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http://hdl.handle.net/11375/28474
Title: | COVID-19 Surveillance of the Homeless Population in Congregate Living Settings |
Other Titles: | COVID-19 Amongst the Homeless Population |
Authors: | Maciejewski, Julia |
Advisor: | Smieja, Marek |
Department: | Health Research Methodology |
Publication Date: | 2023 |
Abstract: | Background The homeless population is at high risk for SARS-CoV-2 infection and outbreaks. There have been no longitudinal studies to assess the impact on this population throughout the various stages of the pandemic. A surveillance study will allow for the observation of trends over time, the identification of potential risk factors, and the assessment of the feasibility of routine testing in this population, which can inform public health decisions on infection control and prevention in these at-risk communities. Methods This study was a prospective surveillance study of homeless individuals and staff in 53 facilities in Hamilton, ON from January 1 to December 31, 2021. Self-collected oral-nasal swabs were collected once a week and used for SARS-CoV-2 testing using a PCR triplex. Results A total of 42,331 tests were conducted for 3155 clients and 1823 staff. There were 295 unique infections among clients and 117 unique infections among staff. The overall positivity rate of SAR-CoV-2 among all facilities was 1%. Isolation centres had the highest positivity rate (4.26%), followed by drop-in sites (1.91%), emergency shelters (1.08%), supportive housing (0.61%), and offices (0%). There were 52 outbreaks across 23 of the facilities. The median (interquartile range) for size and duration (days) of outbreaks was 4 (2,8) people and 8 (3,14) days, respectively. Individual-level risk factors for infection in congregate settings were being a client (OR=2.30, 95% CI 1.43-3.68), visiting two or more facilities (OR=1.72, 95% CI 1.13-2.61), and no vaccination (OR=2.03, 95% CI 1.37-3.02). Facility-level risk factors for infection were emergency shelters (OR=1.88, 95% CI 1.16-3.05) and facility capacity of 26-50 people and over 100 people (OR=3.52, 95% CI 1.59-7.80; OR=5.24, 95% CI 2.43-11.31). Conclusion Our findings support the presence of SARS-CoV-2 in the homeless population and the potential for large outbreaks. A large-scale surveillance program proves to be a promising intervention in effectively reducing transmission in this population provided the availability of funding and the appropriate lab support for high-capacity testing. Both individual and facility-level risk factors need to be considered in any public health effort that looks to minimize the transmission of infectious diseases in the homeless population. |
URI: | http://hdl.handle.net/11375/28474 |
Appears in Collections: | Open Access Dissertations and Theses |
Files in This Item:
File | Description | Size | Format | |
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Maciejewski_Julia_2023April_MSc.pdf | 1.18 MB | Adobe PDF | View/Open |
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