Drivers and prevalence of COVID-19 vaccine uptake among homeless and precariously housed people in France: a cross-sectional population-based study

Background Few global data exist regarding COVID-19 vaccine coverage in people experiencing homelessness (PEH) or precariously housed (PH) who are at high risk for COVID-19 infection, hospitalization, and death. Given the absence of documented French data, we aimed to determine COVID-19 vaccine coverage in PEH/PH in France, and its drivers. Methods We carried out a cross-sectional study following a two-stage cluster-sampling design in Ile-de-France and Marseille, France, in late 2021. Participants aged over 18 years were recruited where they slept the previous night, and then stratified for analysis into three housing groups (“Streets”, “Accommodated”, and “Housed”). Interviews were conducted face-to-face in the participant’s preferred language. Multilevel univariate and multivariable logistic regression models were built. Findings 3,690 individuals were surveyed: 855 in the “Housed” stratum, 2,321 in the “Accommodated” stratum and 514 in the “Streets” stratum. 76·2% (95%CI 74·3-78·1) reported receiving at least one COVID-19 vaccine dose. Vaccine uptake varied by stratum, with uptake highest (85.6%; reference) in “Housed”, followed by “Accommodated” (75·4%; AOR=0·79 ; 95%CI 0·51-1·09 vs Housed) and lowest in “Streets” (42·0%; AOR=0·38 ; 95%CI 0·25-0·57 vs Housed). Use for vaccine certificate, socioeconomic drivers and vaccine hesitancy explained vaccine coverage. Interpretation In France, PEH/PH are less likely than the general population likely to receive COVID-19 vaccines; with the most excluded being the least likely. The influence of both structural drivers and vaccine beliefs in PEH/PH reinforces the importance of targeted outreach, on-site vaccination and sensitisation activities to further vaccine uptake. Funding Santé Publique France, Agence Nationale de Recherches sur le Sida/Capnet, Agence Régionale de Santé – Ile de France, Médecins Sans Frontières, and Société de Pathologie Infectieuse de Langue Française. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was funded by Sante Publique France, Agence Nationale de Recherches sur le Sida (ANRS-MiE/Capnet)and Agence Regionale de Sante-Ile de France with additional support provided by Medecins Sans Frontieres and Societe de Pathologie Infectieuse de Langue Francaise. External donors had no role in the study design, data collection, interpretation, analysis, report writing, or the decision to submit for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Comite de Protection des Personnes III, Ile de France gave ethical approval for this work (ref. 2021-A01960-41) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.