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Conderino S, E Thorpe L, Shilpi Islam N, A Berry C, Bendik S, Massar R, Hong C, Fair A, Bershteyn A. Evaluation of the New York City COVID-19 case investigation and contact tracing program: a cascade of care analysis. BMC Public Health 2024; 24:2356. [PMID: 39210385 PMCID: PMC11363647 DOI: 10.1186/s12889-024-19838-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND New York City (NYC) was the first COVID-19 epicenter in the United States and home to one of the country's largest contact tracing programs, NYC Test & Trace (T2). Understanding points of attrition along the stages of program implementation and follow-up can inform contact tracing efforts for future epidemics or pandemics. The objective of this study was to evaluate the completeness and timeliness of T2 case and contact notification and monitoring using a "cascade of care" approach. METHODS This cross-sectional study included all SARS-CoV-2 cases and contacts reported to T2 from May 31, 2020 to January 1, 2022. Attrition along the "cascade of care" was defined as: (1) attempted, (2) reached, (3) completed intake (main outcome), (4) eligible for monitoring, and (5) successfully monitored. Timeliness was assessed: (1) by median days from a case's date of testing until their positive result was reported to T2, (2) from result until the case was notified by T2, and (3) from a case report of a contact until notification of the contact. RESULTS A total of 1.45 million cases and 1.38 million contacts were reported to T2 during this period. For cases, attrition occurred evenly across the first three cascade steps (~-12%) and did not change substantially until the Omicron wave in December 2021. During the Omicron wave, the proportion of cases attempted dropped precipitously. For contacts, the largest attrition occurred between attempting and reaching (-27%), and attrition rose with each COVID-19 wave as contact volumes increased. Attempts to reach contacts discontinued entirely during the Omicron wave. Overall, 67% of cases and 49% of contacts completed intake interviews (79% and 57% prior to Omicron). T2 was timely, with a median of 1 day to receive lab results, 2 days to notify cases, and < 1 day to notify contacts. CONCLUSIONS T2 provided a large volume of NYC residents with timely notification and monitoring. Engagement in the program was lower for contacts than cases, with the largest gap coming from inability to reach individuals during call attempts. To strengthen future test-and-trace efforts, strategies are needed to encourage acceptance of local contact tracer outreach attempts.
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Affiliation(s)
- Sarah Conderino
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Nadia Shilpi Islam
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Carolyn A Berry
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Stefanie Bendik
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rachel Massar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Chuan Hong
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Andrew Fair
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Anna Bershteyn
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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2
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Martin S, Dill J, Demeritte D, Geressu H, Dahal R, Kirkland C, Hunt S, Parikh R. A Scoping Review of Health Equity Interventions in Governmental Public Health. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:479-489. [PMID: 38830006 DOI: 10.1097/phh.0000000000001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
CONTEXT Despite major efforts in research, practice, and policy, racial and ethnic disparities in health and health care persist in the United States. Interventions in collaboration with governmental public health may provide ways to address these persistent racial and ethnic health and health care disparities and improve health outcomes. OBJECTIVE To conduct a comprehensive review of health equity interventions performed in collaboration with public health agencies. DESIGN This scoping review includes intervention studies from Ovid MEDLINE, PsycINFO, and Academic Search Premier, published between 2017 and 2023. The search strategy used terminology focused on 4 concepts: race/ethnicity, equity, health departments, and epidemiologic studies. ELIGIBILITY CRITERIA The following inclusion criteria were determined a priori: (1) intervention tailored to reduce racial/ethnic health disparities, (2) public health department involvement, (3) health outcome measures, (4) use of epidemiologic study methods, (5) written in English, (6) implemented in the United States, (7) original data (not a commentary), and (8) published between January 2017 and January 2023. MAIN OUTCOME MEASURES This review focused primarily on 4 dimensions of racial health equity interventions including intervention components, intervention settings, intervention delivery agents, and intervention outcomes. RESULTS This review indicated that health equity interventions involving public health agencies focused on the following categories: (1) access to care, (2) health behavior, (3) infectious disease testing, (4) preventing transmission, and (5) cancer screening. Critical strategies included in interventions for reaching racial/ethnic minoritized people included using community settings, mobile clinics, social media/social networks, phone-based interventions, community-based workers, health education, active public health department involvement, and structural/policy change. CONCLUSIONS This scoping review aims to provide an evidence map to inform public health agencies, researchers, and funding agencies on gaps in knowledge and priority areas for future research and to identify existing health equity interventions that could be considered for implementation by public health leaders.
