Implementation of rapid and frequent SARS-CoV2 antigen testing and response in congregate homeless shelters.

BACKGROUND: People experiencing homelessness who live in congregate shelters are at high risk of SARS-CoV2 transmission and severe COVID-19. Current screening and response protocols using rRT-PCR in homeless shelters are expensive, require specialized staff and have delays in returning results and implementing responses. METHODS: We piloted a program to offer frequent, rapid antigen-based tests (BinaxNOW) to residents and staff of congregate-living shelters in San Francisco, California, from January 15th to February 19th, 2021. We used the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to evaluate the implementation. RESULTS: Reach: We offered testing at ten of twelve eligible shelters. Shelter residents and staff had variable participation across shelters; approximately half of eligible individuals tested at least once; few tested consistently during the study. Effectiveness: 2.2% of participants tested positive. We identified three outbreaks, but none exceeded 5 cases. All BinaxNOW-positive participants were isolated or left the shelters. Adoption: We offered testing to all eligible participants within weeks of the project's initiation. Implementation: Adaptations made to increase reach and improve consistency were promptly implemented. Maintenance: San Francisco Department of Public Health expanded and maintained testing with minimal support after the end of the pilot. CONCLUSION: Rapid and frequent antigen testing for SARS-CoV2 in homeless shelters is a viable alternative to rRT-PCR testing that can lead to immediate isolation of infectious individuals. Using the RE-AIM framework, we evaluated and adapted interventions to enable the expansion and maintenance of protocols.

Ethnic and educational inequalities in COVID-19 vaccine hesitancy: cross-sectional analysis of the UK household longitudinal study

BackgroundVaccination is crucial to address the COVID-19 pandemic but inequalities in uptake may exacerbate existing health inequalities. We investigate the UK prevalence of COVID-19 vaccine hesitancy, identify which population subgroups are more likely to be vaccine hesitant, and report stated reasons for hesitancy.MethodsNationally representative survey data from 12,035 participants were collected from 24th November to 1st December 2020 for wave 6 of the UK Household Longitudinal Study (‘Understanding Society’) COVID-19 web survey. Participants self-reported ethnicity, highest educational attainment, gender, age, how likely they would be to have a vaccine if offered and their main reason for hesitancy. Weighted cross-sectional analysis assessed the prevalence of vaccine hesitancy and logistic regression models estimated independent associations.ResultsOverall vaccine hesitancy was low (18% unlikely/very unlikely). Vaccine hesitancy was higher in women (21.0% vs 14.7% in men), in younger age groups (26.5% in 16–24 year olds vs 4.5% in 75+) and in those with lower education levels (18.6% no qualifications vs 13.2% degree qualified). Vaccine hesitancy was high in Black (71.8%) and Pakistani/Bangladeshi (42.3%) ethnic groups. Odds ratios for vaccine hesitancy after adjustment for age and gender were 13.42 (95% CI:6.86, 26.24) in Black, 2.54 (95% CI:1.19, 5.44) in Pakistani/Bangladeshi groups, and 1.76 (95% CI:1.10, 2.82) for Other White (including Eastern European) ethnic groups (compared to White British/Irish). Vaccine hesitancy was not higher in all minority ethnic groups;for example, ORs were 1.11 (95% CI:0.64, 1.95) for Indian ethnicity and 0.67 (95% CI:0.24, 1.87) for Other Asian (including Chinese) ethnicity. Lower education was also related to vaccine hesitancy (no qualifications versus degree OR 3.54;95% CI:2.06, 6.09) but ethnic differences largely remained when education was included in the model. For those who were vaccine hesitant the most common stated reason for hesitancy was concerns over unknown future effects (42.7%). However, when compared to the White British/Irish group, Black participants were more likely to state they ‘Don’t trust vaccines’ (29.2% vs 5.7%) and the Pakistani/Bangladeshi ethnic group more frequently cited worries about side-effects (35.4% vs 8.6%).ConclusionVaccine hesitancy is strongly associated with education and ethnicity, with marked ethnic heterogeneity. Black and Pakistani/Bangladeshi participants reported considerably greater vaccine hesitancy than White British/Irish ethnicity, but some minority ethnic groups did not. Educational inequalities did not account for ethnic differences. Vaccine programmes need to understand reasons for vaccine hesitancy within specific population sub-groups and take urgent action to improve uptake.

Predictors of COVID-19 vaccine hesitancy in the UK household longitudinal study.

Vaccine hesitancy could undermine efforts to control COVID-19. We investigated the prevalence of COVID-19 vaccine hesitancy in the UK and identified vaccine hesitant subgroups. The 'Understanding Society' COVID-19 survey asked participants (n = 12,035) their likelihood of vaccine uptake and reason for hesitancy. Cross-sectional analysis assessed vaccine hesitancy prevalence and logistic regression calculated odds ratios. Overall vaccine hesitancy was low (18% unlikely/very unlikely). Vaccine hesitancy was higher in women (21.0% vs 14.7%), younger age groups (26.5% in 16-24 year olds vs 4.5% in 75 + ) and those with lower education levels (18.6% no qualifications vs 13.2% degree qualified). Vaccine hesitancy was high in Black (71.8%) and Pakistani/Bangladeshi (42.3%) ethnic groups. Odds ratios for vaccine hesitancy were 13.42 (95% CI:6.86, 26.24) in Black and 2.54 (95% CI:1.19, 5.44) in Pakistani/Bangladeshi groups (compared to White British/Irish) and 3.54 (95% CI:2.06, 6.09) for people with no qualifications versus degree. Urgent action to address hesitancy is needed for some but not all ethnic minority groups.