Completeness of the COVID-19 Vaccination Schedule among Persons Experiencing Homelessness in Brazil (preprint)

Almost four years after COVID-19 was declared a global health emergency, equitable distribution of the vaccine remains a challenge, especially among homeless people, the fastest growing population in Brazil. Therefore, we sought to identify the factors associated with completion of the COVID-19 vaccination schedule among homeless people in Brazil. Materials and Methods: We carried out a cross-sectional study in the capital cities of Brazil's Federative Units, considering people living on the streets as the target population. We used a sequential inclusion approach, with individual interviews conducted by trained professionals, using a validated questionnaire. We used descriptive statistics to analyze the data and a binary logistic regression model to identify factors associated with homeless individuals who completed the COVID-19 vaccination schedule. Results: It was identified that the highest density of homeless people and indicators related to COVID-19 is located in the Northeast, Southeast and South regions of Brazil. The primary data sample consisted of 1,392 participants, predominantly male (n: 961; 69.0%), with an average age of 38.3±15.2 years, belonging to the black/brown race/color (n: 1,097; 78.8%), with an elementary school education (n: 1,060; 76.1%). The factors associated with completing the vaccination schedule were: receiving government aid (OR: 1.58; 95%CI: 1.09 - 2.30), visits from Health Agents from the Street Clinic (OR: 3.19; 95%CI: 1.95 - 5.36), history of COVID-19 (OR: 5.77; 95%CI: 3.17 - 11.15), support for mandatory vaccination against COVID-19 (OR: 3.76; 95%CI: 2.48 - 5.76), trust in the efficacy of vaccines (OR: 3.92; 95%CI: 2.63 - 5.89), seeking information from NGOs, street clinics, community leaders (OR: 1.91; 95%CI: 1.01 - 3.88) and trust in the Federal Government's statements on vaccines (OR: 1.57; 95%CI: 1.06 - 2.31).Conclusion: The study advances knowledge by highlighting the completeness of the COVID-19 vaccination schedule among the homeless population. The source of information proved to be one of the determinants of completeness, and the Unified Health System played a leading role in raising awareness among homeless people, notably through its strategy of street clinics, when available. The evidence points to the importance of affirmative and inclusive actions that guarantee access to the vaccine for homeless people.

The Intersection of Vulnerabilities Among Homeless Populations Exacerbated by the Covid-19 Pandemic: a Mixed Methods Study (preprint)

Background: With the onset of the COVID-19 pandemic, there has been a discernible amplification of inherent vulnerabilities in the global population, with the most susceptible segments exemplified by the Homeless Population experiencing exacerbated adverse impacts.. This study aims to analyze the intersection of vulnerabilities among homeless populations aggravated by the COVID-19 pandemic.  Method: This is a parallel convergent mixed methods study, incorporating a cross-sectional quantitative study and a qualitative study. A survey-type questionnaire was employed in the quantitative approach, analyzed using descriptive and inferential techniques, and a semi-structured interview in the qualitative aspect, with interviews analyzed using Minayo's thematic analysis methodology.  Results: Significant associations were identified between the vulnerabilities faced by the homeless population, which were further compounded with the advent of the COVID-19 pandemic. This period witnessed a critical intersection of these vulnerabilities, resulting in an even deeper social destabilization for this group.  Conclusions: Individuals experiencing homelessness confront a complex accumulation of intertwined inequalities, intensifying their social vulnerability. This scenario underscores the intersection of vulnerabilities within this group and emphasizes the urgent need for an integrated approach to understand their health and the pandemic's impact on these individuals.

Perceived Risk of Developing Severe Illness or Complications Due to Covid-19 in the Brazilian Population (preprint)

Background The perception of the risk of developing serious illness as a result of COVID-19 was one of the first reports used to reflect the health condition of infected people after hospital admission. The effects of COVID-19 are more severe in individuals with chronic noncommunicable diseases (NCDs), indicating that the characteristics and implications of these diseases in people with COVID-19 need to be investigated.Methods This cross-sectional study was was carried out with 1961 people aged 18 or older living in Brazil. An open research approach (survey) was used for the sample design, which involved the use of an online questionnaire. Descriptive statistical analysis and logistic regression were applied to identify factors associated with the perceived risk of complications due to COVID-19.Results The sample was mostly composed of women (n = 1383; 70.5%), 18 to 39 years old (n = 1144; 58.3%), and white (n = 1140; 56.4%). It was possible to observe that people who perceived a risk of developing diseases or complications if they became infected with COVID-19 were more likely to have a chronic noncommunicable disease (NCD) (OR: 4.51; 95% CI: 3.61–5.65), self-perception of potential risk of becoming infected with COVID-19 (OR: 2.34; 95% CI: 1.87–2.93), self-perceived potential risk of the population becoming infected with COVID-19 (OR: 5.80; 95% CI: 3.30–10.74), wearing a protective mask (OR: 12.98; 95% CI: 5.8–31.35) during the pandemic period and having a religion (OR: 1.29; 95% CI: 1.02–1.63).Conclusions The study showed that the perception of the risk of developing a severe form of the disease was significant in certain groups, such as religious people or those with chronic noncommunicable diseases.

Factors Associated With Adherence or Hesitation to Protective Measures That Influenced the Control of COVID-19 in Brazil in the Pre-vaccine Era (preprint)

Preventive behavior is one of the main strategies to contain the spread of the coronavirus, understand the factors that influence adherence or hesitation to protective measures and the way the population behaves during a health crisis is of great importance. Aim: To analyze the factors associated with adherence to protection measures against Covid-19 in Brazil. Method: cross-sectional study, survey type online, between the period of August 2020 and February 2021. The population included in the study were Brazilians, aged 18 years or older. Non-probabilistic sampling was used to obtain the sample. The data was stored on the "Redcap" platform and analyzed in a descriptive and inferential approach. Results: The sample consisted of 1,516 people, women adopted 10% more protective measures than men, people with higher education level and higher income, within the age group between 40-59 years, were those who most adhered to the measures imposed by health agencies. Carrier of Asthma, Diabetes Mellitus, Systemic Arterial Hypertension, Obesity and smoking were factors that increased the adherence of protective measures in the fight against COVID-19. Conclusion: Being female, aged between 40 and 59 years, higher education, smoking, not having a religion, having health insurance, and being a carrier of chronic diseases were associated with greater adherence to protective measures against COVID-19.

Population confidence in federal entities’ governance to face the COVID-19 pandemic in Brazil and its associated factors: Evidence from the Social Thermometer Project – COVID-19 (preprint)

Background The crisis brought about by the COVID-19 pandemic brought a great connection with the population's level of trust in the governance of federative entities, in the intention of feeling supported and protected, whether at an individual or collective level. Here, we aimed to investigate the level of confidence of the Brazilian population in the governance of federative entities to combat COVID-19 and its associated factors.Methods A cross-sectional survey was developed, applied to the general Brazilian population, with a validated instrument, and a hybrid application online and in the field. Convenience sampling was used for recruitment using the snowball technique. Multinomial logistic regression was applied.Results The sample included 1,018 participants, with a mean age of 46.1 years, the majority being female (75.2%). Brazil has three levels of governance: the Federal, State, and Municipal Government. Residents in the Northeast and Central-West regions were more confident than those in the Southeast. The sources of information consulted by the participants were also associated with governance confidence.Conclusions The study advanced knowledge by showing that trust in governance capacity is socially determined and is crossed by forces that can lead to dissent, reducing the level of trust, especially in the Federal Government.