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Affiliation(s)
- Skky Martin
- Author Affiliations: Center for Public Health Systems, University of Minnesota School of Public Health, Minneapolis, Minnesota
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Polat A, Demircioğlu Z, Küçükali H. Are we heroes or couriers? A phenomenological study on reappropriation of professional subjectivity and agency among health professionals during COVID-19 contact tracing in Türkiye. Soc Sci Med 2024; 351:116924. [PMID: 38743991 DOI: 10.1016/j.socscimed.2024.116924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/05/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024]
Abstract
During the COVID-19 pandemic, Türkiye implemented a distinctive contact tracing approach involving in-person home visits by medical professionals to individuals who tested positive for the virus. This study examines the experiences of health professionals involved in contact tracing, exploring how they reappropriated their professional subjectivity and agency during their deployment in this role. It is an interpretive phenomenological qualitative study. We conducted 21 semi-structured in-depth interviews, subsequently carried out two separate focus group interviews with an additional 31 participants from various districts in Istanbul. Participants were selected from different medical professions (i.e. doctors, nurses, midwives), career stages, gender and age groups, and hierarchical levels (i.e. officers and directors). Data analysis was conducted collaboratively by the research team from sociology and public health disciplines. Our main finding is that for the majority of health professionals, contact tracing was a novel experience with challenges and ambivalances. Yet, regardless of their perceptions (positive, negative, or mixed), the experience promoted a reaffirmation of professional identity and reappropriation of professional subjectivity and agency, which discloses that professional subjectivity is not firm but dynamic, carrying stability as well as flexibility and adjustment. Four main themes are identified in their reappropriation of professional subjectivity and agency: uncovering professional fulfillment, feeling restrained in professional dissatisfaction, assessing the job, and engaging in professional and bureaucratic negotiations.The profound exploration into the dynamics of contact tracing amidst the pandemic illuminates a multidimensional narrative that transcends the conventional discourse on physical and psychological stress experienced by medical professionals. Contact tracing experience had a transformative impact on meaning and purpose of professional identity. Our findings highlight a need for a balanced approach between centralized decision-making, mobilization of professionals, quantitative evaluation, and professional autonomy and discretion, qualitative assessments, and meaningful engagement.
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Affiliation(s)
- Ayşe Polat
- Istanbul Boğaziçi University, Faculty of Arts and Sciences, Department of Sociology, Istanbul, Türkiye
| | - Zübeyde Demircioğlu
- İstanbul Medeniyet University, Faculty of Arts and Humanities, Department of Sociology, Istanbul, Türkiye
| | - Hüseyin Küçükali
- Queen's University Belfast, Centre for Public Health, Belfast, UK; Istanbul Medipol University, School of Medicine, Department of Public Health, Istanbul, Türkiye.
