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8. Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters — Four U.S. Cities, March 27–April 15, 2020

Author

COVID-19 Homelessness Team, Mosites, Emily, Parker, Erin M., Clarke, Kristie E. N., Gaeta, Jessie M., Baggett, Travis P., Imbert, Elizabeth, Sankaran, Madeline, Scarborough, Ashley, Huster, Karin, Hanson, Matt, Gonzales, Elysia, Rauch, Jody, Page, Libby, McMichael, Temet M., Keating, Ryan, Marx, Grace E., Andrews, Tom, Schmit, Kristine, Morris, Sapna Bamrah, Dowling, Nicole F., and Peacock, Georgina

Published
2020

13. Awareness, Utilization, and Preferences of Harm Reduction Interventions among Street-Involved Young Adults in Boston

Author

Noyes, Elizabeth A., primary, Dunleavy, Spencer, additional, Mail, Victoria, additional, Plakas, Isabel, additional, Keyes, Susan, additional, Gaeta, Jessie M., additional, Obando, Aura, additional, Paci, Elizabeth, additional, Lent, Claudia, additional, Regis, Craig, additional, Taveras, Elsie M., additional, Yule, Amy M., additional, and Chatterjee, Avik, additional

Published
2022
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17. Health Care Spending And Use Among People Experiencing Unstable Housing In The Era Of Accountable Care Organizations

Author

Koh, Katherine A., Racine, Melanie, Gaeta, Jessie M., Goldie, John, Martin, Daniel P., Bock, Barry, Takach, Mary, O’Connell, James J., and Song, Zirui

Subjects
Accountable Care Organizations, Massachusetts, Housing, Humans, Health Expenditures, Article, United States, Boston
Abstract

Provider organizations are increasingly held accountable for health care spending in vulnerable populations. Longitudinal data on health care spending and use among people experiencing episodes of homelessness could inform the design of alternative payment models. We used Medicaid claims data to analyze spending and use among 402 people who were continuously enrolled in the Boston Health Care for the Homeless Program (BHCHP) from 2013 through 2015, compared to spending and use among 18,638 people who were continuously enrolled in Massachusetts Medicaid with no evidence of experiencing homelessness. The BHCHP population averaged $18,764 per person per year in spending-2.5 times more than spending among the comparison Medicaid population ($7,561). In unadjusted analyses this difference was explained by greater spending in the BHCHP population on outpatient care, including emergency department care, as well as on inpatient care and prescription drugs. After adjustment for covariates and multiple hypothesis testing, the difference was largely driven by outpatient spending. Differences were sensitive to adjustments for risk score, which suggests that housing instability and health risk are meaningfully correlated. This longitudinal analysis improves understanding of health care use and resource needs among people who are homeless or have unstable housing, and it could inform the design of alternative payment models for vulnerable populations.

Published
2020

22. Phylogenetic analysis of SARS-CoV-2 in Boston highlights the impact of superspreading events

Author

Lemieux, Jacob E., primary, Siddle, Katherine J., additional, Shaw, Bennett M., additional, Loreth, Christine, additional, Schaffner, Stephen F., additional, Gladden-Young, Adrianne, additional, Adams, Gordon, additional, Fink, Timelia, additional, Tomkins-Tinch, Christopher H., additional, Krasilnikova, Lydia A., additional, DeRuff, Katherine C., additional, Rudy, Melissa, additional, Bauer, Matthew R., additional, Lagerborg, Kim A., additional, Normandin, Erica, additional, Chapman, Sinéad B., additional, Reilly, Steven K., additional, Anahtar, Melis N., additional, Lin, Aaron E., additional, Carter, Amber, additional, Myhrvold, Cameron, additional, Kemball, Molly E., additional, Chaluvadi, Sushma, additional, Cusick, Caroline, additional, Flowers, Katelyn, additional, Neumann, Anna, additional, Cerrato, Felecia, additional, Farhat, Maha, additional, Slater, Damien, additional, Harris, Jason B., additional, Branda, John A., additional, Hooper, David, additional, Gaeta, Jessie M., additional, Baggett, Travis P., additional, O’Connell, James, additional, Gnirke, Andreas, additional, Lieberman, Tami D., additional, Philippakis, Anthony, additional, Burns, Meagan, additional, Brown, Catherine M., additional, Luban, Jeremy, additional, Ryan, Edward T., additional, Turbett, Sarah E., additional, LaRocque, Regina C., additional, Hanage, William P., additional, Gallagher, Glen R., additional, Madoff, Lawrence C., additional, Smole, Sandra, additional, Pierce, Virginia M., additional, Rosenberg, Eric, additional, Sabeti, Pardis C., additional, Park, Daniel J., additional, and MacInnis, Bronwyn L., additional

