ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Although widespread vaccination in prisons is crucial for preventing COVID-19 morbidity and mortality in both prisons and their surrounding communities, there is little data on how to effectively perform vaccine outreach to people experiencing incarceration who remain unvaccinated. DESCRIPTION OF PROGRAM/INTERVENTION: In 2021, California state prisons started hosting institution- wide COVID-19 vaccine education events with a focus on those who remain unvaccinated;based on their success, these events are being replicated across the state. Elements that contributed to their success are summarized so that they may be employed in other facilities. 1) Make vaccine education enjoyable, for example with games, an art contest, or free food in addition to question and answer sessions. 2) Optimize attendance by co-locating with another popular event. 3) Administer vaccines at the event and offer more than one option if possible. 4) Diversify sources of information and bring in outside public health experts, trusted advocates, or formerly incarcerated people to ensure residents have access to multiple sources of information. 5) Consider engaging formal and informal leaders in prisons beforehand as their support may encourage peer vaccination. 6) Distribute high quality information that is easy to read, for example AMEND's COVID-19 FAQs that are based on questions from incarcerated people and their loved ones. 7) Continue to offer the vaccine after the event and ensure those who remain unvaccinated know how to access vaccines if they become interested. MEASURES OF SUCCESS: Program success was measured by the percentage of the population who attended the event and the percentage of unvaccinated residents who were vaccinated at the event. Future events should assess what information unvaccinated participants believe would be most beneficial in their decision-making process and whether the event delivered that content. FINDINGS TO DATE: At the first event at a high security prison with over 2800 residents, 11% of unvaccinated residents (113 individuals) received their first COVID-19 vaccine. At the second prison with over 2600 residents, 19% of unvaccinated residents received their first vaccine (165 individuals). KEY LESSONS FOR DISSEMINATION: As vaccination against COVID19 continues to be a critical method for optimizing the health and safety of people living in congregate living environments, interventions that increase trust and acceptance of vaccines in correctional settings are of paramount importance. These successful vaccination events in California state prison hold important lessons for other correctional institutions and congregate living facilities seeking to disseminate vaccine information and encourage COVID19 vaccine uptake.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Individuals at risk for HIV often face barriers to routine outpatient care which were exacerbated during the COVID-19 pandemic, creating a need and an opportunity to leverage hospital admissions for HIV screening. DESCRIPTION OF PROGRAM/INTERVENTION: This resident-led quality improvement project ran from 10/01/2020 to 6/30/2021 and aimed to increase rates of HIV screening among inpatients on the Medicine service at Zuckerberg San Francisco General Hospital (ZSFG), an urban safety net hospital. The QI intervention was informed by an initial gap analysis and consisted of three components: provider education, targeted outreach including biweekly performance metrics with peer comparisons, and electronic health record (EHR) optimizations. A pre-existing multidisciplinary care team was available to provide follow-up for positive test results, facilitating rapid linkage to HIV care. MEASURES OF SUCCESS: Given the high prevalence of HIV risk factors in this population, appropriate screening was defined as having an HIV test within the past 6 months. Our target for appropriate HIV screening was 55% of hospitalized patients on the Medicine service without a known HIV diagnosis, an increase of 10% from baseline. As a secondary goal, we sought to increase resident education about HIV as measured by pre- and post- intervention surveys. FINDINGS TO DATE: Among patients admitted during the intervention period (N = 1701), there was a 17.6% absolute increase in HIV screening rates compared to baseline (N = 885) (45.3% v. 62.9%, p < 0.001). To assess the impact of our intervention on previously identified differences in screening rates by gender, race, and language, we conducted post-intervention subgroup analyses. These results demonstrated persistently lower screening rates among females (59.6% v. 64.6%, p = 0.044), Asians (55.0% v. 64.5, p < 0.01), and patients speaking Chinese-based languages (53.5% v. 63.8, p = 0.01). Comparisons of pre- and post-intervention survey data showed an increase in provider comfort and knowledge across all domains assessed. KEY LESSONS FOR DISSEMINATION: Quality improvement interventions including education, targeted outreach, and EHR optimization can increase HIV screening rates of hospitalized patients. We found that despite improvement in overall screening rates, disparities persisted for women, Asians, and non-English speaking patients. Targeted interventions to address these disparities in HIV screening are needed. Inpatient providers are well-poised to help address HIV screening gaps, particularly for underserved patient populations who may face increased barriers to routine HIV prevention services.