{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T13:56:45Z","timestamp":1775138205805,"version":"3.50.1"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UCSF Benioff Homelessness and Housing Initiative"},{"name":"Kaiser Community Benefits"},{"name":"Heluna Health"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People experiencing homelessness who live in congregate shelters are at high risk of SARS-CoV2 transmission and severe COVID-19. Current screening and response protocols using rRT-PCR in homeless shelters are expensive, require specialized staff and have delays in returning results and implementing responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We piloted a program to offer frequent, rapid antigen-based tests (BinaxNOW) to residents and staff of congregate-living shelters in San Francisco, California, from January 15\n                      <jats:sup>th<\/jats:sup>\n                      to February 19\n                      <jats:sup>th<\/jats:sup>\n                      , 2021. We used the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to evaluate the implementation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Reach: We offered testing at ten of twelve eligible shelters. Shelter residents and staff had variable participation across shelters; approximately half of eligible individuals tested at least once; few tested consistently during the study.<\/jats:p>\n                    <jats:p>Effectiveness: 2.2% of participants tested positive. We identified three outbreaks, but none exceeded 5 cases. All BinaxNOW-positive participants were isolated or left the shelters.<\/jats:p>\n                    <jats:p>Adoption: We offered testing to all eligible participants within weeks of the project\u2019s initiation.<\/jats:p>\n                    <jats:p>Implementation: Adaptations made to increase reach and improve consistency were promptly implemented.<\/jats:p>\n                    <jats:p>Maintenance: San Francisco Department of Public Health expanded and maintained testing with minimal support after the end of the pilot.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rapid and frequent antigen testing for SARS-CoV2 in homeless shelters is a viable alternative to rRT-PCR testing that can lead to immediate isolation of infectious individuals. Using the RE-AIM framework, we evaluated and adapted interventions to enable the expansion and maintenance of protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0264929","type":"journal-article","created":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T13:29:09Z","timestamp":1646918949000},"page":"e0264929","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Implementation of rapid and frequent SARS-CoV2 antigen testing and response in congregate homeless shelters"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0566-4901","authenticated-orcid":true,"given":"Andr\u00e9s","family":"Aranda-D\u00edaz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Imbert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Strieff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dave","family":"Graham-Squire","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer L.","family":"Evans","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Moore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willi","family":"McFarland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Fuchs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret A.","family":"Handley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1361-6889","authenticated-orcid":true,"given":"Margot","family":"Kushel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,3,10]]},"reference":[{"issue":"10117","key":"pone.0264929.ref001","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/S0140-6736(17)31869-X","article-title":"Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis","volume":"391","author":"RW Aldridge","year":"2018","journal-title":"Lancet"},{"issue":"3","key":"pone.0264929.ref002","doi-asserted-by":"crossref","first-page":"420","DOI":"10.3201\/eid2603.190643","article-title":"Public Health Response to Tuberculosis Outbreak among Persons Experiencing Homelessness, Minneapolis, Minnesota, USA, 2017\u20132018","volume":"26","author":"KK Tibbetts","year":"2020","journal-title":"Emerg Infect Dis"},{"issue":"22","key":"pone.0264929.ref003","doi-asserted-by":"crossref","first-page":"2585","DOI":"10.1016\/j.jacc.2018.02.077","article-title":"Cardiovascular Disease and Homelessness","volume":"71","author":"TP