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Szwarcwald CL, Almeida WS, Boccolini CS, Soares Filho AM, Malta DC. The unequal impact of the pandemic at subnational levels and educational attainment-related inequalities in COVID-19 mortality, Brazil, 2020-2021. Public Health 2024; 231:39-46. [PMID: 38615470 DOI: 10.1016/j.puhe.2024.03.011] [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: 10/04/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES We estimated COVID-19 mortality indicators in 2020-2021 to show the epidemic's impact at subnational levels and to analyze educational attainment-related inequalities in COVID-19 mortality in Brazil. STUDY DESIGN This was an ecological study with secondary mortality information. METHODS Crude and age-standardized COVID-19 mortality rates were calculated by gender, major regions, and states. The COVID-19 proportional mortality (percentage) was estimated by gender and age in each region. Measures of education-related inequalities in COVID-19 mortality were calculated per state, in each of which the COVID-19 maternal mortality rate (MMR) was estimated by the number of COVID-19 maternal deaths per 100,000 live births (LBs). RESULTS The analysis of mortality rates at subnational levels showed critical regional differences. The North region proved to be the most affected by the pandemic, followed by the Center-West, with age-standardized COVID-19 mortality rates above 2 per 1000 inhabitants. The peak of COVID-19 mortality occurred in mid-March/April 2021 in all regions. Great inequality by educational level was found, with the illiterate population being the most negatively impacted in all states. The proportional mortality showed that males and females aged 50-69 years were the most affected. The MMR reached critical values (>100/100,000 LB) in several states of the North, Northeast, Southeast, and Center-West regions. CONCLUSIONS This study highlights stark regional and educational disparities in COVID-19 mortality in Brazil. Exacerbated by the pandemic, these inequalities reveal potential areas for intervention to reduce disparities. The results also revealed high MMRs in certain states, underscoring pre-existing healthcare access challenges that worsened during the pandemic.
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Affiliation(s)
- C L Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - W S Almeida
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - C S Boccolini
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - A M Soares Filho
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - D C Malta
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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SeyedAlinaghi S, Afzalian A, Dashti M, Ghasemzadeh A, Parmoon Z, Shahidi R, Varshochi S, Pashaei A, Mohammadi S, Akhtaran FK, Karimi A, Nasiri K, Mehraeen E, Hackett D. Estimating Hidden Population Size of COVID-19 using Respondent-Driven Sampling Method - A Systematic Review. Infect Disord Drug Targets 2024; 24:e310124226549. [PMID: 38299412 DOI: 10.2174/0118715265277789240110043215] [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: 09/19/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Currently, the ongoing COVID-19 pandemic is posing a challenge to health systems worldwide. Unfortunately, the true number of infections is underestimated due to the existence of a vast number of asymptomatic infected individual's proportion. Detecting the actual number of COVID-19-affected patients is critical in order to treat and prevent it. Sampling of such populations, so-called hidden or hard-to-reach populations, is not possible using conventional sampling methods. The objective of this research is to estimate the hidden population size of COVID-19 by using respondent-driven sampling (RDS) methods. METHODS This study is a systematic review. We have searched online databases of PubMed, Web of Science, Scopus, Embase, and Cochrane to identify English articles published from the beginning of December 2019 to December 2022 using purpose-related keywords. The complete texts of the final chosen articles were thoroughly reviewed, and the significant findings are condensed and presented in the table. RESULTS Of the 7 included articles, all were conducted to estimate the actual extent of COVID-19 prevalence in their region and provide a mathematical model to estimate the asymptomatic and undetected cases of COVID-19 amid the pandemic. Two studies stated that the prevalence of COVID-19 in their sample population was 2.6% and 2.4% in Sierra Leone and Austria, respectively. In addition, four studies stated that the actual numbers of infected cases in their sample population were significantly higher, ranging from two to 50 times higher than the recorded reports. CONCLUSIONS In general, our study illustrates the efficacy of RDS in the estimation of undetected asymptomatic cases with high cost-effectiveness due to its relatively trouble-free and low-cost methods of sampling the population. This method would be valuable in probable future epidemics.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Arian Afzalian
