Monitoring for COVID-19 by universal testing in a homeless shelter in Germany: a prospective feasibility cohort study

Abstract

Background Living conditions in homeless shelters facilitate the transmission of COVID-19. Social determinants and pre-existing health conditions place homeless people at increased risk of severe disease. Described outbreaks in homeless shelters resulted in high proportions of infected residents and staff members. In addition to other infection prevention strategies, regular shelter-wide (universal) testing for COVID-19 may be valuable, depending on the level of community transmission and when resources permit. Methods This was a prospective feasibility cohort study to evaluate universal testing for COVID-19 at a homeless shelter with 106 beds in Berlin, Germany. Co-researchers were recruited from the shelter staff. A PCR analysis of saliva or self-collected nasal/oral swab was performed weekly over a period of 3 weeks in July 2020. Acceptability and implementation barriers were analyzed by process evaluation using mixed methods including evaluation sheets, focus group discussion and a structured questionnaire. Results Ninety-three out of 124 (75%) residents were approached to participate in the study. Fifty-one out of the 93 residents (54.8%) gave written informed consent; thus 41.1% (51 out of 124) of all residents were included in the study. Among these, high retention rates (88.9–93.6%) of a weekly respiratory specimen were reached, but repeated collection attempts, as well as assistance were required. Around 48 person-hours were necessary for the sample collection including the preparation of materials. A self-collected nasal/oral swab was considered easier and more hygienic to collect than a saliva specimen. No resident was tested positive by RT-PCR. Language barriers were the main reason for non-participation. Flexibility of sample collection schedules, the use of video and audio materials, and concise written information were the main recommendations of the co-researchers for future implementation. Conclusions Voluntary universal testing for COVID-19 is feasible in homeless shelters. Universal testing of high-risk facilities will require flexible approaches, considering the level of the community transmission, the available resources, and the local recommendations. Lack of human resources and laboratory capacity may be a major barrier for implementation of universal testing, requiring adapted approaches compared to standard individual testing. Assisted self-collection of specimens and barrier free communication may facilitate implementation in homeless shelters. Program planning must consider homeless people’s needs and life situation, and guarantee confidentiality and autonomy.

Participatory development and implementation of inclusive digital health communication on COVID-19 with homeless people

“…In the second step, we designed multilingual posters with seven different motifs ( Figures 2 , 3 ) ( 19 ). With two versions, we have covered a total of nine languages identified as most relevant in a previous local project ( 9 ):…”

“…After they were shared with and adapted by all stakeholders, the main protagonist translated them to a simple and clear language. Native speakers translated the scripts into four other languages that were identified in the previous project we performed ( 9 ). Quality control was performed by professional translators.…”

“…In July 2021, the Robert Koch Institute, the national public health institute in Germany, published targeted recommendations for COVID-19 in the context of homelessness that were developed together with experts from the field ( 8 ). Many good practice solutions were implemented locally to protect PEH during the pandemic, such as provision of adequate isolation and quarantine options addressing possible complex needs of PEH, 24/7 accommodation with single rooms, regular voluntary universal testing for SARS-CoV-2, and mobile vaccination campaigns ( 9 , 10 ). However, in many places, isolation, access to vaccination and testing as well as targeted information remained a challenge.…”

“…In a previous COVID-19 project among PEH, we identified the necessity to address language barriers, to include digital information formats, and to use participatory approaches considering homeless people's needs and life situation ( 9 ). This follow-up project aimed a participatory development of inclusive health communication on COVID-19 to strengthen options for IPC for PEH.…”

From disgusting and complicated to simple and brilliant: Implementation perspectives and lessons learned from users and rejectors of mail-in SARS-CoV-2 gargle tests

“…While studies have outlined provider perspectives of testing sites, gaps exist about how users experience testing interventions, how test rejectors perceive testing methods and how individuals respond to mail in SARS-CoV-2 tests ( 29 ). Studies examined how to improve the implementation of SARS-CoV-2 tests in Germany among specific settings such as homeless shelters and schools ( 22 , 30 , 31 ). This study aims to gain a deeper understanding of how test users and test rejectors perceived SARS-CoV-2 gargle tests and their implementation as mail-in tests with self-sampling and laboratory-based sample analysis.…”