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4
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He K, Foerster S, Vora NM, Blaney K, Keeley C, Hendricks L, Varma JK, Long T, Shaman J, Pei S. Evaluating completion rates of COVID-19 contact tracing surveys in New York City. BMC Public Health 2024; 24:414. [PMID: 38331772 PMCID: PMC10854191 DOI: 10.1186/s12889-024-17920-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
IMPORTANCE Contact tracing is the process of identifying people who have recently been in contact with someone diagnosed with an infectious disease. During an outbreak, data collected from contact tracing can inform interventions to reduce the spread of infectious diseases. Understanding factors associated with completion rates of contact tracing surveys can help design improved interview protocols for ongoing and future programs. OBJECTIVE To identify factors associated with completion rates of COVID-19 contact tracing surveys in New York City (NYC) and evaluate the utility of a predictive model to improve completion rates, we analyze laboratory-confirmed and probable COVID-19 cases and their self-reported contacts in NYC from October 1st 2020 to May 10th 2021. METHODS We analyzed 742,807 case investigation calls made during the study period. Using a log-binomial regression model, we examined the impact of age, time of day of phone call, and zip code-level demographic and socioeconomic factors on interview completion rates. We further developed a random forest model to predict the best phone call time and performed a counterfactual analysis to evaluate the change of completion rates if the predicative model were used. RESULTS The percentage of contact tracing surveys that were completed was 79.4%, with substantial variations across ZIP code areas. Using a log-binomial regression model, we found that the age of index case (an individual who has tested positive through PCR or antigen testing and is thus subjected to a case investigation) had a significant effect on the completion of case investigation - compared with young adults (the reference group,24 years old < age < = 65 years old), the completion rate for seniors (age > 65 years old) were lower by 12.1% (95%CI: 11.1% - 13.3%), and the completion rate for youth group (age < = 24 years old) were lower by 1.6% (95%CI: 0.6% -2.6%). In addition, phone calls made from 6 to 9 pm had a 4.1% (95% CI: 1.8% - 6.3%) higher completion rate compared with the reference group of phone calls attempted from 12 and 3 pm. We further used a random forest algorithm to assess its potential utility for selecting the time of day of phone call. In counterfactual simulations, the overall completion rate in NYC was marginally improved by 1.2%; however, certain ZIP code areas had improvements up to 7.8%. CONCLUSION These findings suggest that age and time of day of phone call were associated with completion rates of case investigations. It is possible to develop predictive models to estimate better phone call time for improving completion rates in certain communities.
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Affiliation(s)
- Kaiyu He
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Steffen Foerster
- New York City Department of Health and Mental Hygiene (DOHMH), Long Island City, NY, 11001, USA
| | - Neil M Vora
- New York City Department of Health and Mental Hygiene (DOHMH), Long Island City, NY, 11001, USA
| | - Kathleen Blaney
- New York City Department of Health and Mental Hygiene (DOHMH), Long Island City, NY, 11001, USA
| | | | | | - Jay K Varma
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Theodore Long
- NYC Health + Hospitals, New York, NY, USA
- Department of Population Health, New York University, New York, NY, 10016, USA
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- Columbia Climate School, Columbia University, New York, NY, 10025, USA
| | - Sen Pei
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
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Aranda Z, Vázquez S, Gopaluni A, Martínez L, Ramírez M, Jiménez A, Bernal D, Rodríguez AL, Chacón S, Vargas B, Fulcher IR, Barnhart DA. Evaluation of the implementation of a community health worker-led COVID-19 contact tracing intervention in Chiapas, Mexico, from March 2020 to December 2021. BMC Health Serv Res 2024; 24:97. [PMID: 38233915 PMCID: PMC10795220 DOI: 10.1186/s12913-024-10590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Mexico is one of the countries with the greatest excess death due to COVID-19. Chiapas, the poorest state in the country, has been particularly affected. Faced with an exacerbated shortage of health professionals, medical supplies, and infrastructure to respond to the pandemic, the non-governmental organization Compañeros En Salud (CES) implemented a COVID-19 infection prevention and control program to limit the impact of the pandemic in the region. We evaluated CES's implementation of a community health worker (CHW)-led contact tracing intervention in eight rural communities in Chiapas. METHODS Our retrospective observational study used operational data collected during the contract tracing intervention from March 2020 to December 2021. We evaluated three outcomes: contact tracing coverage, defined as the proportion of named contacts that were located by CHWs, successful completion of contact tracing, and incidence of suspected COVID-19 among contacts. We described how these outcomes changed over time as the intervention evolved. In addition, we assessed associations between these three main outcomes and demographic characteristics of contacts and intervention period (pre vs. post March 2021) using univariate and multivariate logistic regression. RESULTS From a roster of 2,177 named contacts, 1,187 (54.5%) received at least one home visit by a CHW and 560 (25.7%) had successful completion of contact tracing according to intervention guidelines. Of 560 contacts with complete contact tracing, 93 (16.6%) became suspected COVID-19 cases. We observed significant associations between sex and coverage (p = 0.006), sex and complete contact tracing (p = 0.049), community of residence and both coverage and complete contact tracing (p < 0.001), and intervention period and both coverage and complete contact tracing (p < 0.001). CONCLUSIONS Our analysis highlights the promises and the challenges of implementing CHW-led COVID-19 contact tracing programs. To optimize implementation, we recommend using digital tools for data collection with a human-centered design, conducting regular data quality assessments, providing CHWs with sufficient technical knowledge of the data collection system, supervising CHWs to ensure contact tracing guidelines are followed, involving communities in the design and implementation of the intervention, and addressing community member needs and concerns surrounding stigmatization arising from lack of privacy.
