Regulation, Evaluation, and Governance Lab, Stanford University, Stanford, California, United States of America.
County of Santa Clara Public Health Department, San Jose, California, United States of America.
PLoS One. 2023 May 16;18(5):e0285752. doi: 10.1371/journal.pone.0285752. eCollection 2023.
COVID-19 exposed and exacerbated health disparities, and a core challenge has been how to adapt pandemic response and public health in light of these disproportionate health burdens. Responding to this challenge, the County of Santa Clara Public Health Department designed a model of "high-touch" contact tracing that integrated social services with disease investigation, providing continued support and resource linkage for clients from structurally vulnerable communities. We report results from a cluster randomized trial of 5,430 cases from February to May 2021 to assess the ability of high-touch contact tracing to aid with isolation and quarantine. Using individual-level data on resource referral and uptake outcomes, we find that the intervention, randomized assignment to the high-touch program, increased the referral rate to social services by 8.4% (95% confidence interval, 0.8%-15.9%) and the uptake rate by 4.9% (-0.2%-10.0%), with the most pronounced increases in referrals and uptake of food assistance. These findings demonstrate that social services can be effectively combined with contact tracing to better promote health equity, demonstrating a novel path for the future of public health.
新冠疫情暴露并加剧了健康不平等现象，核心挑战之一是如何根据这些不成比例的健康负担来调整大流行应对和公共卫生措施。为应对这一挑战，圣克拉拉县公共卫生部设计了一种“高接触”接触者追踪模式，将社会服务与疾病调查相结合，为来自结构脆弱社区的客户提供持续支持和资源联系。我们报告了 2021 年 2 月至 5 月期间对 5430 例病例进行的一项集群随机试验的结果，以评估高接触接触者追踪在隔离和检疫方面的辅助能力。使用资源转介和采用结果的个体水平数据，我们发现干预措施（随机分配到高接触计划）将社会服务转介率提高了 8.4%（95%置信区间，0.8%-15.9%），采用率提高了 4.9%（-0.2%-10.0%），其中食品援助的转介和采用率增幅最大。这些发现表明，可以有效地将社会服务与接触者追踪相结合，以更好地促进健康公平，为公共卫生的未来展示了一条新途径。
