Protocol > Research Study
Roederer T, Fourrey E, Mollo B, Vanhomwegen J, Simons E, et al.
2020 May 1
Journal Article > ResearchFull Text
Lancet Public Health. 2021 April 1; Volume 6 (Issue 4); DOI:10.1016/s2468-2667(21)00001-3
Roederer T, Mollo B, Vincent C, Nikolay B, Llosa AE, et al.
Lancet Public Health. 2021 April 1; Volume 6 (Issue 4); DOI:10.1016/s2468-2667(21)00001-3
Between June 23 and July 2, 2020, 426 (52%) of 818 individuals recruited tested positive in 14 sites. Seroprevalence varied significantly by type of recruitment site (χ2 p<0·0001), being highest among those living in workers' residences (88·7%, 95% CI 81·8-93·2), followed by emergency shelters (50·5%, 46·3-54·7), and food distribution sites (27·8%, 20·8-35·7). More than two thirds of COVID-19 seropositive individuals (68%, 95% CI 64·2-72·2; 291 of 426) did not report any symptoms during the recall period. COVID-19 seropositivity was strongly associated with overcrowding (medium density: adjusted odds ratio [aOR] 2·7, 95% CI 1·5-5·1, p=0·0020; high density: aOR 3·4, 1·7-6·9, p<0·0001).
Conference Material > Abstract
Vincent C
Epicentre Scientific Day Paris 2022. 2022 June 1
CONTEXT
People experiencing recurrent homelessness (PEH) or precariously housed have been overexposed to SARS-CoV2 with high morbidity and attack rates. While most guidelines prioritize the vaccination of PEH, implementation is usually challenging. Objectives of our survey were to estimate COVID-19 vaccination coverage and its drivers in PEH.
METHODS
We carried out a cross-sectional stratified survey using a two-stage cluster sampling design. Between November 15 and December 22, 2021, 227 sites were surveyed in the Ile-de-France region (IDF) and Marseille and divided into 3 strata. We interviewed 3,691 participants in their preferred language.
RESULTS
Three-quarters of surveyed individuals (76.2% ; 95%CI 74.3-78.1) received at least one dose of COVID-19 vaccine in 2021. It was highest (85.6%; 95%CI 83.0-88.2) among housed individuals, followed by those accommodated (75.4%; 95%CI 73.0- 77.8) and lowest in the streets (42.0%; 95%CI 34.3-49.7). Vaccine uptake was thus lower in all strata compared to French population at the end of 2021 (91% in France). Public vaccination centers were the place of preference in all strata. Reasons for vaccination were mostly related to protection (personal, of vulnerable people, overall) while roughly a quarter of participants felt compelled to be vaccinated (to get the vaccine certificate, travel, or work). Reasons for nonvaccination were more refusals than physical/practical obstacles, with around 10% of participants without any intention to get vaccinated.
Multivariate analysis highlighted the following vaccine uptake drivers: age, administrative status, source of meals, food distribution attendance, source of COVID-19 information, onsite vaccination activity and medical coverage were associated with higher vaccine uptake. Negative opinions on COVID-19 vaccines, fear of the vaccine, living with his/her family, and having no need for vaccine certificate were associated with lower vaccine uptake.
CONCLUSION
Access to COVID-19 vaccine is low for an overexposed population. Reinforcing comprehensive and inclusive social care for these people, relying on trustworthy third parties with personal ties to them, and extended use of “outreach” strategies appear to be key levers for improving vaccine coverage.
KEY MESSAGE
People experiencing recurrent homelessness are less vaccinated than the general population. It seems essential to strengthen their social support and to rely on trusted third parties and outreach activitieS.
This abstract is not to be quoted for publication.
People experiencing recurrent homelessness (PEH) or precariously housed have been overexposed to SARS-CoV2 with high morbidity and attack rates. While most guidelines prioritize the vaccination of PEH, implementation is usually challenging. Objectives of our survey were to estimate COVID-19 vaccination coverage and its drivers in PEH.
METHODS
We carried out a cross-sectional stratified survey using a two-stage cluster sampling design. Between November 15 and December 22, 2021, 227 sites were surveyed in the Ile-de-France region (IDF) and Marseille and divided into 3 strata. We interviewed 3,691 participants in their preferred language.
RESULTS
Three-quarters of surveyed individuals (76.2% ; 95%CI 74.3-78.1) received at least one dose of COVID-19 vaccine in 2021. It was highest (85.6%; 95%CI 83.0-88.2) among housed individuals, followed by those accommodated (75.4%; 95%CI 73.0- 77.8) and lowest in the streets (42.0%; 95%CI 34.3-49.7). Vaccine uptake was thus lower in all strata compared to French population at the end of 2021 (91% in France). Public vaccination centers were the place of preference in all strata. Reasons for vaccination were mostly related to protection (personal, of vulnerable people, overall) while roughly a quarter of participants felt compelled to be vaccinated (to get the vaccine certificate, travel, or work). Reasons for nonvaccination were more refusals than physical/practical obstacles, with around 10% of participants without any intention to get vaccinated.
