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Principal Investigator: MEGAN L COMFORT
Organization: RESEARCH TRIANGLE INSTITUTE
Fiscal Year: 2024
Award: $512,963
Funding agency: National Institute on Minority Health and Health Disparities
PROJECT SUMMARY/ABSTRACT
The public health crisis engendered by the coronavirus (COVID-19) pandemic has fueled unprecedented
efforts to address the risk of infection and transmission among vulnerable populations, including provision of
non-congregate housing to people experiencing homelessness. The expedited implementation of housing
services also addresses one of the oldest and most entrenched contributors to health disparities—lack of
safe and stable housing. In this unique moment, we have the opportunity to examine whether swift provision
of housing at the community level mitigates the impact of COVID-19, as well as how doing so may affect the
individual, social, and structural factors that contribute to consequences of COVID-19. We propose a mixed-
methods study of Operation Safer Ground (OSG), a community-level intervention deployed to stem
COVID-19 infection among people experiencing homelessness in Alameda County, CA. Initiated in April
2020, OSG provides long-term housing to homeless people who are vulnerable to COVID-19 infection
because of age (>65 years) or chronic illness. To date, more than 1,000 people, roughly 10% of the county’s
homeless population, have entered OSG. The proposed study is a “natural experiment.” In Aim 1, we will use
document reviews and qualitative interviews with OSG participants, staff, and local public health officials to
describe the development and implementation of the program, define its operational characteristics, and
investigate contextual factors that influence outcomes for program participants. We will use the Consolidated
Framework for Implementation Research (CFIR) to structure this inquiry. In Aims 2 and 3, we will compare
individual-level outcomes over time among the intervention group (OSG clients) with outcomes among
similar non-clients in a carefully constructed comparison group, which we will create using propensity score
weighting methods. We will incorporate mediation and moderation analyses to examine mechanisms and
interactions that help explain outcomes. Data will be drawn from a county-level database called the Social
Health Information Exchange (SHIE), a centralized system that coordinates health care, housing, and social
service use by county Medicaid consumers with complex health and social needs. Approximately 8,000
homeless consumers, including all OSG participants, are represented in the SHIE. By pursuing this unique
opportunity, we will gain valuable knowledge to help improve the long-term response to the pandemic and
prepare more effectively to protect the health of vulnerable populations in future public health crises.
Terms: <65 and older><65 or older><65 years of age and older><65 years of age or more><65 years of age or older><65+ years><65+ years old><> 65 years><Address><Affect><Age><Aged 65 and Over><Application Context><BIPOC><Behavioral><Black, Indigenous, People of Color><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 affected><COVID-19 consequence><COVID-19 crisis><COVID-19 effect><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 impact><COVID-19 impacted><COVID-19 infection><COVID-19 pandemic><COVID-19 period><COVID-19 predisposition><COVID-19 public health crisis><COVID-19 related risk><COVID-19 risk><COVID-19 risk factor><COVID-19 susceptibility><COVID-19 virus infection><COVID-19 vulnerability><COVID-19 years><COVID19 infection><CV-19><Caring><Characteristics><Chronic Disease><Chronic Illness><Client><CoV pandemic><Collaborations><Communities><Complex><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Coronavirus Infectious Disease 2019><Coronavirus disease 2019 predisposition><Coronavirus disease 2019 susceptibility><Coronavirus disease 2019 vulnerability><County><Data><Data Bases><Data Set><Databases><Development><Evaluation><Event><Future><Health><Health Care Utilization><Health protection><Healthcare><Home><Homeless persons><Homelessness><Housing><Human><Imprisonment><Individual><Intervention><Intervention Strategies><Interview><Investigators><Knowledge><Mediation><Medicaid><Medical Directors><Methods><Modern Man><NIH><National Institutes of Health><Natural experiment><Negotiating><Negotiation><Outcome><Participant><Persons><Physician Executives><Population><Predisposed to COVID-19><Predisposed to SARS-CoV-2><Predisposed to Severe acute respiratory syndrome coronavirus 2><Principal Investigator><Process><Public Health><Qualitative Evaluations><Qualitative Methods><Quasi-experiment><Quasi-experimental analysis><Quasi-experimental approach><Quasi-experimental design><Quasi-experimental methods><Quasi-experimental research><Quasi-experimental study><Quasi-experimental technique><Research><Research Personnel><Researchers><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 infection><SARS-CoV-2 pandemic><SARS-CoV-2 predisposition><SARS-CoV-2 susceptibility><SARS-CoV-2 vulnerability><SARS-CoV2 infection><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Scoring Method><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 infection><Severe acute respiratory syndrome coronavirus 2 pandemic><Severe acute respiratory syndrome coronavirus 2 predisposition><Severe acute respiratory syndrome coronavirus 2 susceptibility><Severe acute respiratory syndrome coronavirus 2 vulnerability><Social Service><Social Work><Social outcome><Structure><System><Time><Transmission><United States National Institutes of Health><Vulnerable Populations><above age 65><accept vaccination><accept vaccine><after age 65><age 65 and greater><age 65 and older><age 65 or older><age > 65><age of 65 years onward><aged 65 and greater><aged 65+><aged ≥65><ages><arm><behavior outcome><behavioral outcome><chronic disorder><community based design><community based research><community intervention><community level intervention><community-based intervention><comparator group><comparison group><contextual factors><coronavirus disease 2019><coronavirus disease 2019 consequence><coronavirus disease 2019 crisis><coronavirus disease 2019 effect><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 impact><coronavirus disease 2019 infection><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease 2019 risk><coronavirus disease 2019 risk factor><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 impact><coronavirus disease-19 pandemic><coronavirus infectious disease-19><coronavirus pandemic><data base><developmental><disparity in health><experience><group intervention><health care><health care service><health care service use><health care service utilization><health definition><health disparity><health disparity community><health disparity group><health disparity populations><healthcare service><healthcare service use><healthcare service utilization><healthcare utilization><homeless><homeless group><homeless individual><homeless population><homes><human old age (65+)><implementation framework><implementation research framework><implementation science framework><improved><incarcerated><incarceration><infected with COVID-19><infected with COVID19><infected with SARS-CoV-2><infected with SARS-CoV2><infected with coronavirus disease 2019><infected with severe acute respiratory syndrome coronavirus 2><infection risk><interventional strategy><mortality><multidisciplinary><old age><operation><operations><over 65 years><pandemic><pandemic disease><predisposed to Coronavirus disease 2019><programs><qualitative reasoning><response><risk associated with COVID-19><risk factor associated with COVID-19><risk factor related to COVID-19><risk related to COVID-19><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><social factors><social influence><social role><stem><structural determinants><structural factors><substance use treatment><susceptible to COVID-19><susceptible to Coronavirus disease 2019><susceptible to SARS-CoV-2><susceptible to Severe acute respiratory syndrome coronavirus 2><transitional housing><transitionally housed><transmission process><unhoused><vaccination acceptability><vaccination acceptance><vaccination confidence><vaccination uptake><vaccination willingness><vaccine acceptability><vaccine acceptance><vaccine confidence><vaccine uptake><vaccine willingness><vulnerable group><vulnerable individual><vulnerable people><vulnerable to COVID-19><vulnerable to Coronavirus disease 2019><vulnerable to SARS-CoV-2><vulnerable to Severe acute respiratory syndrome coronavirus 2><≥65 years>