Factors associated with SARS-CoV-2 infections among migrants in Germany

Abstract Background International research shows increased risks for SARS-CoV-2 infection and severe disease progression in people with migration history. In Germany, data on this topic is scarce. Aim of this contribution is to examine the association between migrant status and risk of SARS-CoV-2 infection and discuss potential explanatory mechanisms. Methods We analysed data from the German COVID-19 Snapshot Monitoring online-survey and performed hierarchical multiple regression models to calculate probabilities for a self-reported SARS-CoV-2 infection. Main predictor variable was the migrant status; besides, the association with gender, age, education, household size, household language (German vs. other), and occupation in the health sector was analysed. Results Of 45,858 participants, 3.5% reported a current or previous infection with SARS-CoV-2, 16% reported own or parental history of migration. The probability of reporting an infection was 3.95 percentage points higher among migrants. The effect of different characteristics on self-reported SARS-CoV-2 infection varied. Higher probabilities were shown for individuals living in bigger households and those not speaking German at home. Stepwise integration decreased the observed association with migrant status. When adding an interaction term of migrant status and occupation in the health sector, the probability to report an infection was 11.5 percentage points higher for migrants working in the health sector. Conclusions People with migration history, health sector employees and particular migrant health workers are at a higher risk of SARS-CoV-2 infection. However, the migrant status itself does not determine the risk of infection, but the living and working conditions. Therefore, targeted and multilingual prevention measures are needed that consider living and working conditions. Key messages • Higher SARS-CoV-2 infection risks are not solely determined by migrant status, but were shown for health care workers, people living in bigger households and those not speaking German at home. • As not the migrant status determines infection risks, multilingual and targeted prevention measures considering the living and working conditions of people are necessary.


Problem:
Comprehensive data on the sexual health of trans and nonbinary people are not available due to lacking focus on these groups and inappropriate study designs that often fail to capture the lived realities of these communities. Description of the practice: A participatory study was developed with trans and non-binary representatives with a qualitative part involving single and group interviews as well as the development and roll-out of a quantitative online questionnaire. After securing funding, we started the study in 2020 ensuring community involvement in as many parts as possible.

Results:
A crucial component is the advisory board including people representing a broad spectrum of trans and non-binary communities, organizations, who are also representing a variety of intersectional perspectives, e.g. BIPoC and neurodiverse people. The advisory board provides crucial input to the design and conduct of the study components. For the qualitative part, a unique study design was developed using sexual health & empowerment workshops for trans and non-binary people in a trustful peer setting combined with qualitative data collection. This way, participants of the study truly benefit from participation and the data quality is improved. The quantitative study was created together with >20 community representatives. Items on gender identity, transition, and experiences of discrimination were developed using online workshops and written feedback. The questionnaire was checked by community members to ensure appropriate language. Through diverse community channels and social media, we recruited 58 participants for the qualitative part and more than 2000 participants for the online questionnaire. The results are expected in late 2022. Lessons: Involvement of community representatives and the participatory study design ensured strong community support. This enables the capture of meaningful information on the sexual health of trans and non-binary people. Key messages: Using a participatory study design was crucial to the success of this study. We were able to conduct a study capturing meaningful data on the sexual health of trans and non-binary communities.

Background:
International research shows increased risks for SARS-CoV-2 infection and severe disease progression in people with migration history. In Germany, data on this topic is scarce. Aim of this contribution is to examine the association between migrant status and risk of SARS-CoV-2 infection and discuss potential explanatory mechanisms.

Methods:
We analysed data from the German COVID-19 Snapshot Monitoring online-survey and performed hierarchical multiple regression models to calculate probabilities for a self-reported SARS-CoV-2 infection. Main predictor variable was the migrant status; besides, the association with gender, age, education, household size, household language (German vs. other), and occupation in the health sector was analysed.
15th European Public Health Conference 2022

Results:
Of 45,858 participants, 3.5% reported a current or previous infection with SARS-CoV-2, 16% reported own or parental history of migration. The probability of reporting an infection was 3.95 percentage points higher among migrants. The effect of different characteristics on self-reported SARS-CoV-2 infection varied. Higher probabilities were shown for individuals living in bigger households and those not speaking German at home. Stepwise integration decreased the observed association with migrant status. When adding an interaction term of migrant status and occupation in the health sector, the probability to report an infection was 11.5 percentage points higher for migrants working in the health sector.

Conclusions:
People with migration history, health sector employees and particular migrant health workers are at a higher risk of SARS-CoV-2 infection. However, the migrant status itself does not determine the risk of infection, but the living and working conditions. Therefore, targeted and multilingual prevention measures are needed that consider living and working conditions. show that trans Ã persons were often presented as subsamples in larger samples of non-binary populations. Also, eHealth solutions related to very different technological solutions and to a wide range of treatment models, with the vast majority relating to sexual health. Hence, we could also see that trans Ã women were the more interesting group in the research included in this review. We found 23 studies relating to COVID-19. eHealth solutions have great potential to contribute to a better healthcare for trans Ã persons but the needs of different groups during healthcare have to be taken into account in further research. During the COVID-19 pandemic, the need for research on eHealth solutions for trans Ã persons came into focus.

Key messages:
Our analyzes showed that research on eHealth solutions for trans Ã persons takes place in complex interdisciplinary settings which need to be taken into account in further research.
The COVID-19 pandemic crisis lead to an uptake of eHealth interventions in mental, endocrinological, and sexual health care, especially in younger groups and in the frame of routine clinical care.
Abstract citation ID: ckac131.509 Barriers to primary care access for asylum seekers and refugees in the UK: a systematic review

Background:
Recent armed conflicts, in addition to the deterioration of humanitarian conditions across the world, has led to the biggest increase in civilian displacement since World War II. Exploration of the barriers and facilitators to primary healthcare access amongst asylum seekers and refugees (ASRs), from the perspective of both service users and service providers, is important for improving policy and practice to ensure more equitable health care.

Methods:
Systematic searches of PubMed, EMBASE, MEDLINE, and CINHL databases were conducted to identify articles until May 2021 using a combination of relevant search terms. Studies were eligible if they were published in English and conducted in ASR populations in primary care settings the UK using qualitative approaches. Literature was thematically analysed using Braun and Clarke's 6-step process. Quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool.

Results:
Nine studies were included in the review. Key themes identified included: accommodation within services; awareness of service navigation, negotiation and eligibility of care; accessibility; availability of appointments; acceptance; complexity within health needs; and cultural appropriateness. Healthcare professionals encounter barriers and facilitators within the healthcare setting, the overall healthcare system, and with regards to their understanding of migration policy. ASRs experience barriers and facilitators with regards to accessing and understanding the health system, cultural appropriateness of care, cost, stigma and prejudice, and availability of specialist services.

Conclusions:
This study highlights the difficulties ASRs and healthcare professionals face in primary care settings, the need for consistent and unambiguous guidance that supports the cultural competence of the heath service, and the need for further research into the efforts made to eliminate health discrimination within primary care. Key messages: Barriers exist to primary healthcare amongst asylum seekers and refugees. Specialised and incorporated healthcare and support is needed due to unique social, cultural, and demographical differences of this population.