COVID-19 vaccination acceptability and experiences among people who inject drugs in San Diego County

Valasek, Chad J.; Streuli, Samantha; Pines, Heather A.; Mittal, Maria Luisa; Strathdee, Steffanie A.; Vera, Carlos F.; Vera, Alicia; Bazzi, Angela R.

doi:10.1016/j.pmedr.2022.101989

Cited by 12 publications

(14 citation statements)

References 25 publications

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“…Although this pilot trial was not powered to fully investigate the mechanisms through which LinkUP promoted COVID-19 testing, based on our community consultations and formative research identifying multilevel barriers to COVID-19 testing in this vulnerable population, we believe that LinkUP’s theoretical grounding and multicomponent nature supported its success. In particular, we had learned that PWID in San Diego County had low levels of COVID-19 knowledge, perceived risk, and motivation for prevention behaviors and service engagement, which could have made structural barriers to COVID-19 testing and vaccination access seem unsurmountable [ 6 , 8 , 9 , 11 ]. We drew from Social Cognitive Theory to identify tailored education, motivational interviewing, and problem-solving and planning [ 14 , 15 ] as key intervention strategies for helping participants overcome these key barriers to cognitive and behavioral change [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Peer counselors delivered the half-hour, single-session, manualized LinkUP intervention that was based on relevant literature, Social Cognitive Theory [ 13 ], formative research [ 6 , 8 , 9 ], and input from our Community and Scientific Advisory Board. The intervention began with a series of brief educational videos on COVID-19 epidemiology, testing, and vaccination (~5 minutes total; in English or Spanish).…”

Section: Methodsmentioning

confidence: 99%

“…Related to these well-documented barriers to healthcare utilization, PWID has suboptimal rates of COVID-19 testing [ 6 ], which may be compounded by limited COVID-19 knowledge and perceived risk [ 7 ] and institutional distrust [ 8 ]. Our research in the San Diego, California, and Tijuana, Mexico border region found that SARS-CoV-2 prevalence was higher among PWID than the general population while levels of COVID-19 testing were lower [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Preliminary Efficacy of a Theory-Informed Intervention to Increase COVID-19 Testing Uptake Among People Who Inject Drugs in San Diego County: Findings From a Pilot Randomized Controlled Trial

Bazzi

Abramovitz

Vera

et al. 2023

Annals of Behavioral Medicine

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Background People who inject drugs (PWID) have low rates of COVID-19 testing yet are vulnerable to severe disease. In partnership with a mobile syringe service program (SSP) in San Diego County, CA, we developed the evidence-, community-, and Social Cognitive Theory-informed “LinkUP” intervention (tailored education, motivational interviewing, problem-solving, and planning) to increase COVID-19 testing uptake among PWID. Purpose To assess preliminary efficacy of LinkUP in increasing PWID COVID-19 testing in a pilot randomized controlled trial (RCT). Methods We referred participants (PWID, ≥18 years old, San Diego County residents who had not recently undergone voluntary COVID-19 testing) to mobile SSP sites that had been randomized (by week) to offer the active LinkUP intervention or didactic attention-control conditions delivered by trained peer counselors. Following either condition, counselors offered on-site rapid COVID-19 antigen testing. Analyses estimated preliminary intervention efficacy and explored potential moderation. Results Among 150 participants, median age was 40.5 years, 33.3% identified as Hispanic/Latinx, 64.7% were male, 73.3% were experiencing homelessness, and 44.7% had prior mandatory COVID-19 testing. The LinkUP intervention was significantly associated with higher COVID-19 testing uptake (p < .0001). Homelessness moderated intervention effects; LinkUP increased COVID-19 testing uptake more among participants experiencing homelessness (adjusted risk ratio [aRR]: 1.80; 95% CI: 1.56–2.09; p < .0001) than those not experiencing homelessness (aRR: 1.20; 95% CI: 1.01–1.43; p = .04). Conclusions Findings from this pilot RCT support the preliminary efficacy of the “LinkUP” intervention to increase COVID-19 testing among PWID and underscore the importance of academic-community partnerships and prevention service delivery through SSPs and other community-based organizations serving vulnerable populations.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preliminary Efficacy of a Theory-Informed Intervention to Increase COVID-19 Testing Uptake Among People Who Inject Drugs in San Diego County: Findings From a Pilot Randomized Controlled Trial

