Lessons Learned through Implementing SARS-CoV-2 Testing and Isolation for People Experiencing Homelessness in Congregate Shelters.

BACKGROUND: The Denver COVID-19 Joint Task Force is a multisector community partnership which formed to coordinate Denver's pandemic response in people experiencing homelessness (PEH). OBJECTIVES: Describe how interdisciplinary community partners collaborated to develop, implement, and pilot severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing and isolation protocols in congregate shelters, and discuss lessons learned and subsequently applied. METHODS: In March through May 2020, community partners collaborated to design, implement and conduct pilot testing paired with isolation in a subset of PEH at a congregate shelter to assess feasibility and inform protocol development.Results and Lessons Learned: We performed SARS-CoV-2 testing in 52 PEH with 14 (27%) testing positive or inconclusive. Thirteen (93%) positive or inconclusive participants were transferred to isolation hotels with 9 of 13 (69%) transferred within 72 hours of testing. CONCLUSIONS: Our findings informed development of coronavirus disease 2019 surveillance testing and isolation protocols for PEH and highlight the value of community partnerships in nimbly responding to the pandemic.

Perception of access to health care by homeless individuals seeking services at a day shelter.

Homeless individuals experience significant physical, mental health and substance abuse issues. This study describes the prevalence of health issues and perceptions of access to care among 300 homeless individuals who use a day shelter. Approximately 43% described a serious/chronic physical health problem, 53% a serious mental health problem, and 49% a substance use disorder. Those reporting a serious problem were more likely to have insurance and to report greater perceived access to care but perceived access to care was less than expected. Having insurance was also related to longer duration of homelessness. Targeting interventions to better match services to homeless individuals is the next challenge for advanced practice psychiatric and other nursing groups. Implications for doctoral level nurses in ways of evaluating models of care for this marginalized group are discussed.

Hepatitis C among clients of health care for the homeless primary care clinics.

OBJECTIVES: To describe the prevalence, distribution and risk factors for hepatitis C virus (HCV) infection among homeless adults using eight Health Care for the Homeless (HCH) clinics nationally. METHODS: Data were collected for 387 participants through blood draws, structured interviews, chart reviews. RESULTS: Overall prevalence of HCV-antibody positivity was 31.0%, including 70.0% among injection drug users and 15.5% among reported non-injectors. Much HCV infection was hidden as the majority (53.3%) of HCV-antibody positive participants was unaware of their status. Independent risk factors for HCV among the total sample included injection drug use, prison, and tattoos; among injectors, risk factors included prison and three or more years of injection drug use; among reported non-injectors, risk factors included tattoos and prison. CONCLUSION: These HCH clinics serve high concentrations of HCV-infected injectors, making these and similar clinics priority intervention sites for aggressive screening, education, testing, and treatment for HCV and other blood-borne diseases.

The CCH Consumer Outcome Scales: a brief instrument to assess the multiple problems of homelessness.

Homeless persons are underresearched; existing instruments do not adequately address this population. Clinical experts developed a brief instrument to assess housing, employment, benefits, physical health, mental health, and substance use that was tested for its psychometric properties. The instrument demonstrated content validity based on expert consensus, adequate interrater reliability (average r = .58), convergent and divergent validity with established measures, freedom from social desirability bias (average r = .00 with the Marlowe-Crowne scale), criterion-related validity for housing (85% accurate) and employment (83% accurate) items, and no floor effects. The benefits item had poorer psychometrics. The Colorado Coalition for the Homeless (CCH) Consumer Outcome Scales are recommended for assessment and service planning with homeless individuals. Further research is needed on the instrument's sensitivity to change over time and applicability to diverse cultural groups.