“This is about the coolest thing I’ve ever seen is that you just showed right up.” COVID-19 testing and vaccine acceptability among homeless-experienced adults: Qualitative data from two samples

Background Homeless-experienced populations are at increased risk of exposure to SARS CoV-2 due to their living environments and face increased risk of severe COVID-19 disease due to underlying health conditions. Little is known about COVID-19 testing and vaccination acceptability among homeless-experienced populations. Objective To understand the facilitators and barriers to COVID-19 testing and vaccine acceptability among homeless-experienced adults. Design We conducted in-depth interviews with participants from July-October 2020. We purposively recruited participants from 1) a longitudinal cohort of homeless-experienced older adults in Oakland, CA (n=37) and 2) a convenience sample of people (n=57) during a mobile outreach COVID-19 testing event in San Francisco. Participants Adults with current or past experience of homelessness. Approach We asked participants about their experiences with and attitudes towards COVID-19 testing and their perceptions of COVID-19 vaccinations. We used participant observation techniques to document the interactions between testing teams and those approached for testing. We audio-recorded, transcribed and content analyzed all interviews and identified major themes and subthemes. Key Results Participants found incentivized COVID-19 testing administered in unsheltered settings and supported by community health outreach workers (CHOWs) to be acceptable. The majority of participants expressed positive inclination toward vaccine acceptability, citing a desire to return to routine life and civic responsibility. Those who expressed hesitancy cited a desire to see trial data, concerns that vaccines included infectious materials, and mistrust of the government. Conclusions Participants expressed positive evaluations of the incentivized, mobile COVID-19 testing supported by CHOWs in unsheltered settings. The majority of participants expressed positive inclination toward vaccination. Vaccine hesitancy concerns must be addressed when designing vaccine delivery strategies that overcome access challenges. Based on the successful implementation of COVID-19 testing, we recommend mobile delivery of vaccines using trusted CHOWs to address concerns and facilitate wider access to and uptake of the COVID vaccine.