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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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Newman PA, Dinh DA, Nyoni T, Allan K, Fantus S, Williams CC, Tepjan S, Reid L, Guta A. Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01882-1. [PMID: 38117443 DOI: 10.1007/s40615-023-01882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Amid persistent disparities in Covid-19 vaccination and burgeoning research on vaccine hesitancy (VH), we conducted a scoping review to identify multilevel determinants of Covid-19 VH and under-vaccination among marginalized populations in the U.S. and Canada. METHODS Using the scoping review methodology developed by the Joanna Briggs Institute, we designed a search string and explored 7 databases to identify peer-reviewed articles published from January 1, 2020-October 25, 2022. We combine frequency analysis and narrative synthesis to describe factors influencing Covid-19 VH and under-vaccination among marginalized populations. RESULTS The search captured 11,374 non-duplicated records, scoped to 103 peer-reviewed articles. Among 14 marginalized populations identified, African American/Black, Latinx, LGBTQ+, American Indian/Indigenous, people with disabilities, and justice-involved people were the predominant focus. Thirty-two factors emerged as influencing Covid-19 VH, with structural racism/stigma and institutional mistrust (structural)(n = 71) most prevalent, followed by vaccine safety (vaccine-specific)(n = 62), side effects (vaccine-specific)(n = 50), trust in individual healthcare provider (social/community)(n = 38), and perceived risk of infection (individual)(n = 33). Structural factors predominated across populations, including structural racism/stigma and institutional mistrust, barriers to Covid-19 vaccine access due to limited supply/availability, distance/lack of transportation, no/low paid sick days, low internet/digital technology access, and lack of culturally- and linguistically-appropriate information. DISCUSSION We identified multilevel and complex drivers of Covid-19 under-vaccination among marginalized populations. Distinguishing vaccine-specific, individual, and social/community factors that may fuel decisional ambivalence, more appropriately defined as VH, from structural racism/structural stigma and systemic/institutional barriers to vaccination access may better support evidence-informed interventions to promote equity in access to vaccines and informed decision-making among marginalized populations.
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Affiliation(s)
- Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
| | - Duy A Dinh
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Thabani Nyoni
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kate Allan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Sophia Fantus
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Luke Reid
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, ON, Canada
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3
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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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4
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Liang Y, Sun Q, Liu Q, Pang Y, Tang S. SARS-CoV-2 incidence, seroprevalence, and COVID-19 vaccination coverage in the homeless population: a systematic review and meta-analysis. Front Public Health 2023; 11:1044788. [PMID: 37900041 PMCID: PMC10600393 DOI: 10.3389/fpubh.2023.1044788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives SARS-CoV-2 infection and COVID-19 vaccination of homeless people are a serious public health concern during COVID-19 pandemic. We aimed to systematically assess SARS-CoV-2 incidence, seroprevalence, and COVID-19 vaccination coverage in homeless people, which are important to inform resource allocation and policy adjustment for the prevention and control of COVID-19. Methods We searched PubMed, Web of Science, and the World Health Organization COVID-19 database for the studies of SARS-CoV-2 incidence, seroprevalence, and COVID-19 vaccination coverage in the homeless population. Subgroup analyses were conducted to pool SARS-CoV-2 incidence and seroprevalence in sheltered homeless, unsheltered homeless, and mixed population, respectively. Potential sources of heterogeneity in the estimates were explored by meta-regression analysis. Results Forty-nine eligible studies with a total of 75,402 homeless individuals and 5,000 shelter staff were included in the meta-analysis. The pooled incidence of SARS-CoV-2 infection was 10% (95% CI: 7 to 12%) in the homeless population and 8% (5 to 12%) for shelter staff. In addition, the overall estimated SARS-CoV-2 specific seroprevalence was 19% (8 to 33%) for homeless populations and 22% (3 to 52%) for shelter staff, respectively. Moreover, for the homeless subjects, the pooled incidence was 10% (4 to 23%) for asymptomatic SARS-CoV-2 infections, 6% (1 to 12%) for symptomatic SARS-CoV-2 infections, 3% (1 to 4%) for hospitalization for COVID-19, and 1% (0 to 2%) for severe COVID-19 cases, respectively while no COVID-19-related death was reported. Furthermore, the data derived from 12 included studies involving 225,448 homeless individuals revealed that the pooled proportion of one dose COVID-19 vaccination was 41% (35 to 47%), which was significantly lower than those in the general population. Conclusion Our study results indicate that the homeless people remain highly susceptible to SARS-CoV-2 infection, but COVID-19 vaccination coverage was lower than the general population, underscoring the need for prioritizing vaccine deployment and implementing enhanced preventive measures targeting this vulnerable group.
