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Self-administered home-based tests are increasingly used as the primary method to detect SARS-CoV-2, the virus that causes COVID-19 (1). In contrast to tests performed at a public health department, laboratory, [...]

Objective: Case investigation and contact tracing (CI/CT) are fundamental public health efforts widely used during the COVID-19 pandemic to mitigate transmission. This study investigated how state, local, and tribal public health departments used CI/CT during the COVID-19 pandemic, including CI/CT methodology, staffing models, training and support, and efforts to identify or prioritize populations disproportionately affected by COVID-19. Methods: During March and April 2022, we conducted key informant interviews with up to 3 public health officials from 43 state, local, and tribal public health departments. From audio-recorded and transcribed interviews, we used the framework method to analyze key themes. Results: Major adjustments to CI/CT protocols during the pandemic included (1) prioritizing populations for outreach; (2) implementing automated outreach for nonprioritized groups, particularly during COVID-19 surges; (3) discontinuing contact tracing and focusing exclusively on case investigation; and (4) adding innovations to provide additional support. Key informants also discussed the utility of having backup staffing to support overwhelmed public health departments and spoke to the difficulty in "right-sizing" the public health workforce, with COVID-19 surges leaving public health departments understaffed as case rates rose and overstaffed as case rates fell. Conclusions: When addressing future epidemics or outbreaks, public health officials should consider strategies that improve the effectiveness of CI/CT efforts over time, such as prioritizing populations based on disproportionate risk, implementing automated outreach, developing models that provide flexible additional staffing resources as cases rise and fall among local public health departments, incorporating demographic data in laboratory reporting, providing community connections and support, and having a system of self-notification of contacts. [ABSTRACT FROM AUTHOR]

