LinkUP intervention improves COVID-19 testing, vaccination referral rates among PWID
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Key Takeaways:
- The LinkUP intervention increased COVID-19 testing and vaccine referral acceptance among people who inject drugs.
- The intervention was particularly effective among people experiencing homelessness.
SEATTLE — An intervention called LinkUP improved rates of COVID-19 testing and vaccination referral acceptance among people who inject drugs, with increased impact among those experiencing homeless, researchers found.
“People who inject drugs (PWID) are vulnerable to SARS-CoV-2 infection and severe disease yet have low rates of COVID-19 testing and vaccination, as has been documented in samples from around the world,” Angela R. Bazzi, PhD, MPH, associate professor at the University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science, said during a presentation at the Conference on Retroviruses and Opportunistic Infections.
Bazzi added that PWID living in the Mexico, U.S. border region — which is where her team is conducting epidemiological research — have high rates of SARS-CoV-2. One data collection from 2021 showed a 37% prevalence. Additionally, she said half of the participants reported missing opportunities for COVID-19 testing in a subsequent data collection time point in March of 2022.
“We know from the literature and our team's experience, that there are multilevel barriers to testing and vaccination for this population, ranging from low knowledge and misperceptions, as well as disinformation and interinstitutional distrust in addition to a number of social and structural barriers to accessing health care and prevention services such as stigma in health care settings, transportation challenges, and homelessness,” she said.
Because of this, Bazzi and colleagues partnered with a mobile syringe service program (SSP) in San Diego to develop and pilot test a multicomponent intervention known as LinkUP — which consisted of trained SSP-hired peer counselors who delivered tailored education, motivational interviewing, and problem-solving and planning to increase COVID-19 testing and vaccination among PWID.
According to the study, the team referred PWID aged 18 years and older who were San Diego County residents without recent voluntary COVID-19 testing or fully vaccinated status to mobile SSP sites randomly assigned by week to offer LinkUP or the control condition. All participants were then offered on-site rapid COVID-19 antigen testing and vaccination referrals.
Among 150 participants included in the study, participants in the group that had more active intervention agreed to COVID-19 testing (77.3% vs. 22.7%; P < .001) and vaccine referrals (32.4% vs. 13.3%; P = .006) compared with control participants.
The researchers found that homelessness, which 73% of participants were experiencing, “moderated” the effects of the intervention. For example, they found that LinkUP increased COVID-19 testing uptake more among participants experiencing homelessness (adjusted RR = 1.64; 95% CI, 1.27-2.12) than those not experiencing homelessness (aRR = 1.25; 95% CI, 0.99-1.56).
Bazzi said that, overall, these findings support the efficacy of LinkUP at increasing COVID-19 testing and uptake.
“Although our data don't provide an exact reason for this, we suspect based on our formative research and our consultations with our community partners, that the intervention was particularly helpful in restoring trust in COVID-19-related prevention services for this population,” she said.
“This research underscores the significance of community academic partnerships when working with PWID and identifies a promising model that could be adapted to increase access to other underutilized vaccines in this vulnerable population,” she said. “We know COVID-19 testing and vaccination are critical prevention tools, but we need intervention and implementation research to ensure that they can reach the communities that need the most.”
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Bazzi AR, et al. Abstract 212. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 19-22, 2023; Seattle.
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