Bazzi

Abramovitz

Vera

et al. 2023

Annals of Behavioral Medicine

Self Cite

View full text Add to dashboard Cite

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“…Specifically, we found that PWID who had been recently incarcerated or were homeless were significantly more likely to have undergone COVID-19 testing [ 13 ]. Consultations with our CSAB and in-depth interviews with PWID, supported with funding from the San Diego Center for AIDS Research, revealed that individuals in contact with the criminal justice system and homeless shelters were often subjected to mandatory (as opposed to voluntary) COVID-19 testing that had made them reluctant to engage in future voluntary testing [ 12 ]. Similarly, our original eligibility criteria would have excluded individuals with only one COVID-19 vaccine dose, and we had not considered that individuals with symptoms consistent with SARS-CoV-2 should be included in the trial irrespective of whether they had been previously tested or vaccinated.…”

Section: Discussionmentioning

confidence: 99%

“…The active condition involves a single-session, manualized intervention that we developed based on literature review, formative research [ 8 , 12 , 13 ], and consultations with our Community and Scientific Advisory Board (CSAB) and collaborating SSP research partners. Aligned with SCT [ 36 ], key intervention strategies involve tailored education, MI, and problem-solving and planning around individual participants’ unique concerns about and barriers to COVID-19 testing and vaccination.…”

Section: Methodsmentioning

confidence: 99%

Study protocol for a pilot randomized controlled trial to increase COVID-19 testing and vaccination among people who inject drugs in San Diego County

Bazzi

Vera

Buesig-Stamos

et al. 2022

Addict Sci Clin Pract

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Background People who inject drugs (PWID) have low rates of COVID-19 testing and vaccination and are vulnerable to severe disease. We partnered with a local, community-based syringe service program (SSP) in San Diego County, CA, to develop the single-session theory- and evidence-informed “LinkUP” intervention to increase COVID-19 testing and vaccination. This paper details the protocol for a pilot randomized controlled trial (RCT) of the LinkUP intervention. Methods With significant community input into study design considerations, including through our Community and Scientific Advisory Board, the LinkUP pilot RCT leverages an ongoing cohort study with adult (≥ 18 years) PWID in San Diego County to recruit participants who have not recently undergone voluntary COVID-19 testing and are unvaccinated. Eligible participants are referred to SSP locations randomized to offer the active intervention (involving tailored education, motivational interviewing, and problem-solving strategies) or a didactic attention-control condition (information sharing only). Both conditions are delivered by trained peer counselors hired by the SSP and were designed to be delivered at mobile (outdoor) SSP sites in ~ 30 min. Intake data assesses COVID-19 testing and vaccination history, health status, and harm reduction needs (to facilitate SSP referrals). At the end of either intervention condition, peer counselors offer onsite rapid COVID-19 antigen testing and COVID-19 vaccination referrals. Out-take and follow-up data (via SSP and state health department record linkages) confirms whether participants received the intervention, COVID-19 testing (and results) onsite or within six months, and vaccination referrals (and uptake) within six months. Planned analyses, which are not powered to assess efficacy, will provide adequate precision for effect size estimates for primary (COVID-19 testing) and secondary (vaccination) intervention outcomes. Findings will be disseminated widely including to local health authorities, collaborating agencies, and community members. Discussion Lessons from this community-based pilot study include the importance of gathering community input into study design, cultivating research-community partnerships based on mutual respect and trust, and maintaining frequent communication regarding unexpected events (e.g., police sweeps, neighborhood opposition). Findings may support the adoption of COVID-19 testing and vaccination initiatives implemented through SSPs and other community-based organizations serving vulnerable populations of people impacted by substance use and addiction. Trial registration This trial was registered prospectively at ClinicalTrials.gov (identifier NCT05181657).

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Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review

Newman,

Dinh,

Nyoni

et al. 2023

J. Racial and Ethnic Health Disparities

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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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COVID-19 vaccination acceptability and experiences among people who inject drugs in San Diego County

Cited by 12 publications

References 25 publications

Preliminary Efficacy of a Theory-Informed Intervention to Increase COVID-19 Testing Uptake Among People Who Inject Drugs in San Diego County: Findings From a Pilot Randomized Controlled Trial

Preliminary Efficacy of a Theory-Informed Intervention to Increase COVID-19 Testing Uptake Among People Who Inject Drugs in San Diego County: Findings From a Pilot Randomized Controlled Trial

Study protocol for a pilot randomized controlled trial to increase COVID-19 testing and vaccination among people who inject drugs in San Diego County

Covid-19 Vaccine Hesitancy and Under-Vaccination among Marginalized Populations in the United States and Canada: A Scoping Review

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