Published
2021
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25. Clinical Outcomes, Costs, and Cost-effectiveness of Strategies for Adults Experiencing Sheltered Homelessness During the COVID-19 Pandemic

Author

Baggett, Travis P., primary, Scott, Justine A., additional, Le, Mylinh H., additional, Shebl, Fatma M., additional, Panella, Christopher, additional, Losina, Elena, additional, Flanagan, Clare, additional, Gaeta, Jessie M., additional, Neilan, Anne, additional, Hyle, Emily P., additional, Mohareb, Amir, additional, Reddy, Krishna P., additional, Siedner, Mark J., additional, Harling, Guy, additional, Weinstein, Milton C., additional, Ciaranello, Andrea, additional, Kazemian, Pooyan, additional, and Freedberg, Kenneth A., additional

Published
2020
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27. Phylogenetic analysis of SARS-CoV-2 in the Boston area highlights the role of recurrent importation and superspreading events

Author

Lemieux, Jacob E., primary, Siddle, Katherine J., additional, Shaw, Bennett M., additional, Loreth, Christine, additional, Schaffner, Stephen F., additional, Gladden-Young, Adrianne, additional, Adams, Gordon, additional, Fink, Timelia, additional, Tomkins-Tinch, Christopher H., additional, Krasilnikova, Lydia A., additional, DeRuff, Katherine C., additional, Rudy, Melissa, additional, Bauer, Matthew R., additional, Lagerborg, Kim A., additional, Normandin, Erica, additional, Chapman, Sinead B., additional, Reilly, Steven K., additional, Anahtar, Melis N., additional, Lin, Aaron E., additional, Carter, Amber, additional, Myhrvold, Cameron, additional, Kemball, Molly E., additional, Chaluvadi, Sushma, additional, Cusick, Caroline, additional, Flowers, Katelyn, additional, Neumann, Anna, additional, Cerrato, Felecia, additional, Farhat, Maha, additional, Slater, Damien, additional, Harris, Jason B., additional, Branda, John, additional, Hooper, David, additional, Gaeta, Jessie M., additional, Baggett, Travis P., additional, O’Connell, James, additional, Gnirke, Andreas, additional, Lieberman, Tami D., additional, Philippakis, Anthony, additional, Burns, Meagan, additional, Brown, Catherine M., additional, Luban, Jeremy, additional, Ryan, Edward T., additional, Turbett, Sarah E., additional, LaRocque, Regina C., additional, Hanage, William P., additional, Gallagher, Glen R., additional, Madoff, Lawrence C., additional, Smole, Sandra, additional, Pierce, Virginia M., additional, Rosenberg, Eric, additional, Sabeti, Pardis C., additional, Park, Daniel J., additional, and Maclnnis, Bronwyn L., additional

Published
2020
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28. Management Strategies for People Experiencing Sheltered Homelessness during the COVID-19 Pandemic: Clinical Outcomes and Costs

Author

Baggett, Travis P., primary, Scott, Justine A., additional, Le, Mylinh H., additional, Shebl, Fatma M., additional, Panella, Christopher, additional, Losina, Elena, additional, Flanagan, Clare, additional, Gaeta, Jessie M., additional, Neilan, Anne, additional, Hyle, Emily P., additional, Mohareb, Amir, additional, Reddy, Krishna P., additional, Siedner, Mark J., additional, Harling, Guy, additional, Weinstein, Milton C., additional, Ciaranello, Andrea, additional, Kazemian, Pooyan, additional, and Freedberg, Kenneth A., additional

Published
2020
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42. Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters--Four U.S. Cities, March 27-April 15, 2020

Author

Mosites, Emily, Parker, Erin M., Clarke, Kristie E.N., Gaeta, Jessie M., Baggett, Travis P., Imbert, Elizabeth, Sankaran, Madeline, Scarborough, Ashley, Huster, Karin, Hanson, Matt, Gonzales, Elysia, Rauch, Jody, Page, Libby, McMichael, Temet M., Keating, Ryan, Marx, Grace E., Andrews, Tom, Schmit, Kristine, Morris, Sapna Bamrah, Dowling, Nicole F., and Peacock, Georgina

Subjects
Coronaviruses -- Analysis -- Health aspects, Public health -- Analysis -- Health aspects, Homeless shelters -- Analysis -- Health aspects, Disease transmission, Coronavirus infections, Setting (Literature), Web sites (World Wide Web), Cities and towns, Communicable diseases, Social services, Diseases, Public health movements, Health
Abstract

On April 22, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). In the United States, approximately 1.4 million persons access emergency shelter or [...]

