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Haworth S, Cranshaw O, Xerri M, Stannard J, Clark R, Pacey E, Leng G, Campos-Matos I. A systematic review of the international evidence on the effectiveness of COVID-19 mitigation measures in communal rough sleeping accommodation. J Public Health (Oxf) 2023; 45:804-815. [PMID: 37477219 PMCID: PMC10788840 DOI: 10.1093/pubmed/fdad114] [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: 01/28/2023] [Revised: 05/11/2023] [Accepted: 06/27/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Accommodations with shared washing facilities increase the risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for people experiencing rough sleeping and evidence on what interventions are effective in reducing these risks needs to be understood. METHODS Systematic review, search date 6 December 2022 with methods published a priori. Electronic searches were conducted in MEDLINE, PubMed, Cochrane Library, CINAHL and the World Health Organization (WHO) COVID-19 Database and supplemented with grey literature searches, hand searches of reference lists and publication lists of known experts. Observational, interventional and modelling studies were included; screening, data extraction and risk of bias assessment were done in duplicate and narrative analyses were conducted. RESULTS Fourteen studies from five countries (USA, England, France, Singapore and Canada) were included. Ten studies were surveillance reports, one was an uncontrolled pilot intervention, and three were modelling studies. Only two studies were longitudinal. All studies described the effectiveness of different individual or packages of mitigation measures. CONCLUSIONS Despite a weak evidence base, the research suggests that combined mitigation measures can help to reduce SARS-CoV-2 transmission but are unlikely to prevent outbreaks entirely. Evidence suggests that community prevalence may modify the effectiveness of mitigation measures. More longitudinal research is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021292803.
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Affiliation(s)
- Steven Haworth
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
- Institute for Social and Economic Research, University of Essex, Essex CO4 3SQ, UK
| | - Owen Cranshaw
- Institute for Social and Economic Research, University of Essex, Essex CO4 3SQ, UK
| | - Mark Xerri
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
| | - Jez Stannard
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
| | - Rachel Clark
- Policy, Systems and Innovations Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
| | - Emma Pacey
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
| | - Gill Leng
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
| | - Ines Campos-Matos
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
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Zeien J, Vieira J, Hanna J, Ramirez A, Miller C, Hartmark-Hill J, Rosales C. Utilization of street-based COVID-19 vaccination clinics in Phoenix's homeless population. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023:2752535X231196415. [PMID: 37635377 DOI: 10.1177/2752535x231196415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
The novel Coronavirus (COVID-19) is a highly contagious viral illness that has caused the most significant global health crisis in recent human history. Individuals experiencing homelessness represent one of the more vulnerable populations for COVID-19 infection and morbidity. Amongst individuals experiencing homelessness in Phoenix, a student-led interprofessional organization called Street Medicine Phoenix (SMP) sought to both reduce the risk of COVID-19 transmission and morbidity/mortality related to infection. Through collaborations with the Maricopa County Department of Public Health and various community organizations, SMP developed a format for street-based vaccination clinics. SMP deployed these clinics on numerous occasions to the streets directly surrounding the community homeless shelter, allowing SMP to vaccinate individuals directly in their encampments. Through SMP's efforts starting in February 2021, 400 individuals experiencing homelessness have received at least one COVID-19 vaccine. Challenges encountered included low health literacy, lack of established rapport and trust, low vaccine confidence, difficulty verifying patients' vaccination status, difficulty obtaining sufficient information from patients to create a record in the Arizona State Immunization Information System (ASIIS), monitoring patients post-vaccination, transporting vaccine supplies from encampment to encampment, and lack of patient awareness of the mobile vaccine clinic services. Despite challenges, SMP's outreach efforts have demonstrated the feasibility and importance of mobile public health services to reach homeless encampments, particularly mobile vaccination clinics in response to disease outbreaks, and the necessity of strategic partnerships with community agencies to effectively meet the needs of underserved populations.
