Mobile COVID-19 Vaccination Clinics Reach Disadvantaged Populations and Increase Vaccination Rates.

BackgroundLow-income and racially diverse populations often have multiple barriers in accessing healthcare and are at increased risk of poor health outcomes. COVID-19 exacerbated these health inequities: decreased in-person appointments, difficult access to virtual care and deprioritization of elective clinical activity led to delays in well-child visits and vaccination. This public health emergency highlighted a need to develop alternative models to enable access to primary care for vulnerable children. While mobile clinics are well-established in the United States, little is known about them in Canada.ObjectivesThis study aims to characterize Canadian mobile clinics providing primary care health services to vulnerable populations, including children, and seeks to inform the implementation of a pediatric mobile clinic under development.Design/MethodsThis environmental scan screened scientific databases and the grey literature using a combination of terms designating mobile health clinics and Canadian locations. Relevant Canadian primary care mobile clinic initiatives were subsequently included. We defined primary care mobile clinics as movable health care units providing primary healthcare services delivered by general medical practitioners (pediatricians and family physicians). Examples of excluded initiatives were mobile clinics focused on education/literacy, dental care, vision care, endocrinology, cancer screening, safe injection sites, vaccination, physical rehabilitation and urgent care. Descriptive statistics and qualitative analysis were performed.Results29 clinics were identified, of which 26 are still active. Most clinics were located in Ontario (n=11), followed by British Columbia (n=8), Alberta (n=5), Quebec (n=2) and the Maritimes (n=2). The first mobile clinic in Canada was launched in 1996, with an increasing number of new clinics in 2021. While all clinics served vulnerable populations, some targeted specific groups, such as children, people experiencing homelessness, immigrants, LGBTQ+ individuals and Indigenous peoples. We identified three pediatric mobile clinics, two of which targeted teenagers. Onboard the clinics, physicians often worked with nurses, outreach workers and social workers. These professionals provided primary care services, as well as healthcare navigation, sexual education, mental health care, harm reduction supplies, vaccination and emergency care. All mobile clinics partnered with their local government, charities or businesses to fund their initiative.ConclusionMobile health clinics are a growing model of primary care in Canada. They are the result of a multidisciplinary collaboration between healthcare providers, social workers and outreach workers. To this date, Canadian pediatric mobile clinics remain a handful and represent an interesting avenue to address health inequities in children, during the pandemic and beyond.