Published
2020

48. The willingness of people who inject drugs in Boston to use a supervised injection facility

Author

León, Casey, Cardoso, Lena, Mackin, Sarah, Bock, Barry, and Gaeta, Jessie M.

Abstract

ABSTRACTBackground: In Massachusetts, the number of opioid-related deaths has increased 350% since 2000. In the setting of increasing overdose deaths, one potential intervention is supervised injection facilities (SIFs). This study explores willingness of people who inject drugs in Boston to use a SIF and examines factors associated with willingness. Methods: A cross-sectional survey of a convenience sample of 237 people who inject drugs and utilize Boston's needle exchange program (NEP). The drop-in NEP provides myriad harm reduction services and referrals to addiction treatment. The survey was mostly self-administered (92%). Results: Results showed positive willingness to use a SIF was independently associated with use of heroin as main substance (odds ratio [OR]: 5.47; 95% confidence interval [CI]: 1.9–15.4; P= .0004), public injection (OR: 5.09; 95% CI: 1.8–14.3; P= .002), history of seeking substance use disorder (SUD) treatment (OR: 4.99; 95% CI: 1.2–21.1; P= .05), having heard of SIF (OR: 4.80; 95% CI: 1.6–14.8; P= .004), Hispanic ethnicity (OR: 4.22; 95% CI: 0.9–18.8; P= .04), frequent NEP use (OR: 4.18; 95% CI: 1.2–14.7; P= .02), current desire for SUD treatment (OR: 4.15; 95% CI: 1.2–14.7; P= .03), hepatitis C diagnosis (OR: 3.68; 95% CI: 1.2–10.1; P= .02), posttraumatic stress disorder (PTSD) diagnosis (OR: 3.27; 95% CI: 1.3–8.4; P= .01), report of at least 1 chronic medical diagnosis (hepatitis C, human immunodeficiency virus [HIV], hypertension, or diabetes) (OR: 3.27; 95% CI: 1.2–8.9; P= .02), and comorbid medical and mental health diagnoses (OR: 2.93; 95% CI: 1.2–7.4; P= .02). Conclusions: Most respondents (91.4%) reported willingness to use a SIF. Respondents with substance use behavior reflecting high risk for overdose were significantly more likely to be willing to use a SIF. Respondents with behaviors that contribute to public health burden of injection drug use were also significantly more likely to be willing to use a SIF. Results indicate that this intervention would be well utilized by individuals who could most benefit from the model. As part of a broader public health approach, SIFs should be considered to reduce opioid overdose mortality, decrease public health burden of the opioid crisis, and promote access to addiction treatment and medical care.

Published
2018
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49. Clinical Outcomes, Costs, and Cost-effectiveness of Strategies for People Experiencing Sheltered Homelessness During the COVID-19 Pandemic.

Author

Baggett TP, Scott JA, Le MH, Shebl FM, Panella C, Losina E, Flanagan C, Gaeta JM, Neilan A, Hyle EP, Mohareb A, Reddy KP, Siedner MJ, Harling G, Weinstein MC, Ciaranello A, Kazemian P, and Freedberg KA

