Iran (the Islamic Republic of)
| | - Laura Roe
- Social Anthropology, University of St Andrews, St Andrews, United Kingdom of Great Britain and Northern Ireland
| | - Anya Sarang
- Andrey Rylkov Foundation for Health and Social Justice, President, RU, Moscow, Russian Federation
| | - China Scherz
- Anthropology, University of Virginia, Charlottesville, United States
| | - Joe Tay Wee Teck
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Lauren Textor
- David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, United States
| | - Khuat Thi Hai Oanh
- Center for Supporting Community Development Initiatives, Executive Director, Hanoi, VN, Vietnam
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McNeil R, Jauffret-Roustide M, Hansen H. Reducing Drug-Related Harms and Promoting Health Justice Worldwide During and After COVID-19: An AJPH Supplement. Am J Public Health 2022; 112:S95-S98. [PMID: 35349319 PMCID: PMC8965184 DOI: 10.2105/ajph.2022.306804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Ryan McNeil
- Ryan McNeil is with the Program in Addiction Medicine, Yale University, New Haven, CT. Marie Jauffret-Roustide is with Centre d'Études des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France, and the Social Science, Drugs and Society Program, Paris, France. Helena Hansen is with the Research Theme in Health Equity Research and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. The authors are also Guest Editors for this supplement issue
| | - Marie Jauffret-Roustide
- Ryan McNeil is with the Program in Addiction Medicine, Yale University, New Haven, CT. Marie Jauffret-Roustide is with Centre d'Études des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France, and the Social Science, Drugs and Society Program, Paris, France. Helena Hansen is with the Research Theme in Health Equity Research and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. The authors are also Guest Editors for this supplement issue
| | - Helena Hansen
- Ryan McNeil is with the Program in Addiction Medicine, Yale University, New Haven, CT. Marie Jauffret-Roustide is with Centre d'Études des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France, and the Social Science, Drugs and Society Program, Paris, France. Helena Hansen is with the Research Theme in Health Equity Research and Translational Social Science, David Geffen School of Medicine, University of California, Los Angeles. The authors are also Guest Editors for this supplement issue
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Van Hout MC, Haddad P, Aaraj E. The Impact of COVID-19 on Drug Use and Harm Reduction Programming in the Middle East and North Africa (MENA) Region: a Regional Consultation of Stakeholders and People Who Use Drugs. Int J Ment Health Addict 2021; 20:2072-2085. [PMID: 34276260 PMCID: PMC8276543 DOI: 10.1007/s11469-021-00500-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 12/24/2022] Open
Abstract
The Middle East and North Africa (MENA) region has witnessed a slow but steady increase in the harm reduction response since 2016. It is likely that such gains are threatened by the impact of COVID-19. Very little is known about the health response and situation of people who use drugs (PWUD) during the pandemic in the region. A mixed method study was conducted by the MENA Harm Reduction Association (MENAHRA) to assess the situation of PWUD and impacts on harm reduction services during COVID-19. Twelve countries and two regional viewpoints responded to the survey. A virtual focus group was held with the MENA Network of People who Use Drugs (MENANPUD) focal points (n = 11). The study highlights how COVID-19 aggravated existing marginalization and stigmatization of PWUD and other key populations in the MENA region, with government level resourcing severely impacted by COVID-19. It further illustrates the commitment by harm reduction non-governmental organizations (NGOs) in diversifying their response, particularly through mobile outreach to drug hot spots, and the reliance of technology to support awareness raising, telemedicine, and medicine supplies. Positive shifts are observed in harm reduction policy by governments in some MENA countries and the continued commitment to support PWUD communities by existing harm reduction NGOs. Continued advocacy for and implementation of harm reduction responses at the domestic and regional levels should be underpinned by inclusion in state health emergency planning and disease control efforts, awareness raising around innovation and telemedicine to support health and NGO support systems and medicine supply chains, resourcing of NGOs, and provision of economic support for PWUD, disease surveillance, and research.
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Affiliation(s)
| | - Patricia Haddad
- Middle East and North African Harm Reduction Association (MENAHRA), Beirut, Lebanon
| | - Elie Aaraj
- Middle East and North African Harm Reduction Association (MENAHRA), Beirut, Lebanon
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