What is the role of primary care in COVID-19 programs focused on people experiencing homelessness?

ABSTRACT

Background: The pandemic has had a disproportionate impact on people who are living in socially disadvantaged situations. People experiencing homelessness are less able to isolate and follow public health messaging to reduce the risk of infection. In addition, due to the higher prevalence of chronic disease, they have a poorer prognosis with infection with higher rates of mortality and hospitalisation. In the early pandemic, many countries implemented programs that were exclusively focused on the care of people experiencing homelessness. Aim/Objectives: Our aim was to describe programs that have been implemented to reduce COVID-19 transmission and severity of illness in homeless populations and to understand the involvement of primary care. Method(s) We performed a rapid review of the international literature documenting COVID-19 related programs for people experiencing homelessness. We searched PubMed, Embase, and CINAHL plus Google using search term combinations of homeless persons and COVID-19. All articles were screened by two independent reviewers and one person extracted the items of interest. Finding(s) After screening 615 studies we included 42 studies and most were from the USA (n = 26). Programs commonly focused on isolation centres for people experiencing homelessness who tested positive for COVID-19 (n = 15). Sixteen studies included an evaluation of program effectiveness and two investigated the perspective of program participants. Universal screening was more effective than symptomatic screening in reducing COVID-19 transmission in homeless shelter settings. Comprehensive healthcare, including mental health and addiction support, was essential for people to be able to tolerate isolation, but care continuity post-isolation was problematic with limited primary care involvement. Implications Few COVID-19 programs for people experiencing homelessness involve the primary care sector. As continuity of care post-program was a common problem, primary care may have a role in cross-sector collaboration.