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Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México.
- Departamento de Salud, El Colegio de La Frontera Sur, San Cristóbal de Las Casas, Chiapas, México.
| | - Sandra Vázquez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Anuraag Gopaluni
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Mayra Ramírez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Ariwame Jiménez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Daniel Bernal
- Escuela de Gobierno y Transformación Pública, Instituto Tecnológico de Monterrey, Ciudad de Mexico, México
| | - Ana L Rodríguez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
- Instituto Nacional de Salud Pública/Escuela de Salud Pública de México, Cuernavaca, Morelos, México
| | - Selene Chacón
- Instituto Nacional de Salud Pública/Escuela de Salud Pública de México, Cuernavaca, Morelos, México
| | - Bruno Vargas
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Isabel R Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Harvard Data Science Initiative, Boston, MA, USA
| | - Dale A Barnhart
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health Rwanda (Inshuti Mu Buzima), Kigali, Rwanda
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Udeagu CCN, Gbedemah M, Pitiranggon M, Feldman S, Cordoba E, Goldenberg S, Keeley C, Blaney K, Vora NM, Long T. Integrating Contact Tracers Into Point-of-Care Testing Workflow to Accelerate the Tracing of People With Exposure to COVID-19, August-December 2020, New York City. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:708-717. [PMID: 37290128 PMCID: PMC10373849 DOI: 10.1097/phh.0000000000001748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We assessed the timeliness of contact tracing following rapid-positive COVID-19 test result at point-of-care testing (POCT) sites in New York City (NYC). DESIGN Interviewed case-patients to elicit exposed contacts and conducted COVID-19 exposure notifications. SETTINGS Twenty-two COVID-19 POCT sites in NYC, the 2 NYC international airports, and 1 ferry terminal. PARTICIPANTS Case-patients with rapid-positive COVID-19 test results and their named contacts. MAIN OUTCOME MEASURES We quantified the proportions of interviewed individuals with COVID-19 and notified contacts and assessed the timeliness between the dates of the rapid-positive COVID-19 test results and the interviews or notifications. RESULTS In total, 11 683 individuals with rapid-positive COVID-19 test results were referred for contact tracing on the day of their diagnosis; 8878 (76) of whom were interviewed within 1 day of diagnosis, of whom 5499 (62%) named 11 486 contacts. A median of 1.24 contacts were identified from each interview. The odds of eliciting contacts were significantly higher among individuals reporting COVID-19 symptoms than among persons with no symptoms (51% vs 36%; adjusted odds ratio [aOR] = 1.37; 95% confidence interval [CI], 1.11-1.70) or living with 1 or more persons than living alone (89% vs 38%; aOR = 12.11; 95% CI, 10.73-13.68). Among the 8878 interviewed case-patients, 8317 (94%) were interviewed within 1 day of their rapid-positive COVID-19 test results and 91% of contact notifications were completed within 1 day of contact identification. The median interval from test result to interview date and from case investigation interview to contact notification were both 0 days (IQR = 0). CONCLUSIONS The integration of contact tracers into COVID-19 POCT workflow achieved timely case investigation and contact notification. Accelerated contact tracing can be used to curb COVID-19 transmission during local outbreaks.