The accessibility of health services is an important factor that affects the health outcomes of populations. A mobile clinic provides a wide range of services but in most countries the main focus is on health services for women and children. It is anticipated that improvement of the accessibility of health services via mobile clinics will improve women's and children's health. To evaluate the impact of mobile clinic services on women's and children's health. For related systematic reviews, we searched the Database of Abstracts of Reviews of Effectiveness (DARE), CRD; Health Technology Assessment Database (HTA), CRD; NHS Economic Evaluation Database (NHS EED), CRD (searched 20 February 2014).For primary studies, we searched ISI Web of Science, for studies that have cited the included studies in this review (searched 18 January 2016); WHO ICTRP, and ClinicalTrials.gov (searched 23 May 2016); Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.cochranelibrary.com (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 7 April 2015); MEDLINE, OvidSP (searched 7 April 2015); Embase, OvidSP (searched 7 April 2015); CINAHL, EbscoHost (searched 7 April 2015); Global Health, OvidSP (searched 8 April 2015); POPLINE, K4Health (searched 8 April 2015); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (searched 8 April 2015); Global Health Library, WHO (searched 8 April 2015); PAHO, VHL (searched 8 April 2015); WHOLIS, WHO (searched 8 April 2015); LILACS, VHL (searched 9 April 2015). We included individual- and cluster-randomised controlled trials (RCTs) and non-RCTs. We included controlled before-and-after (CBA) studies provided they had at least two intervention sites and two control sites. Also, we included interrupted time series (ITS) studies if there was a clearly defined point in time when the intervention occurred and at least three data points before and three after the intervention. We defined the intervention of a mobile clinic as a clinic vehicle with a healthcare provider (with or without a nurse) and a driver that visited areas on a regular basis. The participants were women (18 years or older) and children (under the age of 18 years) in low-, middle-, and high-income countries. Two review authors independently screened the titles and abstracts of studies identified by the search strategy, extracted data from the included studies using a specially-designed data extraction form based on the Cochrane EPOC Group data collection checklist, and assessed full-text articles for eligibility. All authors performed analyses, 'Risk of bias' assessments, and assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Two cluster-RCTs met the inclusion criteria of this review. Both studies were conducted in the USA.One study tested whether offering onsite mobile mammography combined with health education was more effective at increasing breast cancer screening rates than offering health education only, including reminders to attend a static clinic for mammography. Women in the group offered mobile mammography and health education may be more likely to undergo mammography within three months of the intervention than those in the comparison group (55% versus 40%; odds ratio (OR) 1.83, 95% CI 1.22 to 2.74; low certainty evidence).A cost-effectiveness analysis of mammography at mobile versus static units found that the total cost per patient screened may be higher for mobile units than for static units. The incremental costs per patient screened for a mobile over a stationary unit were USD 61 and USD 45 for a mobile full digital unit and a mobile film unit respectively.The second study compared asthma outcomes for children aged two to six years who received asthma care from a mobile asthma clinic and children who received standard asthma care from the usual (static) primary provider. Children who receive asthma care from a mobile asthma clinic may experience little or no difference in symptom-free days, urgent care use and caregiver-reported medication use compared to children who receive care from their usual primary care provider. All of the evidence was of low certainty. The paucity of evidence and the restricted range of contexts from which evidence is available make it difficult to draw conclusions on the impacts of mobile clinics on women's and children's health compared to static clinics. Further rigorous studies are needed in low-, middle-, and high-income countries to evaluate the impacts of mobile clinics on women's and children's health.

Marketing mobile influenza vaccine clinics on a college campus

COVID-19 Vaccine Equity: Codesigning Public Health Interventions with Community Partners.

Using mobile clinics to deliver care to difficult-to-reach populations: A COVID-19 practice we should keep

IntroductionAdolescent girls and young women (AGYW), a priority population for HIV prevention in Africa, show high interest but difficulty in sustained effective use of pre‐exposure prophylaxis (PrEP). With ongoing PrEP scale‐up focused on increasing access, it is important to understand what influences AGYW's choice of PrEP delivery platforms.MethodsThe POWER implementation study in Cape Town provided PrEP between 2017 and 2020 to AGYW (16−25 years) from four differentiated delivery platforms: mobile clinic, government facility, courier delivery or community‐based youth club. Healthcare providers at government and mobile clinics provided PrEP (initiation and refills) as part of comprehensive, integrated sexual and reproductive health services. Courier and youth club platforms provided light‐touch PrEP refill services incorporating rapid HIV self‐testing. We conducted in‐depth interviews with a purposive sample of AGYW who had ≥3 months of PrEP‐use and accessed ≥2 PrEP delivery platforms. The thematic analysis explored AGYW's preferences, decision‐making and habits related to PrEP access to inform market segmentation.ResultsWe interviewed 26 AGYW (median age 20) PrEP‐users between November 2020 and March 2021. AGYW PrEP‐users reported accessing different services with, 24 accessing mobile clinics, 17 courier delivery, 9 government health facilities and 6 youth clubs for their PrEP refills. Qualitative findings highlighted four potential behavioural profiles. The “Social PrEP‐user” preferred PrEP delivery in peer spaces, such as youth clubs or adolescent‐friendly mobile clinics, seeking affirmation and social support for continued PrEP use. The “Convenient PrEP‐user” favoured PrEP delivery at easily accessible locations, providing quick (courier) or integrated contraception‐PrEP refill visits (mobile and government clinic). The “Independent PrEP‐user” preferred PrEP delivery that offered control over delivery times that fit into their schedule, such as the courier service. The “Discreet PrEP‐user” highly valued privacy regarding their PrEP use (courier delivery) and avoided delivery options where unintentional disclosure was evident (youth club). Comfort with HIV self‐testing had minimal influence on PrEP delivery choice.ConclusionsMarket segmentation of AGYW characterizes different types of PrEP‐users and has the potential to enhance tailored messaging and campaigns to reach specific segments, with the aim of improving sustained PrEP use and HIV prevention benefits.

