The COVID-19 pandemic has disproportionately affected people from vulnerable and disadvantaged communities. Research to date has highlighted the factors that contribute to these disparities including differential treatment and experience of marginalized populations in healthcare and research settings, reduced access to testing and care, living in congregate or multigenerational households, the economic consequences of being diagnosed with COVID-19 and quarantining, differing understanding of and attitudes towards the pandemic, and concerns about contact tracing. Immigrant and low income populations, and people experiencing homelessness, many with mental illnesses, and/or have been recently incarcerated, are hesitant to participate in testing and to accept COVID-19 testing and vaccination. There is an urgent need to understand how to deliver information about testing and vaccination that is understandable and resonates with higher risk communities in their cultural and social contexts. Effective public health strategies for delivering this information must include community input and partnerships. Working closely with community partners who have insight into cultural, behavioral, economic, and factors impacting people’s decision making about testing and vaccine acceptance is essential to developing effective communication and outreach strategies for engaging individuals in testing, vaccination, and care. Working with our community partners, we will create and evaluate the impact of a public health intervention in the area of Cumberland County, Maine, to provide outreach, testing, and vaccination education to a large community of immigrants from sub-Saharan Africa, the Middle East, and Central America, higher-risk low-income people accessing a public health facility (with a sexually transmitted infections clinic, needle exchange, and a free clinic), and individuals experiencing homelessness. This will be a longitudinal study to understand beliefs about and knowledge of COVID-19, and barriers and beliefs about testing and vaccination. Results will inform a community-developed and based intervention to engage the cohort and other members of these populations in testing and vaccine education, and evaluate the impact of this intervention on testing and vaccination uptake in our immigrant, low-income, and homeless communities. Specific Aims: 1) To understand patient perceptions of, fears about, and experiences with COVID-19 testing and vaccination, including booster vaccination in our immigrant, low- income, and homeless populations. 2) To use the data from Aim 1 to develop and pilot test a public health messaging and testing program to increase vaccine and testing uptake in our populations of interest. 3) To evaluate the impact of a public health messaging and testing program developed in Aim 2 on rapid COVID-19 testing and vaccine uptake. While it will need to be adapted based on local communities’ cultures and needs, this work could be foundational for creating and sustaining public health measures that will contribute to the control of the pandemic and reducing the COVID-19 related disparities of vulnerable populations in the US.

The Covid19 pandemic has revealed major health disparities in vulnerable populations, including immigrants, and persons with low-income or experiencing homelessness. The project will address the cultural, social and economic barriers to testing and vaccination among these groups. We expect results to provide a model of interventions that can be adapted for other vulnerable communities to reduce fear of testing and vaccine hesitancy.