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Affiliation(s)
- Chi-Chi N. Udeagu
- New York City Department of Health and Mental Hygiene, Queens, New York (Mss Udeagu, Pitiranggon, and Blaney and Dr Vora); New York City Test & Trace Corps, New York City, New York (Mss Udeagu, Gbedemah, Pitiranggon, Feldman, Goldenberg, Keeley, and Blaney and Drs Cordoba, Vora, and Long); and New York City Health + Hospitals Corporation, New York City, New York (Mss Gbedemah, Feldman, Goldenberg, and Keeley and Drs Cordoba and Long)
| | - Misato Gbedemah
- New York City Department of Health and Mental Hygiene, Queens, New York (Mss Udeagu, Pitiranggon, and Blaney and Dr Vora); New York City Test & Trace Corps, New York City, New York (Mss Udeagu, Gbedemah, Pitiranggon, Feldman, Goldenberg, Keeley, and Blaney and Drs Cordoba, Vora, and Long); and New York City Health + Hospitals Corporation, New York City, New York (Mss Gbedemah, Feldman, Goldenberg, and Keeley and Drs Cordoba and Long)
| | - Masha Pitiranggon
- New York City Department of Health and Mental Hygiene, Queens, New York (Mss Udeagu, Pitiranggon, and Blaney and Dr Vora); New York City Test & Trace Corps, New York City, New York (Mss Udeagu, Gbedemah, Pitiranggon, Feldman, Goldenberg, Keeley, and Blaney and Drs Cordoba, Vora, and Long); and New York City Health + Hospitals Corporation, New York City, New York (Mss Gbedemah, Feldman, Goldenberg, and Keeley and Drs Cordoba and Long)
| | - Samantha Feldman
- New York City Department of Health and Mental Hygiene, Queens, New York (Mss Udeagu, Pitiranggon, and Blaney and Dr Vora); New York City Test & Trace Corps, New York City, New York (Mss Udeagu, Gbedemah, Pitiranggon, Feldman, Goldenberg, Keeley, and Blaney and Drs Cordoba, Vora, and Long); and New York City Health + Hospitals Corporation, New York City, New York (Mss Gbedemah, Feldman, Goldenberg, and Keeley and Drs Cordoba and Long)
| | - Evette Cordoba
- New York City Department of Health and Mental Hygiene, Queens, New York (Mss Udeagu, Pitiranggon, and Blaney and Dr Vora); New York City Test & Trace Corps, New York City, New York (Mss Udeagu, Gbedemah, Pitiranggon, Feldman, Goldenberg, Keeley, and Blaney and Drs Cordoba, Vora, and Long); and New York City Health + Hospitals Corporation, New York City, New York (Mss Gbedemah, Feldman, Goldenberg, and Keeley and Drs Cordoba and Long)
| | - Shifra Goldenberg
- New York City Department of Health and Mental Hygiene, Queens, New York (Mss Udeagu, Pitiranggon, and Blaney and Dr Vora); New York City Test & Trace Corps, New York City, New York (Mss Udeagu, Gbedemah, Pitiranggon, Feldman, Goldenberg, Keeley, and Blaney and Drs Cordoba, Vora, and Long); and New York City Health + Hospitals Corporation, New York City, New York (Mss Gbedemah, Feldman, Goldenberg, and Keeley and Drs Cordoba and Long)
| | - Chris Keeley
- New York City Department of Health and Mental Hygiene, Queens, New York (Mss Udeagu, Pitiranggon, and Blaney and Dr Vora); New York City Test & Trace Corps, New York City, New York (Mss Udeagu, Gbedemah, Pitiranggon, Feldman, Goldenberg, Keeley, and Blaney and Drs Cordoba, Vora, and Long); and New York City Health + Hospitals Corporation, New York City, New York (Mss Gbedemah, Feldman, Goldenberg, and Keeley and Drs Cordoba and Long)
| | - Kathleen Blaney