BackgroundIn rural India, mobile medical clinics are useful models for delivering health promotion, education, and care. Mobile medical clinics use fewer providers for larger catchment areas compared to traditional clinic models in resource limited settings, which is especially useful in areas with shortages of healthcare providers and a wide geographical distribution of patients.MethodsFrom 2008 to 2011, we built infrastructure to implement a mobile clinic system to educate rural communities about maternal child health, train community health workers in common safe birthing procedures, and provide comprehensive antenatal care, prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), and testing for specific infections in a large rural catchment area of pregnant women in rural Mysore. This was done using two mobile clinics and one walk-in clinic. Women were tested for HIV, hepatitis B, syphilis, and bacterial vaginosis along with random blood sugar, urine albumin, and anemia. Sociodemographic information, medical, and obstetric history were collected using interviewer-administered questionnaires in the local language, Kannada. Data were entered in Microsoft Excel and analyzed using Stata SE 14.1.ResultsDuring the program period, nearly 700 community workers and 100 health care providers were trained; educational sessions were delivered to over 15,000 men and women and integrated antenatal care and HIV/sexually transmitted infection testing was offered to 3545 pregnant women. There were 22 (0.6%) cases of HIV, 19 (0.5%) cases of hepatitis B, 2 (0.1%) cases of syphilis, and 250 (7.1%) cases of BV, which were identified and treated. Additionally, 1755 (49.5%) cases of moderate to severe anemia and 154 (4.3%) cases of hypertension were identified and treated among the pregnant women tested.ConclusionsPatient-centered mobile medical clinics are feasible, successful, and acceptable models that can be used to provide quality healthcare to pregnant women in rural and hard-to-reach settings. The high numbers of pregnant women attending mobile medical clinics show that integrated antenatal care with PMTCT services were acceptable and utilized. The program also developed and trained health professionals who continue to remain in those communities.

Mobile health clinics are critical avenues for reaching under-resourced populations. There are over 2,000 mobile clinics serving 7 million individuals annually. Costs per patient are low compared to stationary clinics. Further, they play a critical role in reducing healthcare access disparities by ensuring healthcare is delivered at the doorstep of patients. However, this model of healthcare delivery is a tool that is rarely considered for dealing with emergencies such as a pandemic. The case of the COVID-19 pandemic illustrates several potential areas where mobile clinic programs can play a critical role. Apart from the role mobile clinics have played in improving COVID-19 testing for under-resourced populations, and the current efforts in expanding their use in vaccinations, there are other proposed initiatives that should be explored. Establishing a comprehensive approach to incorporate mobile clinics in our entire health system, would not only be effective for addressing health outcomes of under-resourced patient populations, but will also contribute to the success of a national pandemic response. Mobile healthcare clinics are a vital part of equitable national healthcare solutions, and it is time to recognize their broader potential, and include them in preparation efforts for current and future health crises.

