COVID-19 vaccine uptake among people who inject drugs in Tijuana Mexico

Abstract

Background:SARS-CoV-2 prevalence is elevated among people who inject drugs (PWID). In Tijuana, Mexico, COVID-19 vaccines became available to the general population in June 2021, but uptake among PWID was <10%. We studied COVID-19 vaccine uptake among PWID in Tijuana following implementation of a pop-up vaccination clinic.MethodsBeginning in October, 2020, PWID in Tijuana aged ≥18 years were enrolled into a longitudinal cohort study. At baseline and semi-annually, participants underwent interviewer-administered interviews on health behaviors and COVID-19 exposures through April 5, 2022. From June 21—September 20, 2021, staff referred PWID to a temporary COVID-19 vaccine pop-up clinic that was coincidentally established near the study office. Participants attending the clinic completed a short interview on barriers to vaccination and were offered facilitated access to free Janssen® COVID-19 vaccine. All participants were reimbursed $5 for this interview, regardless of whether or not they chose to be vaccinated. Poisson regression was used to evaluate the effect of the pop-up clinic on COVID-19 vaccination uptake, controlling forpotential confounders.ResultsOf 344 participants, 136 (39.5%) reported having received at least one COVID-19 vaccine dose during the 10 months follow-up period, of whom 113 (83.1%) received vaccine at the pop-up clinic and 23 (16.9%) elsewhere. One third of those receiving COVID-19 vaccine during the pop-up clinic were previously vaccine hesitant. Attending the pop-up clinic was independently associated with higher rates of COVID-19 vaccination Adjusted Rate Ratio (AdjRR: 9.15; 95% CI: 5.68–14.74).ConclusionsWe observed a significant increase in COVID-19 vaccine uptake associated with attending a temporary pop-up vaccine clinic in Tijuana suggesting that efforts to improve vaccination in this vulnerable population should include convenient locations and staff who have experience working with substance using populations. Since COVID-19 vaccination rates remain sub-optimal, sustained interventions to increase uptake are needed.

Predictors of COVID-19 vaccine uptake among people who inject drugs

“…Since more than one third of vaccinated PWID had previously been hesitant towards COVID-19 vaccines and half of unvaccinated PWID expressed interest in being vaccinated, our results suggest that targeted efforts to thwart disinformation and medical distrust could improve COVID-19 vaccination in this population. Our study and others found greater COVID-19 vaccination uptake in circumstances where PWID have trust in the medical establishment and when they have received preventive services or health care for other conditions [12] , [13] , [15] , [27] . Resources should be allocated to integrate COVID-19 vaccination into programs that are frequented and trusted by PWID, which includes SSPs and other harm reduction programs, homeless shelters, health fairs and drug treatment centers.…”

“…Since we also found that participants who knew more people who had received COVID-19 vaccines had greater vaccine uptake, public health messaging for PWID should focus on dispelling conspiracy theories and fostering health literacy by enlisting peers, trusted community opinion leaders and outreach workers [28] . In a recent study in Tijuana, significantly higher COVID-19 vaccination rates occurred among PWID who attended a “pop-up” vaccine clinic that was staffed by medical professionals possessing experience working with substance using populations [15] . Similar approaches to increase COVID-19 vaccination should be offered at locations where PWID seek services, such as drug treatment programs, SSPs, soup kitchens, homeless shelters and community health fairs.…”

“…We censored this analysis on March 15, 2022 as this was prior to the initiation of a RADxUP intervention to improve COVID-19 vaccination uptake among PWID in San Diego. Cohort participants living in Tijuana were also excluded since they were subjected to a pop-up COVID vaccine program that significantly improved vaccine uptake [15] .…”

“…Finally, we cannot directly compare our findings to those from our previous manuscript on COVID-19 vaccine hesitancy, since the prior analysis included participants from Tijuana and the present analysis focuses only on those residing in San Diego. This is because Tijuana implemented a successful intervention to increase COVID-19 vaccine uptake among marginalized persons [15] , and thus the COVID vaccination experiences among PWID in the two cities were no longer comparable.…”

COVID‐19 vaccine attitudes and facilitators among people in Australia who inject drugs

“…However, delivery of vaccine at such services requires dedicated funding to increase immunisation service delivery capacity [49]. In the absence of such funding, referral to a public vaccination site via street outreach services has also been shown to increase uptake among people who inject drugs [50].…”