Multivariate analysis highlighted the following vaccine uptake drivers: age, administrative status, source of meals, food distribution attendance, source of COVID-19 information, onsite vaccination activity and medical coverage were associated with higher vaccine uptake. Negative opinions on COVID-19 vaccines, fear of the vaccine, living with his/her family, and having no need for vaccine certificate were associated with lower vaccine uptake.
CONCLUSION
Access to COVID-19 vaccine is low for an overexposed population. Reinforcing comprehensive and inclusive social care for these people, relying on trustworthy third parties with personal ties to them, and extended use of “outreach” strategies appear to be key levers for improving vaccine coverage.
KEY MESSAGE
People experiencing recurrent homelessness are less vaccinated than the general population. It seems essential to strengthen their social support and to rely on trusted third parties and outreach activitieS.
This abstract is not to be quoted for publication.
Journal Article > ResearchFull Text
Commun Med. 2023 February 20; Volume 3 (Issue 1); 30.; DOI:10.1038/s43856-023-00257-1
Roederer T, Mollo B, Vincent C, Leduc G, Sayyad-Hilario J, et al.
Commun Med. 2023 February 20; Volume 3 (Issue 1); 30.; DOI:10.1038/s43856-023-00257-1
BACKGROUND
Migrants, people experiencing homelessness (PEH), or precariously housed (PH) are at high risk for COVID-19 infection, hospitalization, and death from COVID-19. However, while data on COVID-19 vaccine uptake in these populations are available in the USA, Canada, and Denmark, we are lacking, to the best of our knowledge, data from France.
METHODS
In late 2021, we carried out a cross-sectional survey to determine COVID-19 vaccine coverage in PEH/PH residing in Ile-de-France and Marseille, France, and to explore its drivers. Participants aged over 18 years were interviewed face-to-face where they slept the previous night, in their preferred language, and then stratified for analysis into three housing groups (Streets, Accommodated, and Precariously Housed). Standardized vaccination rates were computed and compared to the French population. Multilevel univariate and multivariable logistic regression models were built.
RESULTS
We find that 76.2% (95% confidence interval [CI] 74.3–78.1) of the 3690 participants received at least one COVID-19 vaccine dose while 91.1% of the French population did so. Vaccine uptake varies by stratum, with the highest uptake (85.6%; reference) in PH, followed by Accommodated (75.4%; adjusted odds-ratio = 0.79; 95% CI 0.51–1.09 vs. PH) and lowest in Streets (42.0%; AOR = 0.38; 95%CI 0.25–0.57 vs. PH). Use for vaccine certificate, age, socioeconomic factors, and vaccine hesitancy is associated with vaccination coverage.
CONCLUSIONS
In France, PEH/PH, and especially the most excluded, are less likely than the general population to receive COVID-19 vaccines. While vaccine mandate has proved an effective strategy, targeted outreach, on-site vaccinations, and sensitization activities are strategies enhancing vaccine uptake that can easily be replicated in future campaigns and other settings.
Migrants, people experiencing homelessness (PEH), or precariously housed (PH) are at high risk for COVID-19 infection, hospitalization, and death from COVID-19. However, while data on COVID-19 vaccine uptake in these populations are available in the USA, Canada, and Denmark, we are lacking, to the best of our knowledge, data from France.
METHODS
In late 2021, we carried out a cross-sectional survey to determine COVID-19 vaccine coverage in PEH/PH residing in Ile-de-France and Marseille, France, and to explore its drivers. Participants aged over 18 years were interviewed face-to-face where they slept the previous night, in their preferred language, and then stratified for analysis into three housing groups (Streets, Accommodated, and Precariously Housed). Standardized vaccination rates were computed and compared to the French population. Multilevel univariate and multivariable logistic regression models were built.
RESULTS
We find that 76.2% (95% confidence interval [CI] 74.3–78.1) of the 3690 participants received at least one COVID-19 vaccine dose while 91.1% of the French population did so. Vaccine uptake varies by stratum, with the highest uptake (85.6%; reference) in PH, followed by Accommodated (75.4%; adjusted odds-ratio = 0.79; 95% CI 0.51–1.09 vs. PH) and lowest in Streets (42.0%; AOR = 0.38; 95%CI 0.25–0.57 vs. PH). Use for vaccine certificate, age, socioeconomic factors, and vaccine hesitancy is associated with vaccination coverage.