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Affiliation(s)
- Justin Zeien
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jaime Vieira
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Jeffery Hanna
- University of Arizona Mel and Enid Zuckerman College of Public Health, Phoenix, AZ, USA
| | - Alma Ramirez
- University of Arizona Mel and Enid Zuckerman College of Public Health, Phoenix, AZ, USA
| | - Catherine Miller
- University of Arizona Mel and Enid Zuckerman College of Public Health, Phoenix, AZ, USA
| | | | - Cecilia Rosales
- University of Arizona Mel and Enid Zuckerman College of Public Health, Phoenix, AZ, USA
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3
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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: 6] [Impact Index Per Article: 3.0] [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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4
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Kaur S, Jagpal P, Paudyal V. Provision of services to persons experiencing homelessness during the COVID-19 pandemic: A qualitative study on the perspectives of homelessness service providers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1805-e1814. [PMID: 34668258 PMCID: PMC8653035 DOI: 10.1111/hsc.13609] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 05/22/2023]
Abstract
This study aimed to explore the perspectives of homelessness service providers on the impact of the COVID-19 pandemic on service provision, barriers encountered and learning for the future. Semi-structured online interviews were conducted with homelessness service providers (n = 15) identified through the network of homelessness services operating within the United Kingdom. Data were transcribed verbatim and analysed thematically using framework technique. Six key themes were identified including the impact of the pandemic on health and well-being of persons experiencing homelessness (PEH); the changing needs of service users during the pandemic; impact of emergency provision of housing support on services offered; service adaptations; sustainability of services and learnings from the pandemic. Participants described that being able to offer accommodation through government schemes provided protection to PEH through 'wrap-around support'. The pandemic was deemed to have precipitated change and developed resilience in some services. However, lack of resources, donations and sponsors during the pandemic constrained the services forcing many to close or offer reduced services. Reduced face-to-face contact with PEH and lack of ability to offer skills sessions led to the exacerbation of mental health concerns amongst clients. The pandemic was also identified to have encouraged positive relationship building between clients and service providers, better communications between service providers and effective housing of PEH. There is a need to address the barriers, sustain the positive learnings and enable organisations and PEH to adapt to the transition when transient and emergency support from the government and local councils ends.
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Affiliation(s)
- Simran Kaur
- School of PharmacyInstitute of Clinical SciencesUniversity of BirminghamBirminghamUK
| | - Parbir Jagpal
- School of PharmacyInstitute of Clinical SciencesUniversity of BirminghamBirminghamUK
| | - Vibhu Paudyal
- School of PharmacyInstitute of Clinical SciencesUniversity of BirminghamBirminghamUK
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COVID-19 Vaccine Coverage and Sociodemographic, Behavioural and Housing Factors Associated with Vaccination among People Experiencing Homelessness in Toronto, Canada: A Cross-Sectional Study. Vaccines (Basel) 2022; 10:vaccines10081245. [PMID: 36016133 PMCID: PMC9412474 DOI: 10.3390/vaccines10081245] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
People experiencing homelessness were prioritized for COVID-19 vaccination in Toronto, Canada, due to the high risk of infection and associated complications relative to the general population. We aimed to ascertain COVID-19 vaccine coverage in this population and explore factors associated with the receipt of at least one dose. We collected survey and blood sample data from individuals ages 16+ recruited by random selection at 62 shelters, hotels and encampment sites between 16 June 2021 and 9 September 2021. We report vaccine coverage by dose number and explored sociodemographic, behavioral, health and housing factors associated with vaccination using multivariable modified Poisson regression. In total, 80.4% (95% CI 77.3–83.1%) received at least one vaccine dose, and 63.6% (CI 60.0–67.0%) received two or more doses. Vaccination was positively associated with age (every 10 years adjusted rate ratio (aRR) 1.05 [95% CI 1.03–1.08]), and receipt of influenza vaccination (aRR 1.19 [95% CI 1.11–1.27]). Factors negatively associated with vaccination included female gender (aRR 0.92 [95% CI 0.85–1.0]), Black racial self-identification (aRR 0.89 [95% CI 0.80–0.99]) and low frequencies of masking in public places (aRR 0.83 [95% CI 0.72–0.95]). COVID-19 vaccine coverage is very high among people experiencing homelessness in Toronto, suggesting advocacy and outreach efforts may have been effective.