- New York City Department of Health and Mental Hygiene, Queens, New York (Mss Udeagu, Pitiranggon, and Blaney and Dr Vora); New York City Test & Trace Corps, New York City, New York (Mss Udeagu, Gbedemah, Pitiranggon, Feldman, Goldenberg, Keeley, and Blaney and Drs Cordoba, Vora, and Long); and New York City Health + Hospitals Corporation, New York City, New York (Mss Gbedemah, Feldman, Goldenberg, and Keeley and Drs Cordoba and Long)
| | - Neil M. Vora
- New York City Department of Health and Mental Hygiene, Queens, New York (Mss Udeagu, Pitiranggon, and Blaney and Dr Vora); New York City Test & Trace Corps, New York City, New York (Mss Udeagu, Gbedemah, Pitiranggon, Feldman, Goldenberg, Keeley, and Blaney and Drs Cordoba, Vora, and Long); and New York City Health + Hospitals Corporation, New York City, New York (Mss Gbedemah, Feldman, Goldenberg, and Keeley and Drs Cordoba and Long)
| | - Theodore Long
- New York City Department of Health and Mental Hygiene, Queens, New York (Mss Udeagu, Pitiranggon, and Blaney and Dr Vora); New York City Test & Trace Corps, New York City, New York (Mss Udeagu, Gbedemah, Pitiranggon, Feldman, Goldenberg, Keeley, and Blaney and Drs Cordoba, Vora, and Long); and New York City Health + Hospitals Corporation, New York City, New York (Mss Gbedemah, Feldman, Goldenberg, and Keeley and Drs Cordoba and Long)
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Rodríguez AL, Aranda Z, Brun E, DiChiara S, Esquinca A, González E, González S, Jiménez A, Molina-Orozco CU, Martínez L, Mullen J, Vargas B, Vázquez S, Chacón-Hernández S. A comprehensive and healthcare equity promoting response by a civil society-public partnership to COVID-19 in Chiapas, Mexico. BMJ Glob Health 2023; 8:bmjgh-2022-011244. [PMID: 36941004 PMCID: PMC10030274 DOI: 10.1136/bmjgh-2022-011244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/22/2023] [Indexed: 03/23/2023] Open
Abstract
Following the first COVID-19 case in Chiapas, Mexico in March 2020, the non-governmental organisation Compañeros En Salud (CES) and the state's Ministry of Health (MOH) decided to join forces to respond to the global pandemic. The collaboration was built over 8 years of partnership to bring healthcare to underserved populations in the Sierra Madre region. The response consisted of a comprehensive SARS-CoV-2 infection prevention and control programme, which included prevention through communication campaigns to combat misinformation and stigma related to COVID-19, contact tracing of suspected and confirmed COVID-19 cases and their contacts, outpatient and inpatient care for patients with respiratory symptoms, and CES-MOH collaboration on anti-COVID-19 immunisation campaigns. In this article, we describe these interventions and their principal outcomes, as well as reflect on notable pitfalls identified during the collaboration, and we suggest a series of recommendations to prevent and mitigate their occurrence. As with many cities and towns across the globe, the poor preparedness of the local health system for a pandemic and pandemic response led to the collapse of the medical supply chain, the saturation of public medical facilities and the exhaustion of healthcare personnel, which had to be overcome through adaptation, collaboration and innovation. For our programme in particular, the lack of a formal definition of roles and clear lines of communication between CES and the MOH; thoughtful planning, monitoring and evaluation and active engagement of the communities served in the design and implementation of health interventions affected the outcomes of our efforts.
