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Stakeholders perspective of, and experience with contact tracing for COVID-19 in Ghana: A qualitative study among contact tracers, supervisors, and contacts

Our take —

Qualitative interviews with contact tracers, contact tracing managers, and close contacts being monitored for COVID-19 revealed that limited personal protective equipment, delayed payments to staff, poor coordination between contact tracing and laboratory activities in a centralized system, and patient-level factors (i.e., limited resources for self-quarantine, anticipated stigma) posed early implementation challenges in Ghana’s SARS-CoV-2 contact tracing program. Findings from this study are likely not transferable to other contexts, particularly as the COVID-19 burden has increased in Ghana since April 2020.

Study design

Other

Study population and setting

Between April 6 and 26th, 2020, 27 in-depth interviews were conducted with SARS-CoV-2 contact tracers, contact tracing supervisors, and close contacts under investigation for COVID-19 in the Greater Accra Region of Ghana. Interview transcripts were analyzed thematically to explore experiences implementing and participating in a national contact tracing program implemented in Ghana following its first confirmed case of SARS-CoV-2 on March 12, 2020.

Summary of Main Findings

Contact tracers including qualified health professionals (i.e., epidemiologists, district health officers), were rapidly trained in COVID-19 contact tracing, and deployed in pairs into communities when conducting contact tracing. Primary motivations for complying with quarantine recommendations reported by identified contacts and contact tracers included lockdowns, preventing onward SARS-CoV-2 transmission, and perceived stigma towards those infected with SARS-CoV-2. Quarantine compliance, however, was challenged by limited household resources (i.e. income, food/water) to support self-quarantine, internalized disease stigma by being visited daily by contact tracers, and delays in receiving SARS-CoV-2 test results, which demotivated testing among close contacts and resulted in close contacts questioning the legitimacy of delayed test results. Barriers to effective implementation of contact tracing included limited provision of personal protective equipment (PPE) for contact tracers, delayed salary payments to staff, and suboptimal coordination between contact tracing activities and laboratory testing.

Study Strengths

Investigators interviewed managers and field staff, as well as close contacts being monitored for COVID-19, to more explore different dimensions of and parallel experiences with Ghana’s national contact tracing program for SARS-CoV-2.

Limitations

Results principally focused on describing contact tracing procedures and summarizing experiences implementing contact tracing, rather than outlining solutions adopted to respond to emerging contact tracing challenges and comparing perspectives across participants. Because all interviews were conducted in early April 2020 (during the early stage of Ghana’s COVID-19 epidemic), insights gleaned from interviews may not reflect the experiences implementing contact tracing at later stages in the epidemic, when COVID-19 case burdens were higher. Interviews were also all conducted in a single metropolitan area in Ghana, and results may not be transferable to other regions in Ghana. Fewer than seven interviews were conducted with close contacts being monitored for COVID-19 and contact tracing supervisors, respectively, raising concerns about sufficient thematic saturation within these participant subgroups. Lastly, investigators did not include any index COVID-19 cases in their sampling plan, which could have supplemented perspectives from the participant subgroups actually included in the study.

Value added

This is among the first studies to qualitatively examine early experiences implementing contact tracing for SARS-CoV-2 in sub-Saharan Africa.

This review was posted on: 12 March 2021