The state of COVID-19 contact tracing following relaxation of the national lockdown: A qualitative study among surveillance response teams in Kampala, Uganda

Abstract

Introduction: The surge in COVID-19 cases triggered a need for surveillance systems to implement new strategies that augment and accelerate manual contact tracing. In Uganda, COVID-19 cases increased exponentially following the relaxation of the national lockdown. However, little is known about how the surveillance system mitigated COVID-19 transmission during this period. We sought to understand how contact tracing was being conducted in Kampala district following relaxation of the national lockdown. Methods: We conducted a cross-sectional qualitative study, between November and December 2020, among surveillance response officials in the five Divisions of Kampala-Uganda. We purposively selected and interviewed 14 key informants from the Division health offices who included five Division surveillance focal persons, four data analysts and five laboratory personnel. Interviews were audio recorded and transcribed verbatim. We used a conventional approach for content analysis to identify emergent themes. Results: We found that adjustments were made in the contact tracing system to cope with the increasing number of COVID-19 cases. Online and mobile application technology systems including Go-data, WhatsApp, Open Data Kit and City Health Information System were adopted for collection, storage, analysis and reporting of contact tracing data. In one Division, community health workers were trained and engaged. Phone calls were adopted to supplement physical follow-up of contacts. We found managerial barriers such as delays in communication, limited skilled-workforce and insufficient laboratory supplies. Behavioral barriers including lack of cooperation from cases and contacts triggered by perceived stigma affected effective implementation and sustainability of the adjustments in contact tracing. Conclusion: Online systems and engagement of community health workers were adopted to optimize contact tracing coverage in Kampala. There is need to assess the effectiveness and outcomes of digital solutions to contact tracing in resource-limited settings. Besides, clear strategies should be designed to ensure the attainment of gains from community health workers when engaged in surveillance response activities.