Context: General acceptance of COVID-19 vaccination is needed to end the pandemic, but vaccine hesitancy is a challenge. Identifying predictors of acceptance of COVID-19 vaccines and sources of positive influence on vaccine decisions could inform and guide the efforts to improve vaccination rates. Objective: 1) To determine the proportion and predictors of vaccine intentions among adults served by our mobile free clinic. 2) To determine the sources of positive influence on vaccine uptake. Study Design: Cross-sectional (phone-survey) study. Setting: Mobile free clinic, Athens, GA. Population studied: Adults with direct phone numbers who tested negative for COVID-19 through our mobile free clinic from 6/1/20-7/9/20 (358 eligible, N=55). Outcome Measures: Intention to get COVID-19 vaccine once available, overall, and by personal characteristics (age, sex, race, and education) and by potential predictors (receipt of flu or other adult vaccines, health insurance status, worry about impact of the pandemic on health and finances, and frequency of mask wearing, distancing, and hand washing). Associations examined using chi-squared, Fisher’s exact, and logistic regression. Frequency of positive, negative, or no influence on vaccine decisions was examined for health care providers, public health officials, family, friends, political and religious leaders, and news and social media. Results: Overall, 66% intended to get vaccinated. Reported flu vaccination in the last year was positively associated with COVID-19 vaccine intention (OR 4.4, 95% CI: 1.3-14.7), but reported receipt of other adult vaccines was not. Higher frequency of worry about impact of COVID-19 on health was also positively associated with vaccine intention (always worry 83%; p=0.006). No other significant variations by personal characteristics or listed potential predictors were observed. The largest proportion of adults identified health care providers (66%) and family (62%) as positive influences; social media had the smallest proportion (8% positive, 6% negative) on intention to accept vaccination. Conclusions: Similar to national averages, 66% of our sample intended to accept a COVID-19 vaccine. Flu vaccination in the last year and worrying about health during the pandemic predicted intention to receive the vaccine. Health care providers were most frequently identified as a positive influence on vaccine uptake, underscoring the importance of their role in recommending COVID-19 vaccinations.

Introduction: Given the importance of medical services and health care in societies and the difficulty of accessing suitable health services for people living in remote locations. Aim: The goal of this study reviewed the challenges faced when creating mobile clinics to understand the challenges and provide accessible and feasible medical care in remote locations. Methods: This study used Review method to search for Persian and international articles between years 2004 and 2014 with keywords mobile specialized clinics, mobile clinic, health care, and mobile health care in credible websites and databases including PubMed, Science Direct, Google Scholar, Web of Sciences, and extract the report the relevant information from these articles. Results: Mobile clinics are an important proposal in health and medical systems and provide advantages such as accessibility, variety of services, and the possibility of providing health care for remote or underprivileged locations and during disasters while having disadvantages such as structural, procedural and financial problems, lacking certain tools and specializations and unwillingness of people for using these clinics. Conclusion: Given the strengths of mobile clinics in provision a variety of medical services and disease prevention, the possibility of contacting other medical centers in order to improve the quality of services and reduction of costs, these clinics are able to answer some of the medical needs of people and their weaknesses can be reduced with the help of proper laws, planning and a feedback system in order to determine the quality of services. It is possible to improve the effectiveness of these clinics and provide services that are in line with the needs of the target population.

BackgroundIn 2018, new HIV diagnoses among heterosexual persons who inject drugs (PWID) in King County, WA increased over 300%, from 7 to 30 cases. A cluster of 15 related cases...

Interventions are needed to increase low HPV vaccination rates within rural areas in the United States, particularly in the state of Florida, which has the seventh highest number of HPV-related cancers. Florida also ranks low compared to other states in terms of HPV vaccination. Rural-residing parents may benefit from two evidence-based strategies to increase vaccination rates: reminder messages informing and prompting vaccination appointments and mobile clinics to reduce transportation barriers. We sought to identify parental attitudes towards (1) message features that promote rural-residing parents' receptivity to HPV vaccination; (2) parents' acceptability of three reminder message modalities (text, postcard, phone); and (3) implementation factors that promote parents' acceptability of using a mobile clinic for vaccination. We recruited 28 rural-residing parents of 9- to 12-year-old children (unvaccinated for HPV) for focus group and individual interviews and thematically analyzed transcripts. Three features promoted parents' receptivity to HPV vaccination messages: source credibility, specific information coverage, and personalization (name and birthday wishes). Parents most preferred text messages and identified three factors promoting parents' mobile clinic use: convenience and feasibility, trustworthiness, and detailed information. The findings indicate rural-residing parents' acceptability of reminder messages and mobile clinics as well as the importance of trust and feasibility when implementing these evidence-based strategies for rural-residing parents.