Baggett","year":"2018","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"pone.0264929.ref004","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/cid\/ciz788","article-title":"Homelessness and Hepatitis A-San Diego County, 2016\u20132018","volume":"71","author":"CM Peak","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"7","key":"pone.0264929.ref005","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1111\/j.1525-1497.2006.00493.x","article-title":"BRIEF REPORT: the aging of the homeless population: fourteen-year trends in San Francisco","volume":"21","author":"JA Hahn","year":"2006","journal-title":"J Gen Intern Med"},{"key":"pone.0264929.ref006","unstructured":"Henry M, Watt R, Mahathey A, Ouellette J, Sitler A. The 2019 Annual Homeless Assessment (AHAR) Report. Washington, DC: The US Department of Housing and Urban Development. 2020."},{"issue":"3","key":"pone.0264929.ref007","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1007\/s11524-008-9270-2","article-title":"Homelessness and the response to emerging infectious disease outbreaks: lessons from SARS","volume":"85","author":"CS Leung","year":"2008","journal-title":"J Urban Health"},{"issue":"4","key":"pone.0264929.ref008","doi-asserted-by":"crossref","first-page":"e186","DOI":"10.1016\/S2468-2667(20)30053-0","article-title":"COVID-19: a potential public health problem for homeless populations","volume":"5","author":"J Tsai","year":"2020","journal-title":"Lancet Public Health"},{"issue":"26","key":"pone.0264929.ref009","doi-asserted-by":"crossref","first-page":"E716","DOI":"10.1503\/cmaj.200834","article-title":"COVID-19 and people experiencing homelessness: challenges and mitigation strategies","volume":"192","author":"M Perri","year":"2020","journal-title":"CMAJ"},{"issue":"5","key":"pone.0264929.ref010","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.5811\/westjem.2020.7.48725","article-title":"Homeless Shelter Characteristics and Prevalence of SARS-CoV-2","volume":"21","author":"R Karb","year":"2020","journal-title":"West J Emerg Med"},{"key":"pone.0264929.ref011","article-title":"Coronavirus Disease 2019 (COVID-19) Outbreak in a San Francisco Homeless Shelter","author":"E Imbert","year":"2020","journal-title":"Clin Infect Dis"},{"key":"pone.0264929.ref012","article-title":"Pandemic Planning in Homeless Shelters: A pilot study of a COVID-19 testing and support program to mitigate the risk of COVID-19 outbreaks in congregate settings","author":"C Bodkin","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0264929.ref013","doi-asserted-by":"crossref","DOI":"10.1126\/sciadv.abd5393","article-title":"Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening","volume":"7","author":"DB Larremore","year":"2021","journal-title":"Sci Adv"},{"issue":"7","key":"pone.0264929.ref014","doi-asserted-by":"crossref","first-page":"e2016818","DOI":"10.1001\/jamanetworkopen.2020.16818","article-title":"Assessment of SARS-CoV-2 Screening Strategies to Permit the Safe Reopening of College Campuses in the United States","volume":"3","author":"AD Paltiel","year":"2020","journal-title":"JAMA Netw Open"},{"key":"pone.0264929.ref015","article-title":"Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study","author":"LAC Chapman","year":"2020","journal-title":"medRxiv"},{"key":"pone.0264929.ref016","article-title":"Management Strategies for People Experiencing Sheltered Homelessness during the COVID-19 Pandemic: Clinical Outcomes and Costs","author":"TP Baggett","year":"2020","journal-title":"medRxiv"},{"key":"pone.0264929.ref017","article-title":"Frequency of routine testing for SARS-CoV-2 to reduce transmission among workers","author":"ET Chin","year":"2020","journal-title":"medRxiv"},{"key":"pone.0264929.ref018","article-title":"Modeling the frequency and number of persons to test to detect and control COVID-19 outbreaks in congregate settings","author":"P Paul","year":"2020","journal-title":"bioRxiv"},{"issue":"7","key":"pone.0264929.ref019","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1261\/rna.076232.120","article-title":"Overcoming the bottleneck to widespread testing: a rapid review of nucleic acid testing approaches for COVID-19 detection","volume":"26","author":"MN Esbin","year":"2020","journal-title":"RNA"},{"key":"pone.0264929.ref020","unstructured":"Centers for Disease Control and Prevention. Interim Guidance for Antigen Testing for SARS-CoV-2 2020 [cited 2021 March 20th]. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/lab\/resources\/antigen-tests-guidelines.html."