Abstract

Importance: Approximately 356,000 people stay in homeless shelters nightly in the US. They are at high risk for COVID-19., Objective: To assess clinical outcomes, costs, and cost-effectiveness of strategies for COVID-19 management among sheltered homeless adults., Design: We developed a dynamic microsimulation model of COVID-19 in sheltered homeless adults in Boston, Massachusetts. We used cohort characteristics and costs from Boston Health Care for the Homeless Program. Disease progression, transmission, and outcomes data were from published literature and national databases. We examined surging, growing, and slowing epidemics (effective reproduction numbers [R e ] 2.6, 1.3, and 0.9). Costs were from a health care sector perspective; time horizon was 4 months, from April to August 2020., Setting & Participants: Simulated cohort of 2,258 adults residing in homeless shelters in Boston., Interventions: We assessed daily symptom screening with polymerase chain reaction (PCR) testing of screen-positives, universal PCR testing every 2 weeks, hospital-based COVID-19 care, alternate care sites [ACSs] for mild/moderate COVID-19, and temporary housing, each compared to no intervention., Main Outcomes and Measures: Cumulative infections and hospital-days, costs to the health care sector (US dollars), and cost-effectiveness, as incremental cost per case prevented of COVID-19., Results: We simulated a population of 2,258 sheltered homeless adults with mean age of 42.6 years. Compared to no intervention, daily symptom screening with ACSs for pending tests or confirmed COVID-19 and mild/moderate disease led to 37% fewer infections and 46% lower costs (R e =2.6), 75% fewer infections and 72% lower costs (R e =1.3), and 51% fewer infections and 51% lower costs (R e =0.9). Adding PCR testing every 2 weeks further decreased infections; incremental cost per case prevented was $1,000 (R e =2.6), $27,000 (R e =1.3), and $71,000 (R e =0.9). Temporary housing with PCR every 2 weeks was most effective but substantially more costly than other options. Results were sensitive to cost and sensitivity of PCR and ACS efficacy in preventing transmission., Conclusions & Relevance: In this modeling study of simulated adults living in homeless shelters, daily symptom screening and ACSs were associated with fewer COVID-19 infections and decreased costs compared with no intervention. In a modeled surging epidemic, adding universal PCR testing every 2 weeks was associated with further decrease in COVID-19 infections at modest incremental cost and should be considered during future surges., Competing Interests: CONFLICTS OF INTEREST AND FINANCIAL DISCLOSURES The authors have no conflicts of interest or financial disclosures.

Published
2020
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50. Phylogenetic analysis of SARS-CoV-2 in the Boston area highlights the role of recurrent importation and superspreading events.

Author

Lemieux JE, Siddle KJ, Shaw BM, Loreth C, Schaffner SF, Gladden-Young A, Adams G, Fink T, Tomkins-Tinch CH, Krasilnikova LA, DeRuff KC, Rudy M, Bauer MR, Lagerborg KA, Normandin E, Chapman SB, Reilly SK, Anahtar MN, Lin AE, Carter A, Myhrvold C, Kemball ME, Chaluvadi S, Cusick C, Flowers K, Neumann A, Cerrato F, Farhat M, Slater D, Harris JB, Branda J, Hooper D, Gaeta JM, Baggett TP, O'Connell J, Gnirke A, Lieberman TD, Philippakis A, Burns M, Brown CM, Luban J, Ryan ET, Turbett SE, LaRocque RC, Hanage WP, Gallagher GR, Madoff LC, Smole S, Pierce VM, Rosenberg E, Sabeti PC, Park DJ, and Maclnnis BL

Abstract

SARS-CoV-2 has caused a severe, ongoing outbreak of COVID-19 in Massachusetts with 111,070 confirmed cases and 8,433 deaths as of August 1, 2020. To investigate the introduction, spread, and epidemiology of COVID-19 in the Boston area, we sequenced and analyzed 772 complete SARS-CoV-2 genomes from the region, including nearly all confirmed cases within the first week of the epidemic and hundreds of cases from major outbreaks at a conference, a nursing facility, and among homeless shelter guests and staff. The data reveal over 80 introductions into the Boston area, predominantly from elsewhere in the United States and Europe. We studied two superspreading events covered by the data, events that led to very different outcomes because of the timing and populations involved. One produced rapid spread in a vulnerable population but little onward transmission, while the other was a major contributor to sustained community transmission, including outbreaks in homeless populations, and was exported to several other domestic and international sites. The same two events differed significantly in the number of new mutations seen, raising the possibility that SARS-CoV-2 superspreading might encompass disparate transmission dynamics. Our results highlight the failure of measures to prevent importation into MA early in the outbreak, underscore the role of superspreading in amplifying an outbreak in a major urban area, and lay a foundation for contact tracing informed by genetic data., Competing Interests: Competing interests: J.E.L. has received consulting fees from Sherlock Biosciences. J.B. has been a consultant for T2 Biosystems, DiaSorin, and Roche Diagnostics. A.P. is a Venture Partner at Google Ventures. P.C.S. is a co-founder and shareholder of Sherlock Biosciences, and a Board member and shareholder of Danaher Corporation.

Published
2020
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