Building case investigation and contact tracing programs in U.S. state and local health departments: a conceptual framework

Abstract

The COVID-19 pandemic and earlier health events have demonstrated that when effectively implemented, case investigation and contact tracing (CI/CT) can break chains of transmission by promptly identifying, quarantining, and monitoring the contacts of infected cases, thereby limiting further spread of a disease in a community. Many public health experts agree that implementing CI/CT at the early stages of an outbreak can be an extremely effective approach to controlling an outbreak; as such, health departments must have CI/CT capacities in place prior to the detection of an outbreak to ensure readiness to respond. At the onset of the COVID-19 pandemic, and to this day, U.S. state and local public health departments lack comprehensive CI/CT guidelines that clearly define the capabilities, capacities, outcomes, and impacts of CI/CT programs. This research has resulted in the first comprehensive analysis of the goals, capabilities, and capacities of CI/CT programs, as well as a conceptual framework that represents the relationships between these program components and considerations. Our findings highlight the need for further guidance to assist U.S. state and local public health departments in shifting CI/CT program goals as outbreaks evolve. Moreover, training the public health workforce on making decisions around CI/CT program implementation during evolving outbreaks is critical to ensure readiness to respond to a variety of outbreak scenarios.

Lessons learned from the launch and implementation of the COVID-19 contact tracing program in New York City: a qualitative study

“…Frontline staff identi ed preemptively sta ng for surges as an area of improvement. Our ndings reinforce lessons gathered from a narrative literature review and qualitative interviews with US state and local health department o cials and public health experts [10] -case investigation and contact tracing programs need to be able to pivot their goals and practices as an outbreak evolves, including updating procedures, training materials, call scripts, and data systems, and scaling up the workforce as needed.…”

“…Several studies published regarding other COVID-19 contact tracing programs emphasized the importance of public health programs recruiting staff from communities that they seek to serve [9][10][11].…”

Case Investigation and Contact Tracing in US State and Local Public Health Agencies: Sustaining Capacities and Applying Lessons Learned From the COVID-19 Pandemic and 2022 Mpox Outbreak

“…Our earlier research described a narrative literature review to identify the capacities of CI/CT programs. 5 Capacities were bucketed into 3 broad domains—organizational, technical, and social—based on the nature of their function. Once this CI/CT capacity framework was developed, we conducted qualitative interviews between May and August 2022 with officials at US state and local health agencies and public health experts in federal agencies and public health organizations.…”

“…To address the lack of comprehensive guidelines describing the capacities and capabilities of CI/CT programs, our earlier research identified and described the relationships between these capacities and capabilities. 5 Capacities refer to the organizational, technical, and social resources (eg, governance, workforce, technology) that are needed to support a CI/CT program's capabilities. Capabilities are aligned with the goals of a CI/CT program and describe what the program is able to accomplish.…”

“…To date, there has been little guidance around the minimum, baseline capacities that should be maintained in state and local public health agencies on a continuous basis to ensure that programs are able to conduct both routine CI/CT and maintain readiness to scale up these programs during large outbreaks. 5 …”