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Dashti
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afsaneh Ghasemzadeh
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zohal Parmoon
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Shahidi
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Sanaz Varshochi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ava Pashaei
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samaneh Mohammadi
- Department of Health Information Technology, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Nasiri
- Department of Nursing, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Daniel Hackett
- Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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da Silva MRT, Costa AP, da Luz AA, Pelaio CH, Cruz FB, Steil GF, Giamberardino HIG, Prando C. From Acute Phase to Long COVID: A Cross-Sectional Study of the Epidemiological Profile and Clinical Evaluation of SARS-CoV-2 Infection in Employees at a Pediatric Hospital. J Clin Med 2023; 12:4325. [PMID: 37445359 DOI: 10.3390/jcm12134325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic began in Brazil on 26 February 2020. By 6 May 2023, 37.4 million cases had been confirmed, causing 701 thousand deaths in the country. We aimed to describe the epidemiological profile and clinical development of COVID-19 cases among the employees of a health institution, from acute infection to long COVID. METHODS This was a longitudinal study using a retrospective and prospective approach via questionnaires referring to epidemiological investigation, which was the inclusion criteria, and about long-term symptoms. RESULTS A total of 809 employees were detected with SARS-CoV-2 infection via RT-PCR, 466 of them answered the epidemiological investigation, and 101 completed the Long COVID Symptom Questionnaire. The most commonly affected employees were women (88.6%) working in patient care (68.6%). Headache, myalgia, cough, odynophagia, and runny nose were the most frequent symptoms. Only three employees (0.6%) required hospitalization, while the other employees required outpatient management due to mild symptoms. We identified 19 (4.1%) cases of reinfection, and 42 (41.6%) employees reported long-term symptoms, such as myalgia, dyspnea, and headache. CONCLUSIONS Although most cases were mild with good outcomes, long COVID cases identified are noteworthy, as these symptoms may impact quality of life even months after SARS-CoV-2 infection.
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Affiliation(s)
| | | | - Amanda Almeida da Luz
- Faculdades Pequeno Príncipe, Curitiba 80230-020, PR, Brazil
- Instituto de Pesquisa Pelé Príncipe, Curitiba 80250-060, PR, Brazil
| | - Caio Henrique Pelaio
- Instituto de Pesquisa Pelé Príncipe, Curitiba 80250-060, PR, Brazil
- Biomedical and Clinical Analyses Department, Centro Universitário Curitiba, Curitiba 80220-181, PR, Brazil
| | - Felipe Baleche Cruz
- Instituto de Pesquisa Pelé Príncipe, Curitiba 80250-060, PR, Brazil
- Medical School, Faculdade Evangélica Mackenzie do Paraná, Curitiba 80730-000, PR, Brazil
| | - Giovanna Fischer Steil
- Faculdades Pequeno Príncipe, Curitiba 80230-020, PR, Brazil
- Instituto de Pesquisa Pelé Príncipe, Curitiba 80250-060, PR, Brazil
| | | | - Carolina Prando
- Faculdades Pequeno Príncipe, Curitiba 80230-020, PR, Brazil
- Instituto de Pesquisa Pelé Príncipe, Curitiba 80250-060, PR, Brazil
- Hospital Pequeno Príncipe, Curitiba 80250-060, PR, Brazil
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Neştian ȘA, Tiţă SM, Turnea ES, Stanciu O, Poroch V. Exposure risk management: Personal protective equipment and the risk of accidents occurring during aerosol generating procedures applied to COVID-19 patients. PLoS One 2023; 18:e0282673. [PMID: 36881601 PMCID: PMC9990922 DOI: 10.1371/journal.pone.0282673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND COVID-19 is considered to be very contagious as it can be spread through multiple ways. Therefore, exposure risk of healthcare workers (HCWs) treating COVID-19 patients is a highly salient topic in exposure risk management. From a managerial perspective, wearing personal protective equipment and the risk of accidents occurring during aerosol generating procedures applied to COVID-19 patients are two