Author:
Conderino Sarah,E. Thorpe Lorna,Shilpi Islam Nadia,A. Berry Carolyn,Bendik Stefanie,Massar Rachel,Hong Chuan,Fair Andrew,Bershteyn Anna
Abstract
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.
Publisher
Springer Science and Business Media LLC
Reference35 articles.
1. Keeling MJ, Hollingsworth TD, Read JM. Efficacy of contact tracing for the containment of the 2019 novel coronavirus (COVID-19). J Epidemiol Community Health. 2020;74(10):861–6.
2. Thompson CN, Baumgartner J, Pichardo C, Toro B, Li L, Arciuolo R, et al. COVID-19 outbreak - New York City, February 29-June 1, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(46):1725–9.
3. Madad S, Cagliuoso NVS, Chokshi DA, Allen M, Newton-Dame R. NYC Health + hospitals’ Rapid responses to COVID-19 were built on a Foundation of Emergency Management, Incident Command, and Analytics. Health Affairs Blog; 2020.
4. Medland NA, McMahon JH, Chow EP, Elliott JH, Hoy JF, Fairley CK. The HIV care cascade: a systematic review of data sources, methodology and comparability. J Int AIDS Soc. 2015;18(1):20634.
5. Bershteyn A, Sharma M, Akullian AN, Peebles K, Sarkar S, Braithwaite RS, et al. Impact along the HIV pre-exposure prophylaxis cascade of prevention in western Kenya: a mathematical modelling study. J Int AIDS Soc. 2020;23:e25527.