Addressing Vaccine AcceptaNce in Carceral Settings through Community Engagement (ADVANCE)

PROJECT SUMMARY The COVID-19 pandemic has had a disproportionate impact on those who are incarcerated and work in our nation's prisons and jails. The prison population has had an infection rate that is five times the rate in the general population and correctional staff have been infected at three times the rate of the general population. High rates of COVID-19 in correctional systems are linked to high rates in surrounding communities, especially in jails with high population turnover and in communities where correctional officers work. Vaccination in correctional systems is an important community-wide COVID-19 mitigation strategy. But rates of vaccine acceptance vary considerably, in part due to issues of distrust and unique social norms and policies within correctional systems. Prior work on vaccine acceptance strategies, even amongst Black and Latinx people who are disproportionately incarcerated, has rarely focused on strategies that work in corrections. Until this knowledge gap is addressed, it will be difficult to reduce the disproportionate impact of COVID-19 on minoritized populations in correctional facilities and the communities to which they return. This is especially important with ongoing new variants emerging. The overall objective of this proposal, ADdressing Vaccine AcceptaNce in Carceral Settings through Community Engagement (ADVANCE), is to identify feasible and effective interventions to improve vaccine uptake in prisons. We will adapt the successful P3 vaccine acceptance model for healthcare practices, developed by our team, to identify new and iterate on old strategies appropriate for prisons, creating a new Patient, Provider, Practice, Prison-level (P4) framework. The central hypothesis of the proposal is that strategies developed by and studied in partnership with people directly impacted by the correctional system will increase vaccine acceptance. To test this hypothesis, we will tackle three aims: (1) identify promising correctional system-based strategies to improve vaccine acceptance; (2) adapt these strategies into an updated P4 framework using community based participatory research approach; and (3) study the effectiveness of these interventions through rapid cycle, cluster-randomized trials in the Pennsylvania correctional system. Throughout study phases, currently and previously incarcerated people and correctional staff will provide input so P4 interventions are most likely to succeed. ADVANCE represents a substantial departure from previous work on vaccine acceptance by focusing on providing an evidence base for addressing vaccine acceptance in correctional systems that can be scaled and adapted for other justice- involved populations.