Unequal Access to Testing and Vaccination Services for the Homeless and Undocumented Population During COVID-19 Pandemic

Abstract

Objectives: To furnish a model to ensure access and use of healthcare services to the undocumented and homeless population.Methods: Between March 2020 and October 2021, public and third sector actors in Rome implemented an accessible COVID-19 screening service and vaccination program targeting the homeless and undocumented population.Results: 95.6% of the patients tested negative to both rapid and molecular tests. 0.9% tested positive to both. 0.7% were false negatives, while 2.8% were false positives. None of the participants refused the diagnostic treatment. From July to October 2021, 1384 people received a complete cycle of the COVID-19 vaccine through the program. 632 (45.6%) also agreed to perform the antibodies testing before inoculation. 318 (50.31%) of these were positive at the time of vaccination.Conclusion: We present a cost-effective model for reducing structural barriers to access diagnostic and preventive services for the homeless and undocumented population that can be applied to different public health settings.

SARS-CoV-2 incidence, seroprevalence, and COVID-19 vaccination coverage in the homeless population: a systematic review and meta-analysis

“…Out of the 49 included studies ( Supplementary Table S1 ), 20 eligible studies ( N = 29,513) were conducted in the United States ( 43–45 , 47–50 , 52 , 53 , 56 , 57 , 60 , 63 , 73 , 74 , 82 , 83 , 86 , 88 , 89 ), 7 ( N = 25,074) in Canada ( 46 , 54 , 59 , 62 , 64 , 69 , 84 ), 7 ( N = 3,957) in France ( 65–68 , 70 , 72 , 85 ), 2 ( N = 4,870) in the United Kingdom ( 78 , 81 ), 2 ( N = 757) in Denmark ( 58 , 91 ), 2 ( N = 181) in Germany ( 76 , 79 ), 2 ( N = 6,641) in Italy ( 55 , 90 ), and one each from Belgium ( N = 1,985) ( 71 ), Brazil ( N = 203) ( 75 ), Iran ( N = 234) ( 80 ), Mexico ( N = 481) ( 87 ), Slovakia ( N = 331) ( 51 ), Switzerland ( N = 215) ( 61 ) and Vatican ( N = 960) ( 77 ), respectively. The estimated pooled median age of 45.0 (95% CI, 42.9, 47.1) years was reported in 33 articles, and 37 publications reported gender of homeless people whose majority was male.…”

“…Thirty-two studies reported the SARS-CoV-2 incidence or seroprevalence in sheltered homeless and their median sample size was 331 (QTR 51-11,463) ( 43 , 44 , 46–51 , 53 , 54 , 56–60 , 63 , 66–69 , 71 , 73 , 75 , 79 , 82 , 83 , 86–89 , 91 ) while 15 studies also simultaneously investigated SARS-CoV-2 incidence or seroprevalence among the shelter staff ( N = 5,000) ( 43 , 46 , 47 , 49 , 53 , 56 , 63 , 66 , 67 , 75 , 77 , 83 , 88 , 89 , 91 ) ( Supplementary Tables S1, S2 ). Four studies ( N = 1,351) ( 53 , 65 , 80 , 86 ) were conducted in the unsheltered homeless people while 15 ( N = 31,232) ( 44 , 52 , 55 , 61 , 62 , 70 , 72 , 74 , 76–78 , 81 , 84 , 85 , 90 ) in the mixed population comprising sheltered and unsheltered homeless subjects whose SARS-CoV-2 incidence or seroprevalence was not separately reported. For the diagnosis of active SARS-CoV-2 infection in homeless people, 40 studies were based on NAATs alone, 1 study was based on antigen tests alone, and 1 investigation was based on the combination of NAAT and antigen tests.…”