Background: Homeless-experienced populations are at increased risk of exposure to SARS CoV-2 due to their living environments and face increased risk of severe COVID-19 disease due to underlying health conditions . Little is known about COVID-19 testing and vaccination acceptability among homeless-experienced populations .

Objective: To understand the facilitators and barriers to COVID-19 testing and vaccine acceptability among homeless-experienced adults .

Design: We conducted in-depth interviews with participants from July-October 2020 . We purposively recruited participants from 1) a longitudinal cohort of homeless-experienced older adults in Oakland, CA (n=37) and 2) a convenience sample of people (n=57) during a mobile outreach COVID-19 testing event in San Francisco . Participants: Adults with current or past experience of homelessness . Approach: We asked participants about their experiences with and attitudes towards COVID-19 testing and their perceptions of COVID-19 vaccinations . We used participant observation techniques to document the interactions between testing teams and those approached for testing . We audio-recorded, transcribed and content analyzed all interviews and identified major themes and subthemes . Key

Results: Participants found incentivized COVID-19 testing administered in unsheltered settings and supported by community health outreach workers (CHOWs) to be acceptable . The majority of participants expressed positive inclination toward vaccine acceptability, citing a desire to return to routine life and civic responsibility . Those who expressed hesitancy cited a desire to see trial data, concerns that vaccines included infectious materials, and mistrust of the government .

Conclusions: Participants expressed positive evaluations of the incentivized, mobile COVID-19 testing supported by CHOWs in unsheltered settings . The majority of participants expressed positive inclination toward vaccination . Vaccine hesitancy concerns must be addressed when designing vaccine delivery strategies that overcome access challenges . Based on the successful implementation of COVID-19 testing, we recommend mobile delivery of vaccines using trusted CHOWs to address concerns and facilitate wider access to and uptake of the COVID vaccine.