BackgroundThe Somali region in Ethiopia has poor health infrastructure, coupled with the adversity experienced by the largely pastoralist population through frequent droughts, disease outbreaks and conflict. From January 2019, MSF strategically focused on improving access to primary healthcare in the Doolo zone of the Somali region by providing 15–20 mobile clinics covering a wide geographical area. We aimed to evaluate the extent to which mobile clinics were an appropriate and effective modality to deliver healthcare for populations living in the region.MethodsIn this mixed-methods study, we conducted a descriptive analysis of 24 months of routine mobile clinic data (February 2019 to January 2021) to evaluate the appropriateness and effectiveness of mobile clinics. We conducted a patient satisfaction survey to assess perceived benefits and challenges, as well as seven interviews with MSF medical staff and four focus group discussions with community members from mobile clinic sites to explore the appropriateness, effectiveness, and connectedness of mobile clinics.ResultsMSF mobile clinics conducted 90,542 outpatient consultations, across 30 mobile clinic sites during the two-year period. However, there were gaps in continuity of care. The ratio of follow-up-to-first antenatal care visits was 0.82, and the ratio of third-to-first dose of DTP/Hib/HepB vaccine was 0.39. The current mobile clinic strategy is generally well perceived by the community in terms of the quality of services provided. However, MSF staff and community members expressed that its appropriateness and effectiveness are limited by mobile clinic opening hours, large patient volumes, referral policies, staffing, and drug supply issues.ConclusionsLimited opening hours, large patient volumes, weak referral processes and supply issues impacted the appropriateness and effectiveness of healthcare provision by mobile clinics to this pastoralist population. These challenges are consistent with those faced by mobile clinics in other contexts. To enhance the effectiveness and appropriateness of mobile clinics for pastoralist populations requires collaboration with both community members and local authorities to design and regularly review the locations, frequency, healthcare service package and referral policies of mobile clinics.

Optimizing ankle-brachial index measurement for peripheral arterial disease screening in mobile clinics

While health providers consistently use malaria rapid diagnostic tests to rule out malaria, they often lack tools to guide treatment for those febrile patients who test negative. Without the tools to provide an alternative diagnosis, providers may prescribe unnecessary antibiotics or miss a more serious condition, potentially contributing to antibiotic resistance and/or poor patient outcomes. This study ascertained which diagnoses and treatments might be associated with poor outcomes in adults who test negative for malaria. Adult patients for rapid diagnostic test of malaria seen in mobile health clinics in Mulanje and Phalombe districts were followed for 14 days. Participants were interviewed on sociodemographic characteristics, health-seeking behaviour, diagnosis, treatment and access to care. Mobile clinic medical charts were reviewed. Two weeks (±2 days) following clinic visit, follow-up interviews were conducted to assess whether symptoms had resolved. Initially, 115 adult patients were enrolled and 1 (0.88%) was lost to follow-up. Of the 114 adult patients remaining in the study, 55 (48%) were seen during the dry season and 59 (52%) during the wet season. Symptoms resolved in 90 (80%) patients at the 14-day follow-up visit (n=90) with the rest (n=24) reporting no change in symptoms. None of the patients in the study died or were referred for further care. Almost all patients received some type of medication during their clinic visit (98.2%). Antibiotics were given to 38.6% of patients, and virtually all patients received pain or fever relief (96.5%). However, no anti-malarials were prescribed. Mobile clinics provide important health care where access to care is limited. Although rapid tests have guided appropriate treatment, challenges remain when a patient's presenting complaint is less well defined. In rural areas of southern Malawi, simple diagnostics are needed to guide treatment decisions.