A Brief Peer-Led Intervention to Increase COVID-19 Vaccine Uptake Among People Who Inject Drugs in San Diego County: Results From a Pilot Randomized Controlled Trial

Abstract

Background We evaluated the impact of a brief, peer-led intervention on COVID-19 vaccination among people who inject drugs (PWID) presenting at syringe services program (SSP) locations in San Diego County, California. Methods Between March and July 2022, PWID aged ≥18 years old without recent voluntary COVID-19 testing who were not up to date on COVID-19 vaccinations received a single-session motivational interviewing intervention (“LinkUP”) or an attention-matched didactic control condition from trained peer counselors at SSP sites randomized by week. Following either 30-minute session, counselors offered referrals to local vaccination services. Multivariable log binomial regression via generalized estimating equations assessed LinkUP effects on i) acceptance of COVID-19 vaccination referrals immediately post-intervention and ii) COVID-19 vaccine uptake at six-month follow-up. Results Of 149 participants, COVID-19 vaccination outcomes were obtained on 135 (90.6%). In multivariable analysis, participants receiving LinkUP had greater acceptance of COVID-19 vaccination referrals than controls (Adjusted Relative Risk [AdjRR]: 3.50; 95% CI: 1.01, 12.2) and were marginally more likely to report receiving a new COVID-19 vaccine dose (AdjRR: 1.57; 95% CI: 0.99, 2.48). After six months, 20% reported receiving a new vaccine dose; however, if COVID-19 vaccine had been available at SSPs, this proportion could have been as high as 34.3% (45.3% LinkUP vs. 24.3% control; p=0.01). Conclusions A brief peer-led SSP-based intervention significantly improved COVID-19 vaccination among PWID. Further improvements could likely be obtained by supporting SSPs to offer COVID-19 vaccination onsite instead of relying on referrals.

Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in Baltimore, Maryland

“…Participants with HIV had a higher prevalence of anti-S antibodies after adjustment for demographic factors, consistent with prior research demonstrating positive associations between HIV serostatus and COVID-19 vaccine uptake in this cohort and other samples of PWID ( Cepeda et al., 2022 ; Iversen et al., 2022 ; Strathdee et al., 2023a ). Participants with HIV in the current study sample were highly engaged in HIV care (e.g., 97% reported antiretroviral therapy use), which may have facilitated more encouragement and/or opportunity to receive the vaccine.…”

“…The finding that anti-S antibody prevalence was significantly lower among younger participants and marginally lower in female participants is consistent with our prior work in this cohort that found younger and female participants were less likely to be vaccinated against COVID-19 during March to June 2021 ( Cepeda et al., 2022 ). The association of age and sex with the probability of COVID-19 vaccine uptake has varied in other samples of PWID ( Des Jarlais et al., 2023 ; Harvey-Vera et al., 2022 ; Iversen et al., 2022 ; Strathdee et al., 2023a ). Notably, in our cohort, we also previously found that younger and female participants were also more likely to express high levels of COVID-19 vaccine hesitancy ( Cepeda et al., 2022 ).…”

“…People who inject drugs (PWID) face many socio-structural and economic inequities, some of which have been exacerbated by the COVID-19 pandemic ( Bradley et al., 2022 ; Carroll et al., 2023 ; Genberg et al., 2021 ; Wiessing et al., 2023 ). Studies conducted in the first two years of the pandemic have found low engagement in infection prevention behaviors (e.g., physical distancing) ( Genberg et al., 2021 ), limited uptake of COVID-19 testing ( Gorbach et al., 2022 ; Yeager et al., 2022 ), and suboptimal coverage of COVID-19 vaccination among PWID ( Cepeda et al., 2022 ; Cioffi et al., 2022 ; Iversen et al., 2022 ; Strathdee et al., 2023a ). PWID also often have chronic comorbidities ( Heidari et al., 2022 ; Lim et al., 2022 ; Sun et al., 2022 ), which are risk factors for developing severe COVID-19 outcomes ( Ng et al., 2021 ).…”

“…Given that the spread of SARS-CoV-2 has been heterogeneous by population, geography, and time throughout the pandemic, these findings on infection risk may not be generalizable or transportable to other populations, settings, or points in time ( Rudolph et al., 2023 ). Previous studies have highlighted disparities in COVID-19 vaccine uptake based on self-reported and medical record data among current and former PWID ( Cepeda et al., 2022 ; Des Jarlais et al., 2023 ; Iversen et al., 2022 ; Strathdee et al., 2023a ); however, there remains limited data characterizing the distribution of infection and/or vaccination-induced anti-S antibodies among PWID following widespread SARS-CoV-2 infection and vaccination.…”

Study protocol: Project 2VIDA! SARS-CoV-2 vaccine intervention delivery for adults in Southern California

“…Since the onset of the pandemic, a variety of approaches have been employed to improve COVID-19 vaccination rates among racial/ethnic minorities and vulnerable populations, including provider delivered educational interventions ( 22 ); patient education, incentives, reminders (e.g., text messaging), motivational interviewing ( 23 ); digital interventions ( 24 ); community-based approaches ( 25 , 26 ) and provision of vaccines in settings serving high risk populations ( 27 ). However, these studies have yield mixed findings, noting that some interventions had no notable change in COVID-19 vaccine uptake ( 23 ).…”