Objective To evaluate changes in Ebola-related knowledge, attitudes and prevention practices during the Sierra Leone outbreak between 2014 and 2015. Methods Four cluster surveys were conducted: two before the outbreak peak (3499 participants) and two after (7104 participants). We assessed the effect of temporal and geographical factors on 16 knowledge, attitude and practice outcomes. Findings Fourteen of 16 knowledge, attitude and prevention practice outcomes improved across all regions from before to after the outbreak peak. The proportion of respondents willing to: (i) welcome Ebola survivors back into the community increased from 60.0% to 89.4% (adjusted odds ratio, aOR: 6.0; 95% confidence interval, CI: 3.9-9.1); and (ii) wait for a burial team following a relative's death increased from 86.0% to 95.9% (aOR: 4.4; 95% CI: 3.2-6.0). The proportion avoiding unsafe traditional burials increased from 27.3% to 48.2% (aOR: 3.1; 95% CI: 2.4-4.2) and the proportion believing spiritual healers can treat Ebola decreased from 15.9% to 5.0% (aOR: 0.2; 95% CI: 0.1-0.3). The likelihood respondents would wait for burial teams increased more in high-transmission (aOR: 6.2; 95% CI: 4.2-9.1) than low- transmission (aOR: 2.3; 95% CI: 1.4-3.8) regions. Self-reported avoidance of physical contact with corpses increased in high but not low-transmission regions, aOR: 1.9 (95% CI: 1.4-2.5) and aOR: 0.8 (95% CI: 0.6-1.2), respectively. Conclusion Ebola knowledge, attitudes and prevention practices improved during the Sierra Leone outbreak, especially in high-transmission regions. Behaviourally-targeted community engagement should be prioritized early during outbreaks. [phrase omitted] [phrase omitted] Objectif Evaluer l'evolution des connaissances, attitudes et techniques de prevention en matiere d'Ebola durant l'epidemie qui a touche la Sierra Leone entre 2014 et 2015. Methodes Quatre enquetes en grappes ont ete menees: deux avant le pic de l'epidemie (3499 participants) et deux apres (7104 participants). Nous avons mesure l'impact des facteurs geographiques et temporels sur 16 resultats lies aux connaissances, aux attitudes et aux techniques de prevention. Resultats Quatorze des seize resultats lies aux connaissances, aux attitudes et aux techniques de prevention ont progresse dans toutes les regions entre la periode avant le pic et celle apres le pic. La proportion de repondants disposes a: (i) accueillir les survivants a Ebola de retour dans leur communaute est passee de 60,0% a 89,4% (odds ratio ajuste, ORA: 6,0; intervalle de confiance de 95%, IC: 3,9-9,1); et (ii) attendre l'equipe d'inhumation apres la mort d'un proche a egalement augmente, passant de 86,0% a 95,9% (ORA: 4,4; IC de 95%: 3,2-6,0). La proportion de repondants ayant abandonne la pratique risquee des funerailles traditionnelles est passee de 27,3% a 48,2% (ORA: 3,1; IC de 95%: 2,4-4,2), tandis que celle convaincue de l'efficacite des guerisseurs spirituels pour traiter Ebola a diminue, passant de 15,9% a 5,0% (ORA: 0,2; IC de 95%: 0,1-03). La probabilite que les repondants attendent les equipes d'inhumation a augmente dans les regions a haut risque de transmission (ORA: 6,2; IC de 95%: 4,2-9,1), plus que dans les regions a faible risque de transmission (ORA: 2,3; IC de 95%: 1,4-3,8). Les repondants declarent avoir davantage evite tout contact physique avec les corps dans les regions a haut risque de transmission, mais pas dans les regions a faible risque de transmission (ORA: 1,9; IC de 95%: 1,4--2,5 et ORA: 0,8; IC de 95%: 0,6-1,2). Conclusion Les connaissances, attitudes et techniques de prevention en matiere d'Ebola ont evolue durant l'epidemie qui a touche la Sierra Leone, surtout dans les regions a haut risque de transmission. Il faut privilegier l'engagement communautaire axe sur le comportement des les premiers stades de l'epidemie. [phrase omitted] Objetivo Evaluar los cambios en los conocimientos, las actitudes y las practicas de prevencion relacionadas con el ebola durante el brote ocurrido en Sierra Leona entre 2014 y 2015. Metodos Se realizaron cuatro encuestas por conglomerados: dos antes del pico del brote (3499 participantes) y dos despues (7104 participantes). Se evaluo el efecto de los factores temporales y geograficos en 16 resultados de conocimientos, actitudes y practicas de prevencion. Resultados 14 de 16 resultados de conocimientos, actitudes y practicas de prevencion mejoraron en todas las regiones desde antes hasta despues del pico del brote. El porcentaje de los encuestados dispuestos a: (i) acoger a los supervivientes del ebola en la comunidad aumento del 60,0 % al 89,4 % (proporcion de probabilidad ajustada, aOR: 6,0; intervalo de confianza del 95 %, IC: 3,9-9,1); y (ii) esperar al servicio funerario tras la muerte de un familiar aumento del 86,0 % al 95,9 % (aOR: 4,4; IC del 95 %: 3,2-6,0). El porcentaje de personas que evitaron los entierros tradicionales inseguros aumento del 27,3 % al 48,2 % (aOR: 3,1; IC del 95 %: 2,4-4,2) y el porcentaje de personas que creen que los sanadores espirituales pueden tratar el ebola disminuyo del 15,9 % al 5,0 % (aOR: 0,2; IC del 95 %: 0,1-03). La probabilidad de que los encuestados esperan a los servicios funerarios aumento mas en las regiones de alta transmision (aOR: 6,2; IC del 95 %: 4,2-9,1) que en las de baja transmision (aOR: 2,3; IC del 95 %: 1,4-3,8). Segun los reportes de los mismos encuestados, se evito mas el contacto fisico con los cadaveres en las regiones de alta pero no de baja transmision, aOR: 1,9 (IC del 95 %: 1,4-2,5) y aOR: 0,8 (IC del 95 %: 0,6-1,2), respectivamente. Conclusion Los conocimientos, las actitudes y las practicas de prevencion del ebola mejoraron durante el brote en Sierra Leona, en especial en las regiones de alta transmision. Se debe dar prioridad a la participacion de la comunidad orientada al comportamiento en las primeras etapas de los brotes., Introduction The 2013-2016 Ebola virus disease outbreak in West Africa mostly affected Guinea, Liberia and Sierra Leone. In Sierra Leone, over 14 000 cases of Ebola and about 4000 deaths [...]