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Partida D, Powell J, Gonzalez D, Khalili M. Gaps in hepatitis A and hepatitis B vaccination among hepatitis C antibody positive individuals experiencing homelessness. Open Forum Infect Dis 2022; 9:ofac175. [PMID: 35531381 PMCID: PMC9070334 DOI: 10.1093/ofid/ofac175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022] Open
Abstract
Vaccination for both hepatitis A (HAV) and hepatitis B (HBV) is recommended in hepatitis C infection (HCV). Among HCV antibody–positive persons experiencing homelessness, we identified high rates of HAV (34%) and HBV vaccine (35%) eligibility, highlighting critical gaps in HCV preventative services. Following education, 54% and 72% underwent HAV and HBV vaccination, respectively.
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Affiliation(s)
- Diana Partida
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Daniel Gonzalez
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mandana Khalili
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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7
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Shariff SZ, Richard L, Hwang SW, Kwong JC, Forchuk C, Dosani N, Booth R. COVID-19 vaccine coverage and factors associated with vaccine uptake among 23 247 adults with a recent history of homelessness in Ontario, Canada: a population-based cohort study. Lancet Public Health 2022; 7:e366-e377. [PMID: 35278362 PMCID: PMC8906815 DOI: 10.1016/s2468-2667(22)00037-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND People experiencing homelessness face a high risk of SARS-CoV-2 infection and transmission, as well as health complications and death due to COVID-19. Despite being prioritised for receiving the COVID-19 vaccine in many regions, little data are available on vaccine uptake in this vulnerable population. Using population-based health-care administrative data from Ontario, Canada-a region with a universal, publicly funded health system-we aimed to describe COVID-19 vaccine coverage (ie, the estimated percentage of people who have received a vaccine) and determinants of vaccine receipt among individuals with a recent history of homelessness. METHODS We conducted a retrospective, population-based cohort study of adults (aged ≥18 years) with a recent experience of homelessness, inadequate housing, or shelter use as recorded in routinely collected health-care databases between June 14, 2020, and June 14, 2021 (a period within 6 months of Dec 14, 2020, when COVID-19 vaccine administration was initiated in Ontario). Participants were followed up from Dec 14, 2020, to Sept 30, 2021, for the receipt of one or two doses of a COVID-19 vaccine using the province's real-time centralised vaccine information system. We described COVID-19 vaccine coverage overall and within predefined subgroups. Using modified Poisson regression, we further identified sociodemographic factors, health-care usage, and clinical factors associated with receipt of at least one dose of a COVID-19 vaccine. FINDINGS 23 247 individuals with a recent history of homelessness were included in this study. Participants were predominantly male (14 752 [63·5%] of 23 247); nearly half were younger than 40 years (11 521 [49·6%]) and lived in large metropolitan regions (12 123 [52·2%]); and the majority (18 226 [78·4%]) visited a general practitioner for an in-person consultation during the observation period. By Sept 30, 2021, 14 271 (61·4%; 95% CI 60·8-62·0) individuals with a recent history of homelessness had received at least one dose of a COVID-19 vaccine and 11 082 (47·7%; 47·0-48·3) had received two doses; in comparison, over the same period, 86·6% of adults in the total Ontario population had received a first dose and 81·6% had received a second dose. In multivariable analysis, factors positively associated with COVID-19 uptake were one or more outpatient visits to a general practitioner (adjusted risk ratio [aRR] 1·37 [95% CI 1·31-1·42]), older age (50-59 years vs 18-29 years: 1·18 [1·14-1·22], ≥60 years vs 18-29 years: 1·27 [1·22-1·31]), receipt of an influenza vaccine in either of the two previous influenza seasons (1·25 [1·23-1·28]), being identified as homeless via a visit to a community health centre versus exclusively a hospital-based encounter (1·13 [1·10-1·15]), receipt of one or more SARS-CoV-2 tests between March 1, 2020, and Sept 30, 2021 (1·23 [1·20-1·26]), and the presence of chronic health conditions (one condition: 1·05 [1·03-1·08]; two or more conditions: 1·11 [1·08-1·14]). By contrast, living in a smaller metropolitan region (aRR 0·92 [95% CI 0·90-0·94]) or rural location (0·93 [0·90-0·97]) versus large metropolitan regions were associated with lower uptake. INTERPRETATION In Ontario, COVID-19 vaccine coverage among adults with a recent history of homelessness has lagged and, as of Sept 30, 2021, was 25 percentage points lower than that of the general adult population in Ontario for a first dose and 34 percentage points lower for a second dose. With high usage of outpatient health services among individuals with a recent history of homelessness, better utilisation of outpatient primary care structures might offer an opportunity to increase vaccine coverage in this population. Our findings underscore the importance of leveraging existing health and service organisations that are accessed and trusted by people who experience homelessness for targeted vaccine delivery. FUNDING The Public Health Agency of Canada. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Salimah Z Shariff