},{"key":"pone.0264929.ref021","article-title":"Performance characteristics of a rapid SARS-CoV-2 antigen detection assay at a public plaza testing site in San Francisco","author":"G Pilarowski","year":"2020","journal-title":"medRxiv"},{"issue":"3","key":"pone.0264929.ref022","doi-asserted-by":"crossref","first-page":"e210490","DOI":"10.1001\/jamanetworkopen.2021.0490","article-title":"Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness","volume":"4","author":"JD Fuchs","year":"2021","journal-title":"JAMA Netw Open"},{"key":"pone.0264929.ref023","doi-asserted-by":"crossref","first-page":"E02","DOI":"10.5888\/pcd15.170271","article-title":"Pragmatic Applications of RE-AIM for Health Care Initiatives in Community and Clinical Settings","volume":"15","author":"RE Glasgow","year":"2018","journal-title":"Prev Chronic Dis"},{"key":"pone.0264929.ref024","unstructured":"Benioff Homelessness and Housing Initiative NHCftHC. Antigen Testing in Congregate Shelters: Process Outline and Implementation Playbook2021."},{"key":"pone.0264929.ref025","unstructured":"Centers for Disease Control and Prevention. CDC Facilities COVID-19 Screening 2021 [cited 2021 March 20th]. https:\/\/www.cdc.gov\/screening\/index.html."},{"key":"pone.0264929.ref026","unstructured":"Diagnostics A. Abbott BinaxNOW COVID-19 Ag package insert, version 2.2 2020 [cited 2021 March 20th]. https:\/\/www.fda.gov\/media\/141570\/download."},{"key":"pone.0264929.ref027","article-title":"Field performance and public health response using the BinaxNOW TM Rapid SARS-CoV-2 antigen detection assay during community-based testing","author":"G Pilarowski","year":"2020","journal-title":"Clin Infect Dis"},{"key":"pone.0264929.ref028","unstructured":"Health CDoP. Non-Healthcare Congregate Setting COVID-19 Outbreak Definitions 2020 [cited 2021 April 12th]. https:\/\/www.cdph.ca.gov\/Programs\/CID\/DCDC\/Pages\/COVID-19\/OutbreakDefinitionandReportingGuidance.aspx."},{"key":"pone.0264929.ref029","unstructured":"The MathWorks I. Matlab. R2020b ed."},{"key":"pone.0264929.ref030","unstructured":"Division SFDoPH-PH. COVID-19 Cases: Summarized by Date, Transmission and Case Disposition. 2021."},{"issue":"17","key":"pone.0264929.ref031","doi-asserted-by":"crossref","first-page":"523","DOI":"10.15585\/mmwr.mm6917e2","article-title":"COVID-19 Outbreak Among Three Affiliated Homeless Service Sites\u2014King County, Washington, 2020","volume":"69","author":"FA Tobolowsky","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0264929.ref032","unstructured":"Emergency Operations Center, County of Santa Clara. County of Santa Clara Reports Significant Increase in COVID-19 cases in Congregate Settings, Including Homeless Shelters and Long-Term Care Facilities 2021 [cited 2021 March 30th]. https:\/\/www.sccgov.org\/sites\/covid19\/Pages\/press-release-12-3-2020-significant-increase-COVID19-in-congregate-settings.aspx."},{"key":"pone.0264929.ref033","unstructured":"San Francisco Department of Homelessness and Supportive Housing. San Francisco\u2019s COVID-19 Response 2021 [cited 2021 April 5th]. https:\/\/hsh.sfgov.org\/covid-19\/."},{"issue":"1","key":"pone.0264929.ref034","doi-asserted-by":"crossref","first-page":"e2035057","DOI":"10.1001\/jamanetworkopen.2020.35057","article-title":"SARS-CoV-2 Transmission From People Without COVID-19 Symptoms","volume":"4","author":"MA Johansson","year":"2021","journal-title":"JAMA Netw Open"},{"key":"pone.0264929.ref035","unstructured":"Centers for Disease Control and Prevention. Interim Guidance for SARS-CoV-2 Testing in Homeless Shelters and Encampments 2021 [cited 2021 March 26th]. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/community\/homeless-shelters\/testing.html."},{"key":"pone.0264929.ref036","article-title":"Scaling up COVID-19 rapid antigen tests: promises and challenges","author":"RW Peeling","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"pone.0264929.ref037","unstructured":"Centers for Disease Control and Prevention. Interim Public Health Recommendations for Fully Vaccinated People 2021 [cited 2021 March 26th]. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/vaccines\/fully-vaccinated-guidance.html."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264929","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T13:29:50Z","timestamp":1646918990000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264929"}},"subtitle":[],"editor":[{"given":"Prasenjit","family":"Mitra","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,10]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0264929","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.04.20.21255787","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,10]]}}}