Background Public health programs varied in ability to reach people with coronavirus disease 2019 (COVID-19) and their contacts to encourage separation from others. For both adult case patients with COVID-19 and their contacts, we estimated the impact of contact tracing activities on separation behaviors from January 2020 until March 2022. Methods We used a probability-based panel survey of a nationally representative sample to gather data for estimates and comparisons. Results An estimated 64 255 351 adults reported a positive severe acute respiratory syndrome coronavirus 2 test result; 79.6% isolated for ≥5 days, 60.2% isolated for ≥10 days, and 79.2% self-notified contacts. A total of, 24 057 139 (37.7%) completed a case investigation, and 46.2% of them reported contacts to health officials. More adults who completed a case investigation isolated than those who did not complete a case investigation (≥5 days, 82.6% vs 78.2%, respectively; ≥10 days, 69.8% vs 54.8%; both P <.05). A total of 84 946 636 adults were contacts of a COVID-19 case patient. Of these, 73.1% learned of their exposure directly from a case patient; 49.4% quarantined for ≥5 days, 18.7% quarantined for ≥14 days, and 13.5% completed a contact tracing call. More quarantined among those who completed a contact tracing call than among those who did not complete a tracing call (≥5 days, 61.2% vs 48.5%, respectively; ≥14 days, 25.2% vs 18.0%; both P <.05). Conclusions Engagement in contact tracing was positively correlated with isolation and quarantine. However, most adults with COVID-19 isolated and self-notified contacts regardless of whether the public health workforce was able to reach them. Identifying and reaching contacts was challenging and limited the ability to promote quarantining, and testing. [ABSTRACT FROM AUTHOR]

Despite the disproportionate burden of HIV among transgender people in the United States, few HIV-related communication materials exist for transgender people or their healthcare providers. Our goal was to understand the barriers and facilitators transgender people face in accessing HIV prevention, testing, and care services and the potential implications for message development and dissemination. We reviewed the literature and interviewed nine key informants representing healthcare and service providers, researchers, and transgender advocates. Healthcare providers who care for transgender patients often demonstrate a lack of transgender competent care strategies. In addition, transgender people face many barriers to accessing HIV services. Although communication materials cannot address many of these barriers, materials specifically developed for transgender people and their healthcare providers would fill a gap and may increase uptake of HIV services. Materials for transgender people should include gender-affirming messaging and imagery, be framed in terms of resiliency, and present HIV information tailored to the needs of transgender people. Materials for healthcare providers should provide basic information to increase transgender competency and provision of comprehensive healthcare for transgender patients, inclusive of gender-affirming and HIV prevention, testing and care services. Channels for disseminating materials to transgender people and healthcare providers are described. [ABSTRACT FROM AUTHOR]

The article discusses the support given to survivors of Ebola virus outbreaks in Sierra Leone as of December 2014. Topics discussed include the role of the Sierra Leone Ebola Emergency Operations Psychosocial Consortium to the survivors of Ebola virus disease, methods used in assessing the needs of survivors, and ways survivors showed interest in the support they received.

The Think. Test. Treat TB health communications campaign aims to increase the awareness of latent tuberculosis infection (LTBI) primarily among people born in the Philippines and Vietnam and other non–US-born groups (consumers) and the health care providers (providers) who serve them. We conducted a process evaluation to assess reach and audience engagement and an outcome evaluation to assess awareness, knowledge, perceptions, and behavioral intentions among audiences of the campaign.To evaluate the process, the Centers for Disease Control and Prevention measured exposure to (eg, with impressions [total advertisements]) and engagement with (eg, online clicks) the campaign during its rollout (March–September 2022). After the rollout, to evaluate outcomes, we administered online surveys to consumers and providers who were exposed and not exposed to the campaign.The Think. Test. Treat TB campaign resulted in >33 million impressions, >2000 materials downloaded from the internet, and >33 000 materials shipped. Of 173 consumers who completed the evaluation survey, 123 (71.1%) were exposed to the campaign, with 108 (87.8%) reporting intention to ask their provider about tuberculosis (TB) during their next visit. Of 44 providers who completed the evaluation survey, 24 (54.5%) did not feel that they were the intended audience of the campaign, yet all felt the campaign materials were relevant to their patients, and 42 (95.5%) felt the materials were relevant to providers who serve patients at risk for TB.The Think. Test. Treat TB campaign was successful in raising awareness of LTBI among the intended audiences. Continuing engagement with key audiences about LTBI to encourage testing and treatment is integral to eliminate TB in the United States. [ABSTRACT FROM AUTHOR]

