• Kelly Ray Knight, Michael R Duke, Caitlin A Carey, Graham Pruss, Cheyenne M Garcia, Marguerita Lightfoot, Elizabeth Imbert, and Margot Kushel.
• Department of Humanities and Social Sciences, University of California, San Francisco, San Francisco, CA, USA.
• J Gen Intern Med. 2022 Mar 1; 37 (4): 823829823-829.

BackgroundHomeless-experienced populations are at increased risk of exposure to SARS-CoV-2 due to their living environments and face an 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.ObjectiveTo understand the facilitators and barriers to COVID-19 testing and vaccine acceptability among homeless-experienced adults.DesignWe conducted in-depth interviews with participants from July to 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.ParticipantsAdults with current or past experience of homelessness.ApproachWe 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 ResultsParticipants 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 a 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.ConclusionsParticipants expressed positive evaluations of the incentivized, mobile COVID-19 testing supported by CHOWs in unsheltered settings. The majority of participants expressed a 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.© 2021. Society of General Internal Medicine.

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