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
| | - Lucie Richard
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Public Health Ontario, Toronto, ON, Canada,University Health Network, Toronto, ON, Canada
| | - Cheryl Forchuk
- Lawson Health Research Institute, London, ON, Canada,Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Naheed Dosani
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard Booth
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,Lawson Health Research Institute, London, ON, Canada,Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
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Balut MD, Gin JL, Alenkin NR, Dobalian A. Vaccinating Veterans Experiencing Homelessness for COVID-19: Healthcare and Housing Service Providers' Perspectives. J Community Health 2022; 47:727-736. [PMID: 35670986 PMCID: PMC9171468 DOI: 10.1007/s10900-022-01097-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 02/05/2023]
Abstract
This study examines challenges experienced during COVID-19 vaccination efforts, facilitating factors that increased vaccination, and lessons learned from healthcare providers and housing program staff who delivered healthcare and services to Veterans experiencing homelessness during the SARS-CoV-2 pandemic. Qualitative, semi-structured interviews were conducted with seven transitional housing program staff in northern California, southern California, Florida, Iowa, Kentucky, Massachusetts, and New Jersey (January-April 2021) and six primary care providers serving Veterans experiencing homelessness, four from clinics in California and two from a clinic in North Dakota (July-August 2021). Interviews were transcribed and analyzed using a rapid analysis approach. COVID-19 vaccination rates were between 40 and 60% among Veterans who received care from the primary care providers and between 20 and 90% among Veterans who were enrolled in the transitional housing programs. Barriers that providers and housing staff encountered when getting Veterans vaccinated for COVID-19 included lack of eligibility, the vaccine appointment scheduling process, transportation and communication challenges, Veterans' distrust in the government, vaccine mandates, and vaccine hesitancy among organization staff. Recommendations to increase COVID-19 vaccine uptake included making vaccination more convenient, using trusted sources such as homeless program staff or Veteran peers to provide educational information about the safety and efficacy of COVID-19 vaccines, and encouraging rather than mandating vaccination. These lessons will enable entities providing care to people experiencing homelessness to develop more effective policies and educational campaigns to improve vaccine acceptance and uptake among this vulnerable population.
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Affiliation(s)
- Michelle D. Balut
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, 91343 North Hills, CA USA
| | - June L. Gin
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, 91343 North Hills, CA USA
| | - Nikola R. Alenkin
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, 91343 North Hills, CA USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs, 16111 Plummer St. MS-152, 91343 North Hills, CA USA ,Division of Health Services Management and Policy, The Ohio State University College of Public Health, 250 Cunz Hall, 1841 Neil Ave, 43210 Columbus, OH USA
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Ralli M, De-Giorgio F, Arcangeli A, Ercoli L. Equal Incidence of COVID-19 among Homeless and Non-Homeless Emergency Department Patients. Am J Emerg Med 2021; 51:409-410. [PMID: 34776283 PMCID: PMC8572377 DOI: 10.1016/j.ajem.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy; Primary Care Services, Eleemosynaria Apostolica, Vatican City State.
| | - Fabio De-Giorgio
- Primary Care Services, Eleemosynaria Apostolica, Vatican City State; Department of Health Care Surveillance and Bioethics, section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Arcangeli
- Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Ercoli
- Primary Care Services, Eleemosynaria Apostolica, Vatican City State; Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
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