interconnected issues encountered in all COVID-19 hospitals. OBJECTIVE The study was conducted to understand the realistic impact of exposure risk management on HCWs exposed to risks of SARS-CoV-2 virus infection in a healthcare unit. In particular, this study discusses the role of personal protective equipment (PPEs) used in aerosol generating procedures (AGPs) to protect HCWs, and the related risk of accidents occurring when performing AGPs. METHODOLOGY This is a cross-sectional single-hospital study conducted at the "Sf. Ioan cel Nou" Hospital in Suceava, Romania, that had to ensure safety of healthcare workers (HCWs) getting in contact with COVID-19 cases. Data used in the study were collected between 10.12.2020-19.03.2021 by means of a questionnaire that collected information on risk assessment and healthcare workers' exposure management, and which was translated and adapted from the World Health Organization (WHO) and applied to respondents online. For this purpose, ethical approval was obtained, doctors and nurses from all hospital departments being invited to complete the questionnaire. Data processing, as well as descriptive, correlation and regression analyses have been done by using the 21.0 version of the Statistical Package for Social Sciences software. RESULTS Most of the 312 HCWs reported having always used disposable gloves (98.13%), medical masks N95 (or equivalent) (92.86%), visors or googles (91.19%), disposable coverall (91.25%) and footwear protection (95.00%) during AGPs. The waterproof apron had always been worn only by 40% of the respondents, and almost 30% of staff had not used it at all during AGPs. Over the last three months, the period when the questionnaire was completed, 28 accidents were reported while performing AGPs: 11 accidents with splashing of biological fluids/ respiratory secretions in the eyes, 11 with splashing of biological fluids/ respiratory secretions on the non-idemn skin, 3 with splashing of biological fluids/ respiratory secretions in the oral/ nasal mucosa and 3 with puncture/ sting with any material contaminated with biological fluids/ respiratory secretions. Also, 84.29% of respondents declared having changed their routine, at least, moderately due to COVID-19. CONCLUSION An effective risk exposure management is based on wearing protective equipment. The only protection offered by the disposable coverall, as it results from our analysis, is related to splashing of biological fluids/ respiratory secretions on the non-idemn skin. In addition, the results show that the number of accidents should decrease due to the fact that disposable gloves and footwear protection are used while performing AGPs on patients with COVID-19 and hand hygiene is practised before and after touching a patient with COVID-19 (regardless of glove wearing).
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Affiliation(s)
- Ștefan Andrei Neştian
- Department of Management, Marketing and Business Administration, Alexandru Ioan Cuza University of Iași, Iași, Romania
| | - Silviu-Mihail Tiţă
- Department of Management, Marketing and Business Administration, Alexandru Ioan Cuza University of Iași, Iași, Romania
| | - Elena-Sabina Turnea
- Department of Management, Marketing and Business Administration, Alexandru Ioan Cuza University of Iași, Iași, Romania
- * E-mail: ,
| | - Oana Stanciu
- Faculty of Medicine and Biological Sciences, University “Stefan cel Mare”, Suceava, Romania
| | - Vladimir Poroch
- Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania
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Arns B, Agani CAJO, Sesin GP, Horvath JDC, Fogazzi DV, Romeiro Silva FK, Costa LS, Pereira AJ, Nassar Junior AP, Cavalcanti BT, Dietrich C, Veiga VC, Catarino DG, Cheno MY, Biasi A, Ferronatto BR, Bassetti BR, Fernandes CCF, Deutschendorf C, Grion CMC, Vidal CFDL, de Oliveira CD, Caser EB, Boschi E, Silva EM, Pizzol FD, Urbano HCDA, Silva I, Maia IS, Rego LRDM, Oliveira LP, Tavares MB, Dracoulakis MDA, Bainy MP, Golin NA, Tomba PO, Kurtz PMP, Foernges RB, Prestes RM, de Melo RMV, Da Silva RR, Toledo TGP, Lima VP, Fernandes VDF, Lovato WJ, Zavascki AP. Evaluation of the characteristics of infection prevention and control programs and infection control committees in Brazilian hospitals: A countrywide cross-sectional study. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e79. [PMID: 37179767 PMCID: PMC10173283 DOI: 10.1017/ash.2023.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 05/15/2023]
Abstract
