Predictors of COVID-19 vaccine uptake and preferences for service delivery among people who inject drugs accessing a syringe service program

Introduction People who inject drugs (PWID) have lower rates of COVID-19 vaccine uptake, despite being disproportionately affected by the COVID-19 pandemic. Multiple implementation adaptations have been proposed to address this gap, including offering the vaccines at syringe service programs (SSPs). To inform their implementation at an SSP in Miami, Florida, this study aimed to identify predictors of COVID-19 vaccine uptake and preferences for service delivery among PWID in our context. Methods Between June 2022 and July 2023, we administered a cross-sectional survey based on the Health Belief Model with PWID accessing services at an SSP in Miami, FL (n = 135). Differences in predictor variables were assessed by COVID-19 vaccination status (vaccinated and/or willing to be vaccinated vs. not vaccinated and not willing to be vaccinated) using bivariate analysis. Results Only 65% of participants had received at least one dose of the COVID-19 vaccine series. Predictors of COVID-19 vaccination included older age ( p  = 0.01), having a primary healthcare provider ( p  = 0.0136), requiring medical care for previous COVID-19 infections ( p  = 0.0232), being confident in the US healthcare system (OR = 4.50, 95% CI: 1.96–10.29), and not believing multiple COVID-19 misconceptions ( p  < 0.05). Perceived benefit was the only Health Belief Model domain with significantly increased odds of COVID-19 vaccination. Most participants (n = 116, 86%) preferred to receive the COVID-19 vaccine at the SSP, and suggestions for increasing uptake included offering compensation, providing information, utilizing peer outreach systems, providing reminders, and allowing for accelerated vaccination schedules. Discussion Our findings reiterate the potential of SSPs to increase uptake of COVID-19 and other vaccines among PWID and provide insight into implementation adaptations to optimize vaccine uptake, including emphasizing the benefit of vaccines in communication efforts, offering compensation, and leveraging the trusted relationship with SSP staff, particularly peer navigators. Together, this evidence reinforces SSPs’ unique ability to increase engagement with and utilization of preventative care services among PWID, within and beyond the COVID-19 pandemic.