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Affiliation(s)
| | | | | | | | - Shixing Tang
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
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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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6
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Rosen AD, Senturia A, Howerton I, Kantrim EU, Evans V, Malluche T, Miller J, Gonzalez M, Robie B, Shover CL, Chang AH, Behforouz H, Nguyen A, Thomas EH. A COVID-19 Vaccination Program to Promote Uptake and Equity for People Experiencing Homelessness in Los Angeles County. Am J Public Health 2023; 113:170-174. [PMID: 36455191 PMCID: PMC9850615 DOI: 10.2105/ajph.2022.307147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/03/2022]
Abstract
People experiencing homelessness (PEH) have been disproportionately affected by COVID-19, yet their vaccination coverage is lower than is that of the general population. We implemented a COVID-19 vaccination program that used evidence-based and culturally tailored approaches to promote vaccine uptake and equity for PEH in Los Angeles County, California. From February 2021 through February 2022, 33 977 doses of vaccine were administered at 2658 clinics, and 9275 PEH were fully vaccinated. This program may serve as a model for future service delivery in vulnerable populations. (Am J Public Health. 2023;113(2):170-174. https://doi.org/10.2105/AJPH.2022.307147).
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Affiliation(s)
- Allison D Rosen
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Alexander Senturia
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Isabelle Howerton
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Emily Uyeda Kantrim
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Vanessa Evans
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Tiffany Malluche
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Jonni Miller
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Miriam Gonzalez
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Brooke Robie
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Chelsea L Shover
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Alicia H Chang
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Heidi Behforouz
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Anh Nguyen
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
| | - Emily H Thomas
- Allison D. Rosen, Alexander Senturia, Isabelle Howerton, Emily Uyeda Kantrim, Vanessa Evans, Tiffany Malluche, Jonni Miller, Miriam Gonzalez, Brooke Robie, Heidi Behforouz, Anh Nguyen, and Emily H. Thomas are with the Los Angeles County Department of Health Services, Los Angeles, CA. Chelsea L. Shover is with the David Geffen School of Medicine, University of California Los Angeles. Alicia H. Chang is with the Los Angeles County Department of Public Health, Los Angeles, CA
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7
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Shover CL, Rosen A, Mata J, Robie B, Alvarado J, Frederes A, Romero R, Beltran J, Bratcher A, Chang AH, Choi KR, Garcia C, Shoptaw S, Guha P, Richard L, Sixx G, Baez A, Coleman A, Harvell S, Jackson S, Lee C, Swan J, Torres K, Kantrim EU, McKeever M, Nguyen A, Rice A, Rosales M, Spoliansky J, Bromley E, Behforouz H, Gelberg L, Gorbach PM, Rimoin AW, Thomas EH. Engaging Same-Day Peer Ambassadors to Increase Coronavirus Disease 2019 Vaccination Among People Experiencing Unsheltered Homelessness in Los Angeles County: A Hybrid Feasibility-Evaluation Study. J Infect Dis 2022; 226:S346-S352. [PMID: 36208168 PMCID: PMC9989733 DOI: 10.1093/infdis/jiac291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the feasibility and acceptability of engaging unhoused peer ambassadors (PAs) in coronavirus disease 2019 (COVID-19) vaccination efforts to reach people experiencing unsheltered homelessness in Los Angeles County. METHODS From August to December 2021, vaccinated PAs aged ≥18 years who could provide informed consent were recruited during vaccination events for same-day participation. Events were held at encampments, service providers (eg, housing agencies, food lines, and mobile showers), and roving locations around Los Angeles. PAs were asked to join outreach alongside community health workers and shared their experience getting vaccinated, receiving a $25 gift card for each hour they participated. Postevent surveys evaluated how many PAs enrolled and how long they participated. In October 2021, we added a preliminary effectiveness evaluation of how many additional vaccinations were attributable to PAs. Staff who enrolled the PAs estimated the number of additional people vaccinated because of talking with the PA. RESULTS A total of 117 PAs were enrolled at 103 events, participating for an average of 2 hours. At events with the effectiveness evaluation, 197 additional people were vaccinated over 167 PA hours ($21.19 gift card cost per additional person vaccinated), accounting for >25% of all vaccines given at these events. DISCUSSION Recruiting same-day unhoused PAs is a feasible, acceptable, and preliminarily effective technique to increase COVID-19 vaccination in unsheltered settings. The findings can inform delivery of other health services for people experiencing homelessness.
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Affiliation(s)
- Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Allison Rosen
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - José Mata
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Brooke Robie
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Julissa Alvarado
- Department of Environmental Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Ashley Frederes
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Ruby Romero
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Jacqueline Beltran
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Anna Bratcher
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Alicia H Chang
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Kristen R Choi
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
- UCLA School of Nursing,, Los Angeles, California, USA
| | - Candelaria Garcia
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Steven Shoptaw
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Priyanka Guha
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Lindsey Richard
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Gunner Sixx
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Angel Baez
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Anthony Coleman
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Sarah Harvell
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Shirnae Jackson
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Caroline Lee
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Joanna Swan
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Kenny Torres
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Emily Uyeda Kantrim
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Maya McKeever
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Anh Nguyen
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Adam Rice
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Marisol Rosales
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Jordan Spoliansky
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Elizabeth Bromley
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Heidi Behforouz
- Los Angeles County Department of Health Services, Los Angeles, California, USA
| | - Lillian Gelberg
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Department of Family Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Pamina M Gorbach
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Anne W Rimoin
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Emily H Thomas
- Los Angeles County Department of Health Services, Los Angeles, California, USA
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