Objective Data are scarce regarding hospital infection control committees and compliance with infection prevention and control (IPC) recommendations in Brazil, a country of continental dimensions. We assessed the main characteristics of infection control committees (ICCs) on healthcare-associated infections (HAIs) in Brazilian hospitals. Methods This cross-sectional study was conducted in ICCs of public and private hospitals distributed across all Brazilian regions. Data were collected directly from the ICC staff by completing an online questionnaire and during on-site visits through face-to-face interviews. Results In total, 53 Brazilian hospitals were evaluated from October 2019 to December 2020. All hospitals had implemented the IPC core components in their programs. All centers had protocols for the prevention and control of ventilator-associated pneumonia as well as bloodstream, surgical site, and catheter-associated urinary tract infections. Most hospitals (80%) had no budget specifically allocated to the IPC program; 34% of the laundry staff had received specific IPC training; and only 7.5% of hospitals reported occupational infections in healthcare workers. Conclusions In this sample, most ICCs complied with the minimum requirements for IPC programs. The main limitation regarding ICCs was the lack of financial support. The findings of this survey support the development of strategic plans to improve IPCs in Brazilian hospitals.
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Affiliation(s)
- Beatriz Arns
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Infectious Diseases Service, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Author for correspondence: Beatriz Arns, MD, Rua Ramiro Barcelos, 630, sala 815. Bairro Moinhos de Vento, Porto Alegre - RS, Brazil. E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emerson Boschi
- Hospital Geral de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | | | | | | | - Iany Silva
- Santa Casa de Misericórdia de São João Del Rei, São João del Rei, Minas Gerais, Brazil
| | - Israel Silva Maia
- HCor Research Institute, São Paulo, Brazil
- Hospital Nereu Ramos, Florianópolis, Santa Catarina, Brazil
| | | | | | | | | | - Marina Peres Bainy
- Hospital Escola Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Pablo Oscar Tomba
- Hospital do Cancer Barretos, Unidade Jales, Jales, São Paulo, Brazil
| | | | | | | | | | | | | | - Valéria Paes Lima
- Hospital Universitário de Brasília, Brasília, Federal District, Brazil
| | | | - Wilson José Lovato
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Alexandre Prehn Zavascki
- Infectious Diseases Service, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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de Lima Osório F, Zuardi AW, Silveira ILM, de Souza Crippa JA, Hallak JEC, Pereira-Lima K, Loureiro SR. Mental health trajectories of Brazilian health workers during two waves of the COVID-19 pandemic (2020-2021). Front Psychiatry 2023; 14:1026429. [PMID: 37032945 PMCID: PMC10076806 DOI: 10.3389/fpsyt.2023.1026429] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
This study aimed to: (a) monitor the progression of symptoms of mental health burden among frontline workers caring for COVID-19 patients in Brazil during the two waves of the pandemic, considering the number of new cases and deaths, and; (b) to verify the different mental health outcomes and potential associations with current burnout symptoms. A non-probabilistic sample of health professionals was assessed as the pandemic progressed in Brazil (May/2020 August/2021). Standardized instruments focusing on anxiety, depression, insomnia, post-traumatic stress, and burnout symptoms were applied online. The results indicate a decrease in anxiety levels, what was related to when the number of new cases declined (end 1th-wave); symptoms returned to higher levels later. Emotional exhaustion increased when there was a higher incidence of cases, returning to the baseline levels at the end of the second wave. Depersonalization symptoms increased in this phase, characterized by a further decrease in new cases, while professional accomplishment decreased during the follow-up. The highest number of new cases was associated with a higher frequency of anxiety (OR = 1.467;95%CI = 1.109-1.941; p = 0.007) and professional accomplishment (OR = 1.490;95%CI = 1.098-2.023; p = 0.011). The subjects with trajectory of resilience against anxiety presented the lowest level of emotional exhaustion and depersonalization (p < 0.05). The conclusion is that the pressure experienced by healthcare professionals throughout the pandemic caused different impacts on their mental health, emphasizing the dynamic nature of this condition and the need for constant monitoring and care. This finding directly affects mental health prevention and intervention measures, which remain a priority and require continuous reinforcement, especially among the most vulnerable groups.
