ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Even though they face a higher risk of COVID-19-related morbidity and mortality, racial and ethnic minorities in the Greater Boston area have had less access to COVID-19 testing and vaccinations. DESCRIPTION OF PROGRAM/INTERVENTION: We implemented a novel, community-based mobile health unit program by repurposing transportation vans with COVID-19 testing equipment, preventive hygiene kits, and mRNA vaccines. Our goal was to expand testing and vaccine availability in highly affected communities in the Greater Boston area. We used a “double equity” model by hiring workers from a local transportation company whose staff were at risk of unemployment. The vans were staffed with racially/ ethnically diverse and multilingual staff, including members of the target communities themselves. We incorporated a system of “trusted messengers” to answer questions about COVID-19 and in particular, vaccination from the community. We implemented this program with crucial input from community-based organizations and municipal public health departments. Van location sites were guided by community partners, in some cases incorporating SARS-CoV-2 wastewater surveillance data to meet rapidly changing community needs. MEASURES OF SUCCESS: Our goals were to (1) demonstrate the feasibility of a COVID-19 testing program guided by community partnerships and SARS-CoV-2 wastewater surveillance data;(2) improve access to COVID-19 testing in underserved communities;and (3) improve access to COVID-19 vaccination among racial/ethnic minorities. We collected ongoing feedback (e.g. through the local community advisory groups etc) on the mobile health program from community partners, patients, and staff. We compared sociodemographic characteristics of mobile health participants with the general population of the state of Massachusetts and the population of the target communities. FINDINGS TO DATE: From January 2021 - January 2022, our mobile health units have tested greater than 4500 persons in predominantly low socioeconomic communities that have been highly impacted by the pandemic. From May 2021 - January 2022, we vaccinated 5480 persons in these communities. An analysis of our program from January 2021 - January 2022 demonstrated that mobile health unit participants receiving COVID-19 vaccines were significantly more likely to be non-White and Hispanic compared with the general vaccinated population of the state of Massachusetts and of the target communities, and these findings were statistically significant. We also found that the mobile health units vaccinated more youth and adolescents in the target community compared with the general state vaccination data. KEY LESSONS FOR DISSEMINATION: Delivery of preventive COVID19 care via mobile health units is feasible and associated with high usage from affected communities when implemented with high stakeholder engagement and expertise from local public health departments. Employing diverse, multilingual, and well-trained healthcare staff as trusted messengers likely improved COVID-19 vaccine uptake in this population.
ABSTRACT
Background. In January-March 2020, the Centers for Disease Control and Prevention (CDC) issued multiple warnings regarding COVID-19 travel-associated risks. We sought to describe US travelers seeking pretravel consultation regarding international travel at US Global TravEpiNet (GTEN) sites before and after the initial COVID-19 travel warnings. Methods. We prospectively collected data at 22 GTEN sites pre-COVID-19 (January-December 2019) and 18 GTEN sites during the COVID-19 pandemic (April 2020-March 2021). We excluded travelers evaluated during January-March 2020, when CDC travel guidance was evolving rapidly. Travelers used standardized questionnaires to self-report data regarding demographics and travel-related characteristics. Providers confirmed these data and documented their recommendations during pretravel consultation, which could be performed virtually. We conducted descriptive analyses of differences in demographics, travel-related characteristics, vaccinations, and medications (SAS v9.4;Cary, NC). Results. Compared with 16,903 pre-COVID-19 consultations, only 1,564 consultations occurred during the COVID-19 pandemic, a 90% reduction (Table). During COVID-19, a greater proportion of travelers were children aged 1-5 years, visiting friends and relatives (VFR), with itineraries ≥ 30 days, and going to Africa;a smaller proportion of travelers were aged > 55 years, or traveling to Southeast Asia or the Western Pacific. During COVID-19, fewer vaccine-eligible travelers received vaccines at the pretravel consultation except for yellow fever, and a greater proportion were referred to another provider for vaccination (Figure). Table. Demographics and travel-related characteristics of international travelers seeking pretravel consultation at Global TravEpiNet sites before and during the COVID-19 pandemic Table continued. Demographics and travel-related characteristics of international travelers seeking pretravel consultation at Global TravEpiNet sites before and during the COVID-19 pandemic Figure. Vaccinations and reasons for nonvaccination among vaccine-eligible international travelers at pretravel consultations at Global TravEpiNet (GTEN) sites before and during the COVID-19 pandemic. Among vaccine-eligible travelers, we summarized those who were vaccinated at the visit (blue) and not vaccinated (orange). We then categorized reasons for nonvaccination into: provider decision (solid), referral to another provider (dots), traveler refusal (striped), or other (hatched). COVID-19 vaccination was not available at GTEN sites during the analysis period;although COVID-19 vaccinations outside of GTEN sites might have affected vaccination recommendations, they were unlikely to have had a large effect given their limited availability in January-March 2021. Conclusion. Compared with pre-COVID-19, US travelers seeking pretravel consultations at GTEN sites during the pandemic might be at higher risk for travel-related infections given VFR status, traveling for ≥ 30 days, and going to Africa. Fewer vaccine-eligible travelers were vaccinated at pretravel consultations, which could reflect more virtual pretravel consultations. Counseling and vaccination for international travelers continue to be priorities during the COVID-19 pandemic.
ABSTRACT
[Figure: see text].