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Affiliation(s)
- Ana Laura Rodríguez
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Zeus Aranda
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Departamento de Salud, El Colegio de la Frontera Sur, San Cristobal de las Casas, Mexico
| | - Elvire Brun
- Compañeros En Salud, Ángel Albino Corzo, Mexico
| | - Samuel DiChiara
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Tulane University, New Orleans, Louisiana, USA
| | | | - Erick González
- Secretaria de Salud del Estado de Chiapas, Ángel Albino Corzo, Mexico
- Brandeis University, Waltham, Massachusetts, USA
| | - Sebastián González
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Universidad Nacional Autónoma de México, Ciudad de Mexico, Mexico
| | | | | | - Laura Martínez
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Socios En Salud Sucursal Peru, Lima, Peru
| | | | | | | | - Selene Chacón-Hernández
- Compañeros En Salud, Ángel Albino Corzo, Mexico
- Instituto Nacional de Salud Publica, Cuernavaca, Mexico
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Udeagu CCN, Pitiranggon M, Misra K, Huang J, Terilli T, Ramos Y, Alexander M, Kim C, Lee D, Blaney K, Keeley C, Long T, Vora NM. Outcomes of a Community Engagement and Information Gathering Program to Support Telephone-Based COVID-19 Contact Tracing: Descriptive Analysis. JMIR Public Health Surveill 2022; 8:e40977. [PMID: 36240019 PMCID: PMC9668330 DOI: 10.2196/40977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/27/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Contact tracing is an important public health tool for curbing the spread of infectious diseases. Effective and efficient contact tracing involves the rapid identification of individuals with infection and their exposed contacts and ensuring their isolation or quarantine, respectively. Manual contact tracing via telephone call and digital proximity app technology have been key strategies in mitigating the spread of COVID-19. However, many people are not reached for COVID-19 contact tracing due to missing telephone numbers or nonresponse to telephone calls. The New York City COVID-19 Trace program augmented the efforts of telephone-based contact tracers with information gatherers (IGs) to search and obtain telephone numbers or residential addresses, and community engagement specialists (CESs) made home visits to individuals that were not contacted via telephone calls. OBJECTIVE The aim of this study was to assess the contribution of information gathering and home visits to the yields of COVID-19 contact tracing in New York City. METHODS IGs looked for phone numbers or addresses when records were missing phone numbers to locate case-patients or contacts. CESs made home visits to case-patients and contacts with no phone numbers or those who were not reached by telephone-based tracers. Contact tracing management software was used to triage and queue assignments for the telephone-based tracers, IGs, and CESs. We measured the outcomes of contact tracing-related tasks performed by the IGs and CESs from July 2020 to June 2021. RESULTS Of 659,484 cases and 861,566 contact records in the Trace system, 28% (185,485) of cases and 35% (303,550) of contacts were referred to IGs. IGs obtained new phone numbers for 33% (61,804) of case-patients and 11% (31,951) of contacts; 50% (31,019) of the case-patients and 46% (14,604) of the contacts with new phone numbers completed interviews; 25% (167,815) of case-patients and 8% (72,437) of contacts were referred to CESs. CESs attempted 80% (132,781) of case and 69% (49,846) of contact investigations, of which 47% (62,733) and 50% (25,015) respectively, completed interviews. An additional 12,192 contacts were identified following IG investigations and 13,507 following CES interventions. CONCLUSIONS Gathering new or missing locating information and making home visits increased the number of case-patients and contacts interviewed for contact tracing and resulted in additional contacts. When possible, contact tracing programs should add information gathering and home visiting strategies to increase COVID-19 contact tracing coverage and yields as well as promote equity in the delivery of this public health intervention.
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Affiliation(s)
- Chi-Chi N Udeagu
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
| | - Masha Pitiranggon
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
| | - Kavita Misra
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
| | - Jamie Huang
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
| | - Thomas Terilli
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
| | - Yasmin Ramos
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
| | - Martha Alexander
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
| | - Christine Kim
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
| | - David Lee
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
| | - Kathleen Blaney
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
| | - Chris Keeley
- New York City Test & Trace Corps, New York City Health + Hospitals, New York City, NY, United States
| | - Theodore Long
- New York City Test & Trace Corps, New York City Health + Hospitals, New York City, NY, United States
| | - Neil M Vora
- New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, Queens, NY, United States
