Corrections Officers' and Sheriffs' Perceptions of COVID-19 Vaccine Operationalization.

Justice-involved populations are at an elevated risk for infectious disease transmission and have been profoundly negatively impacted by the COVID-19 pandemic. Vaccination is being utilized as a primary tool for prevention and protection from serious infection in carceral settings. We examined the barriers and facilitators to vaccine distribution by surveying key stakeholders-sheriffs and corrections officers-in these settings. Most respondents felt prepared for rollout, although they still identified significant barriers to operationalization of vaccine distribution. Barriers ranked highest by stakeholders were vaccine hesitancy and problems related to deficits in communication and planning. There is enormous opportunity to install practices that will address the significant barriers being faced to efficient vaccine distribution and amplify existing facilitators. These could include, for example, the incorporation of in-person community communication models for discussion of the vaccine (and hesitancy) in carceral facilities.

Barriers to severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing reported by healthcare workers during the first pandemic wave at an academic center in Boston, Massachusetts.

Healthcare workers (HCWs) experience barriers to severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing specific to their perceptions of access, and employment factors. A survey was sent to all employees at one Boston hospital to examine their perceived barriers to testing. HCWs who reported difficulty paying their bills were less likely to receive a SARS-CoV-2 test.

Influenza Vaccination in Massachusetts Jails: A Mixed-Methods Analysis.

OBJECTIVES: Influenza infects millions of people each year and contributes to tens of thousands of deaths annually despite the availability of vaccines. People most at risk of influenza complications are disproportionately represented in people incarcerated in US prisons and jails. The objectives of this study were to survey health administrators in Massachusetts county jails about institutional influenza vaccine policies and practices and estimate influenza vaccination rates in Massachusetts jails from 2013 to 2020. METHODS: In April 2020, we administered surveys to the health services administrators in Massachusetts' 14 county jails to gather information about influenza vaccination policies and delivery practices. To calculate influenza vaccination rates for each facility, we obtained data on influenza vaccine orders from the Massachusetts Department of Public Health for each county in Massachusetts for influenza seasons 2013-2020. We calculated summary statistics for each reporting facility and each year, conducted a Kruskal-Wallis analysis to compare vaccination rates between years, and used a linear regression model to identify predictors of vaccination rates. RESULTS: Influenza vaccination rates in Massachusetts jails ranged from 1.9% to 11.8%. We found no significant differences in vaccination rates between years. Influenza vaccine ordering and delivery practices varied by jail, and respondents had high levels of confidence in influenza policies and vaccine delivery practices. CONCLUSIONS: Influenza vaccination rates in Massachusetts jails are low, and delivery practices in jails vary. Lack of influenza vaccinations in jails is a gap in health care that needs to be prioritized, especially considering the current COVID-19 pandemic. Further investigations for effective and equitable vaccination in this population should involve people who are incarcerated and people who make influenza vaccine policies in jails.

Healthcare workers' perspectives on coronavirus testing availability: a cross sectional survey.

BACKGROUND: Studies on the impact of the novel SARS-CoV-2 virus (COVID) for healthcare workers (HCWs) rarely include the full spectrum of hospital workers, including less visible patient support roles. In the early days of the pandemic, COVID testing was preferentially available to HCWs. The objective of this study was to understand how individual experiences for all HCWs during the pandemic were associated with perceptions of access to, and receipt of COVID testing . METHODS: All hospital employees (n = 6736) in a single academic medical center in Boston, Massachusetts were invited to participate in a cross-sectional survey regarding perceived access to, and receipt of COVID testing during the first wave of the pandemic (March - August 2020). Responses were linked to human resources data. Log binomial univariate and multivariable models were used to estimate associations between individual and employment variables and COVID testing. RESULTS: A total of 2543 employees responded to the survey (38 %). The mean age was 40 years (± 14). Respondents were female (76 %), white (55 %), worked as nurses (27 %), administrators (22 %) and patient support roles (22 %); 56 % of respondents wanted COVID testing. Age (RR 0.91, CI 0.88-0.93), full time status (RR 0.85, CI 0.79-0.92), employment tenure (RR 0.96, CI 0.94-0.98), changes in quality of life (RR 0.94, CI 0.91-0.96), changes in job duties (RR 1.19, CI 1.03-1.37), and worry about enough paid sick leave (RR 1.21, CI 1.12-1.30) were associated with interest in testing. Administrators (RR 0.64, CI 0.58-0.72) and patient support staff (RR 0.85, CI 0.78-0.92) were less likely than nurses to want testing. Age (RR 1.04, CI 1.01-1.07), material hardships (RR 0.87, CI 0.79-0.96), and employer sponsored insurance (RR 1.10, CI 1.00-1.22) were associated with receiving a COVID test. Among all employees, only administrative/facilities staff were less likely to receive COVID testing (RR 0.69, CI 0.59-0.79). CONCLUSIONS: This study adds to our understanding of how hospital employees view availability of COVID testing. Hazard pay or other supports for hospital workers may increase COVID testing rates. These findings may be applicable to perceived barriers towards vaccination receipt.

Increased HIV testing in people who use drugs hospitalized in the first wave of the COVID-19 pandemic.

People who use drugs (PWUD) often experience barriers to preventative health care. During the COVID-19 pandemic, due to lapses in harm reduction services, several public health experts forecasted subsequent increases in diagnosis of HIV in PWUD. As many inpatient hospitals reworked patient flow during the COVID-19 surge, we hypothesized that HIV testing in PWUD would decrease. To answer this question, we compiled a deidentified list of hospitalized patients with electronic medical record indicators of substance use-a positive urine toxicology screen, prescribed medications to treat opioid use disorder, a positive CIWA score, or a positive CAGE score-admitted between January, 2020 and August, 2020. The outcome of interest was HIV test completion during inpatient hospitalization. The study used logistic regression to examine associations between type of substance use and receipt of HIV test. The study grouped substance use type into four groups (1) opioids (oxycodone, fentanyl, or other opiates) or opioid use disorder treatments (methadone, buprenorphine, naltrexone); (2) stimulant use (cocaine or amphetamines); (3) alcohol use (presence of a positive CAGE or CIWA score or alcohol present on toxicology screen); and (4) benzodiazepine use (benzodiazepines present on toxicology screen). The proportion of PWUD who were tested for HIV increased from 10.4% in January, 2020 to 28.2% in April, 2020 and back down to 12% in August. Notably, there was an inverse trend over time for number of people hospitalized with drug use, from 259 in January to a nadir of 85 in April, and then up to 217 in August, 2020. Contrary to our hypothesis, HIV testing increased during the COVID-19 pandemic, and we discuss explanations for this finding. The decrease in HIV testing post-pandemic peak is a reminder that we must work to develop interventions that lead to sustained high rates of HIV testing for all people, and especially for PWUD.