Centering Health Equity Within COVID-19 Contact Tracing: Connecticut's Community Outreach Specialist Program

Abstract

Context: The COVID-19 pandemic has disproportionately impacted vulnerable populations, including those who are non–English-speaking and those with lower socioeconomic status; yet, participation of these groups in contact tracing was initially low. Distrust of government agencies, anticipated COVID-19–related stigma, and language and cultural barriers between contact tracers and communities are common challenges. Program: The Community Outreach Specialist (COS) program was established within the Connecticut Department of Public Health (DPH) COVID-19 contact tracing program to encourage participation in contact tracing and address a need for culturally competent care and social and material support among socially vulnerable and non–English-speaking populations in 11 high-burden jurisdictions in Connecticut. Implementation: In partnership with state and local health departments, we recruited 25 COS workers with relevant language skills from target communities and trained them to deliver contact tracing services to vulnerable and non–English speaking populations. Evaluation: We conducted a cross-sectional analysis using data from ContaCT, DPH's enterprise contact tracing system. Overall, the COS program enrolled 1938 cases and 492 contacts. The proportion of residents reached (ie, called and interviewed) in the COS program was higher than that in the regular contact tracing program for both cases (70% vs 57%, P < .001) and contacts (84% vs 64%, P < .001). After adjusting for client age, sex, race and ethnicity, language, and jurisdiction, we found that the COS program was associated with increased reach for 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). Rapid qualitative analysis of programmatic field notes and meeting reports provided evidence that the COS program was feasible and acceptable to clients and contributed to COVID-19 education and communication efforts. Conclusion: A COS program employing a client-centered, community-engaged strategy for reaching vulnerable and non–English-speaking populations was feasible and more effective at reaching contacts than standard COVID-19 contact tracing.

“I can’t do it”: A qualitative study exploring case and contact experiences with COVID-19 contact tracing

“…We also found that initiating tracing through known healthcare professionals or using Caller ID and addressing privacy concerns reinforced credibility and built trust, while redundant or uncoordinated efforts did the opposite. Potential interventions to increase trust in contact tracing indirectly supported by our analysis include hiring community members as contact tracers [38] and using peer-and provider-driven messaging campaigns to educate on the safety and purpose of contact tracing.…”

A Scoping Review of Health Equity Interventions in Governmental Public Health

“…Intervention settings included the physical locations where the intervention was conducted. These 29,32,[44][45][46][47]54,57 (2) community setting, 22,23,26,28,31,[33][34][35]39,40,42,43,48,51,52,55 (3) correctional facility, 30 (4) home-based delivery, 24,27,60 (5) mobile clinics, 36,37,49,50 (6) not-reported, 53,56 and (8) virtual setting. 25,38,41,58,59 Intervention delivery agent…”

“…Intervention components were strategies and tactics that interventions used to reach populations and effect change. These included: (1) health education training,22-29 (2) free/affordable care,30-36 (3) social media/social networks,37-42 (4) training providers,43-48 (5) data-driven strategy,49-52 (6) structural/policy change,53-56(7) phone-based interventions,57-59 and (8) environmental change 60. Some articles used multiple tactics to reach populations.…”

“…Cancer screening (n = 3). 23,29,30 Lastly, 3 interventions focused on cancer screening. An example of a cancer screening intervention led by an LHD was a screening for colon cancer in a correctional facility, which implemented an annual colorectal cancer screening for sentenced people using fecal immunochemical testing 30…”

“…Intervention components were strategies and tactics that interventions used to reach populations and effect change. These included: (1) health education training, [22][23][24][25][26][27][28][29] (2) free/affordable care, [30][31][32][33][34][35][36] (3) social media/social networks, 37-42 (4) training providers, [43][44][45][46][47][48] (5) data-driven strategy, [49][50][51][52] (6) structural/policy change, [53][54][55][56] (7) phonebased interventions, [57][58][59] and (8) environmental change.-60 Some articles used multiple tactics to reach populations. However, for our analysis and Figure 1, we categorized each article using the primary strategy used in intervention; categories are mutually exclusive.…”