Centering Health Equity in COVID-19 Contact Tracing in Connecticut

Recruiting a community workforce that reflects the cultural and linguistic traditions of targeted populations can help increase community engagement, build trust, and improve the reach of state contact tracing programs. Read our article “Centering Health Equity Within COVID-19 Contact Tracing: Connecticut’s Community Outreach Specialist Program” in the Journal of Public Health Management and Practice.

Early in the COVID-19 pandemic, contact tracing was identified as one of the most promising public health interventions for reducing community transmission. In this intervention, contact tracers representing public health agencies or health systems attempt (1) to reach newly diagnosed patients (“cases”) to identify and notify their close contacts from the two weeks prior to diagnosis onset of symptoms, then (2) advise these cases and their close contacts to isolate/quarantine to reduce transmission. Early studies showed that early and effective contact tracing can significantly reduce the rate of viral reproduction, leading to reduced incidence and mortality. Over time, implementation has become more difficult due to more infectious variants of SARS-COV2, greater social mixing, shorter latency between infection and disease, decreased resources for contact tracing and overall pandemic fatigue. As a result, contact tracing no longer seemed effective in reducing COVID-19 incidence and mortality. However, less is known about the impact of contact tracers on other key public health functions, including educating households about COVID-19 and connecting vulnerable individuals and families with social support. and material. The food, housing and income assistance provided through these programs has been widely appreciated to help alleviate pandemic-related health and socio-economic disparities and enable residents to self-isolate and quarantine. safely.

Although contact tracing sounds simple, doing it effectively presents several well-documented challenges. First of all, getting someone to answer a call from an unknown number can be tricky. A 2020 Pew Research survey found that only 19% of US adults accept calls from unknown numbers and >90% believe callers “sometimes” or “often” try to steal their personal information over the phone. Similarly, distrust of government institutions often limits acceptance and participation in contact tracing. The trust gap is particularly pronounced in minority communities, where historical rights violations by state entities and health institutions fuel the lingering suspicion of outreach. Even when cases respond to such calls, distrust and COVID-related stigma can prevent the disclosure of critical information about themselves or their contacts. Finally, language and cultural barriers compound many of the above challenges.

Our Connecticut Department of Public Health Contact Tracing Program team sought to address these challenges by introducing the Community Outreach Specialist (COS) program. Designed to engage and support the most vulnerable and disproportionately affected communities in the state, the program trained and employed a community contact tracing workforce recruited directly from affected communities.

What the COS program did:

In partnership with local health departments and community leaders, we have identified 11 high-needs jurisdictions across the state, with high proportions of individuals from Spanish, Portuguese, Polish or Haitian Creole speaking communities. We hired 25 bilingual contact tracers who lived in these 11 jurisdictions and trained them to provide culturally appropriate contact tracing services to residents who spoke the same language and lived in the same communities. As many of these residents also had unmet needs that affected their ability to safely quarantine or isolate (e.g., food, healthcare, housing), COS workers also provided “warm transfers” to social service providers, in which they directly linked residents to providers, provided translation services and advocated on their behalf. Finally, COS workers created and facilitated health education and awareness activities, including a mass media campaign promoting contact tracing and community health educational workshops focused on COVID-19 prevention. 19.

What we found:

We conducted an evaluation of the program’s processes over the period of December 2020 to May 2021, using quantitative data from Connecticut’s Contact Tracing Management Software Platform and qualitative documentary evidence, including programmatic reports routine. Through this evaluation, we learned:

  1. The COS program has increased our ability to reach our contacts

We were particularly interested in seeing if the COS program improved our ability to reach and interview COVID-19 cases and their contacts. After adjusting for client age, gender, race/ethnicity, language, and jurisdiction, the COS program was associated with increased reach of contacts (odds ratio [OR] = 1.52; 95% confidence interval [95% CI], 1.17-1.99) but not for cases (OR = 0.78; 95% CI, 0.70-0.88). Our results suggest that COS workers were able to draw on a common language or culture and knowledge of their own communities to better engage vulnerable and non-English speaking residents, build trust, and encourage contact participation in research. State DPH contacts. program.

  1. The COS program was feasible and acceptable to residents of the target communities

COS workers reported that their services were well received and highly appreciated by residents. Residents served by COS workers often told them that they felt more comfortable talking to someone in their native language who shared a similar cultural background. COS workers also reported that “warm transfers” were key to connecting vulnerable residents to needed services, especially for undocumented residents who feared being detained by law enforcement after accessing these resources. . Finally, COS’ communication and education efforts have been well received in the target communities.

To advance

Through our evaluation, we found that recruiting a community workforce that reflected the cultural and linguistic traditions of the target populations proved to be a feasible, acceptable and effective strategy to increase community engagement, strengthen trust and improve reach within the state. tracing program. This culturally appropriate outreach model can help build the long-term skills and workforce capacity of residents, obviating the need for costly external consultants who are not drawn from the communities. We recommend that future contact tracing programs adopt, expand, and evaluate similar models.

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Dr. Kelly Johnson is a research fellow at the Global Health Justice Partnership at Yale Law School. She previously served as the Health Equity Manager for Connecticut’s DPH Contact Tracing Program, where she led the Community Outreach Specialist Program. His research focuses on increasing health equity among marginalized populations.

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Dr. Luke Davis is an epidemiologist and pulmonologist and associate professor at the Yale School of Public Health and the Yale School of Medicine. His research uses implementation science to improve the care and prevention of tuberculosis and other respiratory infections in resource-limited settings.