Monitoring for COVID-19 by universal testing in a homeless shelter in Germany: a prospective feasibility cohort study
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Abstract
Background
Living conditions in homeless shelters facilitate the transmission of COVID-19. Social determinants and pre-existing health conditions place homeless people at increased risk of severe disease. Described outbreaks in homeless shelters resulted in high proportions of infected residents and staff members. In addition to other infection prevention strategies, regular shelter-wide (universal) testing for COVID-19 may be valuable, depending on the level of community transmission and when resources permit.
Methods
This was a prospective feasibility cohort study to evaluate universal testing for COVID-19 at a homeless shelter with 106 beds in Berlin, Germany. Co-researchers were recruited from the shelter staff. A PCR analysis of saliva or self-collected nasal/oral swab was performed weekly over a period of 3 weeks in July 2020. Acceptability and implementation barriers were analyzed by process evaluation using mixed methods including evaluation sheets, focus group discussion and a structured questionnaire.
Results
Ninety-three out of 124 (75%) residents were approached to participate in the study. Fifty-one out of the 93 residents (54.8%) gave written informed consent; thus 41.1% (51 out of 124) of all residents were included in the study. Among these, high retention rates (88.9–93.6%) of a weekly respiratory specimen were reached, but repeated collection attempts, as well as assistance were required. Around 48 person-hours were necessary for the sample collection including the preparation of materials. A self-collected nasal/oral swab was considered easier and more hygienic to collect than a saliva specimen. No resident was tested positive by RT-PCR. Language barriers were the main reason for non-participation. Flexibility of sample collection schedules, the use of video and audio materials, and concise written information were the main recommendations of the co-researchers for future implementation.
Conclusions
Voluntary universal testing for COVID-19 is feasible in homeless shelters. Universal testing of high-risk facilities will require flexible approaches, considering the level of the community transmission, the available resources, and the local recommendations. Lack of human resources and laboratory capacity may be a major barrier for implementation of universal testing, requiring adapted approaches compared to standard individual testing. Assisted self-collection of specimens and barrier free communication may facilitate implementation in homeless shelters. Program planning must consider homeless people’s needs and life situation, and guarantee confidentiality and autonomy.
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SciScore for 10.1101/2020.10.04.20205401: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Oral and written study information was provided to the residents to obtain written consent.
IRB: Ethics: This study was approved by the ethics committee of the Charité – Universitätsmedizin (No.: EA4/141/20).Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and …
SciScore for 10.1101/2020.10.04.20205401: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Oral and written study information was provided to the residents to obtain written consent.
IRB: Ethics: This study was approved by the ethics committee of the Charité – Universitätsmedizin (No.: EA4/141/20).Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations: An understanding of the challenges and issues related to recruitment and retention – especially in a so called hard-to-reach population – is important and can help policy makers to foresee strategies to overcome these issues. In Berlin, this may be relevant for the reopening of > 40 emergency overnight shelters in the winter season 2020/21 [28]. The residents of the 24/7 shelter were not representative of all people experiencing homelessness in Berlin. People in highly precarious situations (e.g., with psychiatric disorders) were unlikely fully represented, due to the fact that individuals had to register at the shelter and fulfill certain requirements during their stay. The need of a signature in the study consent form may have discouraged some individuals from participating. The high retention rates may not be fully generalizable, as the co-researchers put huge efforts in conducting the study, demonstrated by the repeated attempts to collect the specimens. The analysis of recruitment and retention barriers may be biased, as it relied on observations made by the co-researchers. Lack of interest to participate or indifference to the topic might have different reasons such as lack of adequate information, or other basic priorities. The interval of a weekly respiratory specimen was a pragmatic decision, as it remains unclear which intervals would most efficiently prevent chains of infection. People experiencing homelessness were not involved in the pl...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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