Background Few global data exist regarding COVID-19 vaccine coverage in people experiencing homelessness (PEH) or precariously housed (PH) who are at high risk for COVID-19 infection, hospitalization, and death. Given the absence of documented French data, we aimed to determine COVID-19 vaccine coverage in PEH/PH in France, and its drivers. Methods We carried out a cross-sectional study following a two-stage cluster-sampling design in Ile-de-France and Marseille, France, in late 2021. Participants aged over 18 years were recruited where they slept the previous night and then stratified for analysis into three housing groups (Streets, Accommodated, and Housed). Interviews were conducted face-to-face in the participant's preferred language. Multilevel univariate and multivariable logistic regression models were built. Findings 3,690 individuals were surveyed: 855 in the Housed stratum, 2,321 in the Accommodated stratum and 514 in the Streets stratum. 76.2% (95%CI 74.3-78.1) reported receiving at least one COVID-19 vaccine dose. Vaccine uptake varied by stratum, with uptake highest (85.6%; reference) in Housed, followed by Accommodated (75.4%; AOR=0.79; 95%CI 0.51-1.09 vs Housed) and lowest in Streets (42.0%; AOR=0.38; 95%CI 0.25-0.57 vs Housed). Use for vaccine certificate, socioeconomic drivers, and vaccine hesitancy explained vaccine coverage. Interpretation In France, PEH/PH are less likely than the general population likely to receive COVID-19 vaccines; with the most excluded being the least likely. The influence of both structural drivers and vaccine beliefs in PEH/PH reinforce the importance of targeted outreach, on-site vaccination and sensitisation activities to further vaccine uptake. Funding Sante Publique France, Agence Nationale de Recherches sur le Sida/Capnet, Agence Regionale de Sante-Ile de France, Medecins Sans Frontieres, and Societe de Pathologie Infectieuse de Langue Francaise.
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