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Affiliation(s)
- Flávia de Lima Osório
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute for Science and Technology (INCT-TM, CNPq), Brasília, Brazil
- *Correspondence: Flávia de Lima Osório,
| | - Antônio Waldo Zuardi
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute for Science and Technology (INCT-TM, CNPq), Brasília, Brazil
| | | | - José Alexandre de Souza Crippa
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute for Science and Technology (INCT-TM, CNPq), Brasília, Brazil
| | - Jaime Eduardo Cecílio Hallak
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute for Science and Technology (INCT-TM, CNPq), Brasília, Brazil
| | - Karina Pereira-Lima
- Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Sonia Regina Loureiro
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- National Institute for Science and Technology (INCT-TM, CNPq), Brasília, Brazil
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Abadie R, Habecker P, Carrasco KG, Chiou KS, Fernando S, Bennett SJ, Valentin-Acevedo A, Dombrowski K, West JT, Wood C. Employing Respondent Driven Sampling (RDS) to recruit people who inject drugs (PWID) and other hard-to-reach populations during COVID-19: Lessons learned. Front Psychiatry 2022; 13:990055. [PMID: 36262631 PMCID: PMC9574048 DOI: 10.3389/fpsyt.2022.990055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background Respondent Driven Sampling (RDS) is an effective sampling strategy to recruit hard-to-reach populations but the impact of the COVID-19 pandemic on the use of this strategy in the collection of data involving human subjects, particularly among marginalized and vulnerable populations, is not known. Based on an ongoing study using RDS to recruit and study the interactions between HIV infection, injection drug use, and the microbiome in Puerto Rico, this paper explores the effectiveness of RDS during the pandemic and provided potential strategies that could improve recruitment and data collection. Results RDS was employed to evaluate its effectiveness in recruiting a group of people who inject drugs (PWID) and controls (N = 127) into a study in the midst of the COVID-19 pandemic. The participants were distributed among three subsets: 15 were HIV+ and PWID, 58 were HIV- PWID, and 54 were HIV+ and not PWID. Findings Results show that recruitment through peer networks using RDS was possible across all sub-groups. Yet, while those in the HIV+ PWID sub-group managed to recruit from other-sub groups of HIV- PWID and HIV+, this occurred at a lower frequency. Conclusion Despite the barriers introduced by COVID-19, it is clear that even in this environment, RDS continues to play a powerful role in recruiting hard-to-reach populations. Yet, more attention should be paid at how future pandemics, natural disasters, and other big events might affect RDS recruitment of vulnerable and hard-to-reach populations.
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Affiliation(s)
- Roberto Abadie
- School of Global and Integrative Studies, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Patrick Habecker
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, United States
| | | | - Kathy S. Chiou
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Samodha Fernando
- Department of Animal Science, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Sydney J. Bennett
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
- Department of Interdisciplinary Oncology, Louisiana State University Health Sciences Center, Louisiana Cancer Research Center, New Orleans, LA, United States
| | - Aníbal Valentin-Acevedo
- Department of Microbiology and Immunology, Universidad Central del Caribe, Bayamón, PR, United States
| | | | - John T. West
- Department of Interdisciplinary Oncology, Louisiana State University Health Sciences Center, Louisiana Cancer Research Center, New Orleans, LA, United States
| | - Charles Wood
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
- Department of Interdisciplinary Oncology, Louisiana State University Health Sciences Center, Louisiana Cancer Research Center, New Orleans, LA, United States
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