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Blaney K, Foerster S, Baumgartner J, Benckert M, Blake J, Bray J, Chamany S, Devinney K, Fine A, Gindler M, Guerra L, Johnson A, Keeley C, Lee D, Lipsit M, McKenney S, Misra K, Perl S, Peters D, Ray M, Saad E, Thomas G, Trieu L, Udeagu CC, Watkins J, Wong M, Zielinski L, Long T, Vora NM. COVID-19 Case Investigation and Contact Tracing in New York City, June 1, 2020, to October 31, 2021. JAMA Netw Open 2022; 5:e2239661. [PMID: 36322090 PMCID: PMC9631107 DOI: 10.1001/jamanetworkopen.2022.39661] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Contact tracing is a core strategy for preventing the spread of many infectious diseases of public health concern. Better understanding of the outcomes of contact tracing for COVID-19 as well as the operational opportunities and challenges in establishing a program for a jurisdiction as large as New York City (NYC) is important for the evaluation of this strategy. OBJECTIVE To describe the establishment, scaling, and maintenance of Trace, NYC's contact tracing program, and share data on outcomes during its first 17 months. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included people with laboratory test-confirmed and probable COVID-19 and their contacts in NYC between June 1, 2020, and October 31, 2021. Trace launched on June 1, 2020, and had a workforce of 4147 contact tracers, with the majority of the workforce performing their jobs completely remotely. Data were analyzed in March 2022. MAIN OUTCOMES AND MEASURES Number and proportion of persons with COVID-19 and contacts on whom investigations were attempted and completed; timeliness of interviews relative to symptom onset or exposure for symptomatic cases and contacts, respectively. RESULTS Case investigations were attempted for 941 035 persons. Of those, 840 922 (89.4%) were reached and 711 353 (75.6%) completed an intake interview (women and girls, 358 775 [50.4%]; 60 178 [8.5%] Asian, 110 636 [15.6%] Black, 210 489 [28.3%] Hispanic or Latino, 157 349 [22.1%] White). Interviews were attempted for 1 218 650 contacts. Of those, 904 927 (74.3%) were reached, and 590 333 (48.4%) completed intake (women and girls, 219 261 [37.2%]; 47 403 [8.0%] Asian, 98 916 [16.8%] Black, 177 600 [30.1%] Hispanic or Latino, 116 559 [19.7%] White). Completion rates were consistent over time and resistant to changes related to vaccination as well as isolation and quarantine guidance. Among symptomatic cases, median time from symptom onset to intake completion was 4.7 days; a median 1.4 contacts were identified per case. Median time from contacts' last date of exposure to intake completion was 2.3 days. Among contacts, 30.1% were tested within 14 days of notification. Among cases, 27.8% were known to Trace as contacts. The overall expense for Trace from May 6, 2020, through October 31, 2021, was approximately $600 million. CONCLUSIONS AND RELEVANCE Despite the complexity of developing a contact tracing program in a diverse city with a population of over 8 million people, in this case study we were able to identify 1.4 contacts per case and offer resources to safely isolate and quarantine to over 1 million cases and contacts in this study period.
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Affiliation(s)
- Kathleen Blaney
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Steffen Foerster
- New York City Department of Health and Mental Hygiene, Queens, New York
| | | | | | - Janice Blake
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Jackie Bray
- New York City Health + Hospitals, New York, New York
- Now with New York State Division of Homeland Security and Emergency Services, Albany, New York
| | - Shadi Chamany
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Katelynn Devinney
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Annie Fine
- New York City Department of Health and Mental Hygiene, Queens, New York
- Now with Council of State and Territorial Epidemiologists, Atlanta, Georgia
| | - Masha Gindler
- New York City Health + Hospitals, New York, New York
| | - Laura Guerra
- New York City Health + Hospitals, New York, New York
| | | | - Chris Keeley
- New York City Health + Hospitals, New York, New York
| | - David Lee
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Mia Lipsit
- New York City Health + Hospitals, New York, New York
| | - Sarah McKenney
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Kavita Misra
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Sarah Perl
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Dana Peters
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Madhury Ray
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Eduardo Saad
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Guajira Thomas
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Lisa Trieu
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Chi-Chi Udeagu
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Julian Watkins
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Marcia Wong
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Lindsay Zielinski
- New York City Department of Health and Mental Hygiene, Queens, New York
| | - Theodore Long
- New York City Health + Hospitals, New York, New York
| | - Neil M. Vora
- New York City Department of Health and Mental Hygiene, Queens, New York
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Haddad MB, McLean JE, Feldman SS, Sizemore EE, Taylor MM. Innovative Approaches to COVID-19 Case Investigation and Contact Tracing. Public Health Rep 2022; 137:5S-10S. [PMID: 36113066 PMCID: PMC9483134 DOI: 10.1177/00333549221120454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Maryam B Haddad
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jody E McLean
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sue S Feldman
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin E Sizemore
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melanie M Taylor
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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