CONCLUSIONS
In France, PEH/PH, and especially the most excluded, are less likely than the general population to receive COVID-19 vaccines. While vaccine mandate has proved an effective strategy, targeted outreach, on-site vaccinations, and sensitization activities are strategies enhancing vaccine uptake that can easily be replicated in future campaigns and other settings.
Journal Article > ResearchFull Text
Vaccine: X. 2024 March 14; Volume 18; 100472.; DOI:10.1016/j.jvacx.2024.100472
Haidar S, Roederer T, Allaire C, Mollo B, Vincent C, et al.
Vaccine: X. 2024 March 14; Volume 18; 100472.; DOI:10.1016/j.jvacx.2024.100472
BACKGROUND
Homeless people have a higher risk of COVID-19 infection, linked to several social, economic and environmental determinants, frequent comorbidities, obstacles to exercising their constitutional social and health rights, poor medical cover, and insufficient use of the healthcare system. Data on COVID-19 vaccine uptake and its main determinants are lacking for this underserved population.
OBJECTIVES
To construct and test a conceptual framework to model structural social determinants of COVID-19 vaccine uptake among underserved homeless populations, and to test this model to identify the determinants of COVID-19 vaccine uptake on the homeless population living in two metropolitan areas in France.
METHODS
We implemented a multicenter cross-sectional survey from 15/11/2021 to 22/12/2021 in homeless adults in the city of Marseille and in the greater Paris area. Persons sheltered in migrant worker hostels or in emergency social shelters, members of the COVID HOMELESS cohort study in Marseille, and Travelers living in traditional housing were all eligible. A standardized face-to-face questionnaire was administered to the participants where they lived in various languages by trained interviewers. We used structural equation modeling to analyze the structural social determinants of COVID-19 vaccine uptake, the latter defined as receiving at least one dose.
RESULTS
The participation rate was 64%, accounting for 3811 participants. There were three main factors associated with greater vaccine uptake: i) opportunity, which included having a personal general practitioner (β = 0.05, p < 0.05), healthcare cover (β = 0.05, p < 0.05), and somebody to accompany the participant for medical appointments (β = -0.04, p < 0.05); ii) motivation, which included attitudes towards vaccination (β = 0.55, p < 0.05), press- and poster-based information (β = 0.03, p < 0.05), and vaccination history (β = 0.03, p < 0.05); iii) type of housing (β = 0.13, p < 0.05) and housing stability (β = 0.04, p < 0.05).
CONCLUSION
Our results highlight that housing exclusion is a structural social determinant of COVID-19 vaccine uptake in homeless people in France. They also underline the role which opportunity and motivation play in improving uptake in this underserved homeless population.
Homeless people have a higher risk of COVID-19 infection, linked to several social, economic and environmental determinants, frequent comorbidities, obstacles to exercising their constitutional social and health rights, poor medical cover, and insufficient use of the healthcare system. Data on COVID-19 vaccine uptake and its main determinants are lacking for this underserved population.
OBJECTIVES
To construct and test a conceptual framework to model structural social determinants of COVID-19 vaccine uptake among underserved homeless populations, and to test this model to identify the determinants of COVID-19 vaccine uptake on the homeless population living in two metropolitan areas in France.
METHODS
We implemented a multicenter cross-sectional survey from 15/11/2021 to 22/12/2021 in homeless adults in the city of Marseille and in the greater Paris area. Persons sheltered in migrant worker hostels or in emergency social shelters, members of the COVID HOMELESS cohort study in Marseille, and Travelers living in traditional housing were all eligible. A standardized face-to-face questionnaire was administered to the participants where they lived in various languages by trained interviewers. We used structural equation modeling to analyze the structural social determinants of COVID-19 vaccine uptake, the latter defined as receiving at least one dose.
RESULTS
The participation rate was 64%, accounting for 3811 participants. There were three main factors associated with greater vaccine uptake: i) opportunity, which included having a personal general practitioner (β = 0.05, p < 0.05), healthcare cover (β = 0.05, p < 0.05), and somebody to accompany the participant for medical appointments (β = -0.04, p < 0.05); ii) motivation, which included attitudes towards vaccination (β = 0.55, p < 0.05), press- and poster-based information (β = 0.03, p < 0.05), and vaccination history (β = 0.03, p < 0.05); iii) type of housing (β = 0.13, p < 0.05) and housing stability (β = 0.04, p < 0.05).
CONCLUSION
Our results highlight that housing exclusion is a structural social determinant of COVID-19 vaccine uptake in homeless people in France. They also underline the role which opportunity and motivation play in improving uptake in this underserved homeless population.