Table 2.

Summary of responses from interviews after implementation of Cups for COVID

Service provider	Type of service/facility	Interview responses
The Drop-In & Rehab Centre	Emergency shelter for people experiencing homelessness	Operations: staff actively handed out cups to clients among the floors that clients resided on. Staff felt that keeping track of cups and acquiring new ones was a straightforward process. Infection prevention value: staff thought that the disposable cups led to decreased drink sharing. They observed groups using individual cups instead of sharing a container. Clients frequently approached staff to request cups. The site used the cups alongside other promotional materials, such as posters to promote COVID-19 and health awareness among clients. Harm reduction value: staff thought the cups were analogous to distributing disposable crack pipe mouthpieces. They also thought the cups reduced the stigma around drinking and were effective for engaging clients in discussions around COVID-19 and infection prevention. Litter: staff reported no change in litter and frequently observed proper disposal of used cups. Other: bottles were often requested by clients and were provided by the site. Staff said that bottles tend to have high rates of reuse and sharing. Some clients preferred bottles over cups because of easier transporting and better concealing when they drink alcohol outdoors.
Safeworks Connect	Facility for safer substance use supplies and resources	Operations: staff kept the cups in their main office and actively offered them to their clientele. Infection prevention value: staff did not think that the cups were desired by their clientele. Clientele generally requested either supplies for drug use or bottles filled with water. Harm reduction value: staff thought that cups would provide harm reduction value among people who use alcohol. Clientele at Safeworks Connect primarily request supplies for drug use and do not report frequent alcohol use. Litter: not applicable, since only a few cups were given out.
Safeworks Outreach	Healthcare outreach service for safer substance use supplies and resources	Operations: bulk cups were light and transportable for outreach work. Staff distributed cups to the subset of clients who were observed sharing alcohol containers. Interactions with clients were very brief, so limited health education was provided. Infection prevention value: staff thought that the cups were very useful for infection prevention among people who use alcohol. Staff noted that they often have very brief interactions with clients, so there were fewer opportunities to provide education when compared with other outreach services. Harm reduction value: cups were useful for people using alcohol and were a useful harm reduction tool. However, they provided limited value for people who do not regularly drink alcohol. Litter: staff did not notice any litter increases. Other comments: clients often requested a bottle or resealable container for repeat usage and easier transportability. Staff were unsure whether bottles would lead to better infection prevention practices among their clientele.
Alpha House Outreach	Non-profit, peer-led, outreach service	Operations: peer support workers assembled kits with health promotion materials that included the disposable cups, water bottles with educational labels to discourage drink sharing, and t-shirts encouraging hand washing. Infection prevention value: encampment outreach staff thought that the cups were very useful to reinforce and demonstrate teachings around COVID-19. Peer workers felt that the cups were only useful for those who share alcohol (~ 50% of clientele). Among people they serve who use alcohol, ~ 50% accepted and used the cups. Harm reduction value: all staff thought that the cups were useful as a harm reduction tool among people who use alcohol. Litter: the encampment team did not notice an increase in litter. The peer group noticed litter from the cups in about half of the locations that they distributed to.
YW Calgary	Supportive housing for female and non-binary clients	Operations: staff actively distributed cups to clients and kept them in the on-site offices. Staff also drank from the cups (without alcohol) to model safer drinking behaviour. Infection prevention value: staff had compelling stories of multiple people routinely requesting disposable cups before going to drink. Prior to the disposable cups, the residents would share reusable cups and bottles. Harm reduction value: “cups are a vector for health education daily”. Groups were still able to drink together, but used separate cups and engaged in COVID-19 prevention. Litter: cups were always properly disposed of in the garbage, even among people who tend to leave reusable cups and bottles around. Other: disposable cups were greatly preferred over previously available options, which included reusable cups and bottles. Staff noted much less reuse and sharing with the disposable cups.