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Co-locating COVID-19 vaccination and infectious disease testing with a syringe services program boosted engagement among people who injected drugs, according to an analysis of the Baltimore-based initiative.

Among 347 participants across 10 co-located clinics participating in the Baltimore City Health Department Syringe Services Program from April 2021 to June 2022, 63% received at least one dose of the COVID vaccine and 58% received one infectious disease test, reported Omeid Heidari, PhD, MPH, of the University of Washington in Seattle, and co-authors in .

"The most important finding for us is that co-location worked," Heidari told MedPage Today.

Overall, 94% of participants completed primary vaccination with either mRNA or viral vector vaccines, a rate that outpaces Heidari and co-authors noted.

"The prevailing thought is that for people who are using and injecting drugs, it's hard to do follow-up care, but this is a population that when you have the right messenger -- someone they trust in -- they'll come back for follow-up services and even complete important preventive care," Heidari said.

Those "trusted messengers" were the syringe exchange services staff, who have a lot of empathy for this population, which is lacking in the traditional medical system, he added.

Even though all participants were eligible for a booster at the time of data analysis, only 30% received a booster dose, which is lower than the general public.

Heidari believes the discrepancy is due in part to a lag between when the primary series was offered and when the clinics restarted and boosters became available.

"When you are not there and present, people are not going to come as often," he said, underscoring the need for consistent engagement.

As for infectious disease testing, 86% of participants received a point-of-care HIV test, 64% received a hepatitis C test, 38% received a syphilis test, 34% received a throat swab for gonorrhea and chlamydia, and 25% received a genital swab for gonorrhea and chlamydia.

Of the eight people with positive HIV tests (5% of those tested), all received treatment. One additional person, who reported HIV exposure within 72 hours, tested negative using a rapid test. That individual received a prescription for postexposure prophylaxis and a referral for clinical services.

Among 21 people who tested positive for hepatitis C (16% of those tested), only six were documented as having a successful referral visit. For the six people who had a confirmed positive syphilis test, all were successfully linked to treatment when it was deemed necessary.

No one tested positive for chlamydia or gonorrhea. One individual tested positive for trichomoniasis and was successfully treated.

This collaborative program was run through a partnership with the Johns Hopkins mobile vaccine unit and the Center for Infectious Disease and Nursing Innovation, which provides testing for HIV, hepatitis C, and other sexually transmitted infections, as well as linkages to care.

The syringe services program, which has its own mobile van, visits neighborhoods with high overdose rates, providing harm reduction counseling and naloxone (Narcan) training. A second mobile vaccine unit provided mRNA (Moderna or Pfizer-BioNTech) or viral vector (Janssen) COVID vaccines.

While it was discussed whether it would be more convenient for this population to receive only the one-dose Janssen vaccine, shortly before staff went into the field, a potential link between the Janssen vaccine and an increased risk of blood clots was found. Therefore, the team decided to offer people the option of any one of the three vaccines.

"I think providing individuals the autonomy to make that decision for themselves really just showed that we were partners who cared about their health and well-being, and not just picking services for them," Heidari noted.

At the start of the program, participants received a $10 gift card for every completed infectious disease test. After the first five clinics, the incentive was changed to a single $20 gift card regardless of the number of tests. Gift cards were not offered for COVID vaccinations until after FDA approval in August 2021.

Any prescriptions provided were billed to participants' insurance, and uninsured individuals were connected to the city's sexual health clinic for free treatment.

With regard to harm reduction, an average 3,057 syringes were distributed and 1,437 syringes were returned across eight co-located clinics that had available data. Additionally, an average of 24 naloxone kits were distributed and accompanied by training.

Of the 347 people who received at least one COVID vaccine or infectious disease test at one of the 10 clinics, mean age was 51, 69% were men, 76% were Black, 15% were white, and 3% were Hispanic or Latino. In all, 40% were insured, 23% were uninsured, and 37% did not specify.

In the future, Heidari said he would like to see programs include more robust services on site. For example, for people with hepatitis C, staff could potentially also provide confirmatory testing and have clinicians available to prescribe curative therapy, in addition to first-line testing.

"You could feasibly have a lot of the services provided in primary care embedded within syringe services of harm reduction sites," he noted.

Other novel approaches that leverage co-location and trusted partners might include providing pre-exposure prophylaxis for HIV, wound care, diabetes and hypertension screening and treatment, mental health counseling, and medications for opioid use disorder, Heidari and team said.

Heidari hopes the study findings will lead payers and government agencies to place more value on this type of care and encourage them to reimburse it appropriately.

A limitation to the study was that it involved self-evaluation: Heidari and his team were involved in both implementing the program and assessing it.

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