CDC recommends testing persons at increased risk for tuberculosis (TB) infection as part of routine health care, using TB blood tests, when possible, and, if a diagnosis of latent TB infection (LTBI) is made, prescribing a rifamycin-based, 3- or 4-month treatment regimen (short-course) to prevent the development of TB disease. In 2022, approximately three quarters (73%) of reported TB cases in the United States occurred among non-U.S.-born persons. To assess TB-related practices among health care providers (HCPs) in the United States, CDC analyzed data from the 2020-2022 Porter Novelli DocStyles surveys. Approximately one half (53.3%) of HCPs reported routinely testing non-U.S.-born patients for TB, and of those who did, 35.7% exclusively ordered recommended blood tests, 44.2% exclusively ordered skin tests, and 20.2% ordered TB skin tests and blood tests. One third (33.0%) of HCPs reported prescribing recommended short-course LTBI treatment regimens, and 4.0% reported doing none of the treatment practices available for patients with LTBI (i.e., prescribing short-course regimens, longer course regimens, or referring patients to a health department). Further efforts are needed to identify and overcome barriers for providers to test for and treat persons at risk for TB., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Case investigation and contact tracing (CI/CT) is a critical part of the public health response to COVID-19. Individuals' experiences with CI/CT for COVID-19 varied based on geographic location, changes in knowledge and guidelines, access to testing and vaccination, as well as demographic characteristics including age, race, ethnicity, income, and political ideology. In this paper, we explore the experiences and behaviors of adults with positive SARS-CoV-2 test results, or who were exposed to a person with COVID-19, to understand their knowledge, motivations, and facilitators and barriers to their actions. We conducted focus groups and one-on-one interviews with 94 cases and 90 contacts from across the United States. We found that participants were concerned about infecting or exposing others, which motivated them to isolate or quarantine, notify contacts, and get tested. Although most cases and contacts were not contacted by CI/CT professionals, those who were reported a positive experience and received helpful information. Many cases and contacts reported seeking information from family, friends, health care providers, as well as television news and Internet sources. Although participants reported similar perspectives and experiences across demographic characteristics, some highlighted inequities in receiving COVID-19 information and resources., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

As of December 6, 2014, Sierra Leone reported 6,317 laboratory-confirmed cases of Ebola virus disease (Ebola), the highest number of reported cases in the current West Africa epidemic. The Sierra Leone Ministry of Health and Sanitation reported that as of December 6, 2014, there were 1,181 persons who had survived and were discharged. Survivors from previous Ebola outbreaks have reported major barriers to resuming normal lives after release from treatment, such as emotional distress, health issues, loss of possessions, and difficulty regaining their livelihoods. In August 2014, a knowledge, attitude, and practice survey regarding the Ebola outbreak in Sierra Leone, administered by a consortium of partners that included the Ministry of Health and Sanitation, UNICEF, CDC, and a local nongovernmental organization, Focus 1000, found that 96% of the general population respondents reported some discriminatory attitude towards persons with suspected or known Ebola. Access to increased psychosocial support, provision of goods, and family and community reunification programs might reduce these barriers. Survivors also have unique potential to contribute to the Ebola response, particularly because survivors might have some immunity to the same virus strain. In previous outbreaks, survivors served as burial team members, contact tracers, and community educators promoting messages that seeking treatment improves the chances for survival and that persons who survived Ebola can help their communities. As caregivers in Ebola treatment units, survivors have encouraged patients to stay hydrated and eat and inspired them to believe that they, too, can survive. Survivors regaining livelihood through participation in the response might offset the stigma associated with Ebola.