Moore Kyler N, Bircher Patrick M, Ogutu Emily A, Kennedy Shanika S, Brown Victoria M, Freeman Matthew C, Phillips Victoria L, Spaulding Anne C, Akiyama Matthew J
Albert Einstein College of Medicine, Emory University Atlanta Georgia United States, 3300 Kossuth Ave, Bronx, NY, USA.
Emory Unversity, Atlanta, GA, USA.
BMC Public Health. 2025 Apr 7;25(1):1299. doi: 10.1186/s12889-025-22015-9.
Implementing public health interventions can be challenging in carceral settings. Jails are institutions with the shortest lengths of stay, resulting in frequent turnover and constantly shifting populations. Jails had particularly acute challenges during the early stages of the COVID-19 pandemic when incarcerated persons were highly susceptible to infection and severe disease. The purpose of this study was to identify barriers and facilitators to wastewater-based surveillance (WBS) and nasal self-testing (NST) as a combined strategy of COVID-19 surveillance in Fulton County Jail (FCJ), Atlanta, Georgia. Implications for efficient and effective infectious disease testing among this susceptible population are relevant for ongoing surveillance of current endemic pathogens and future epidemics.
We utilized a multilevel, theory-informed qualitative approach to conduct semi-structured one-on-one and small group interviews with nine distinct jail stakeholder groups: jail custody leadership, administrators, officers, maintenance workers, Georgia Department of Health's COVID-19 testing contractor, jail health care leaders, nursing staff, laboratory leadership, and staff. Interview guides and analyses were informed by the Consolidated Framework for Implementation Research (CFIR). We used Applied Thematic Analysis to identify domains within CFIR reflecting barriers and facilitators to WBS combined with NST in large urban jail settings.
Twelve interviews were conducted with administrative, healthcare, maintenance, custody, and laboratory personnel from July 2022 to November 2022. Seven CFIR constructs were identified as barriers, sixteen as facilitators, and one as a neutral factor for the implementation of WBS combined with NST. Jail stakeholders underscored the relative advantage of self-testing, highlighted limited resources, and expressed concerns for the sustainability of WBS due to competing priorities. Many of the stakeholders within the jail setting that were interviewed had hierarchical organizational structures, which made decision-making processes regarding WBS and NST complex and challenging to implement.
Given the political, structural, and organizational factors in a jail setting, innovations such as NST and WBS require a rigorous implementation strategy supported by ongoing engagement and collaboration with a multitude of stakeholders.
在监狱环境中实施公共卫生干预措施可能具有挑战性。监狱是关押时间最短的机构，人员流动频繁，人口不断变化。在新冠疫情早期，监狱面临着尤为严峻的挑战，因为被监禁人员极易感染并患上重症。本研究的目的是确定基于废水监测（WBS）和鼻拭子自我检测（NST）作为佐治亚州亚特兰大富尔顿县监狱（FCJ）新冠监测联合策略的障碍和促进因素。对于这一易感人群进行高效且有效的传染病检测，对当前流行病原体的持续监测和未来疫情防控具有重要意义。
我们采用了一种多层次、理论指导的定性方法，对九个不同的监狱利益相关者群体进行了半结构化一对一和小组访谈：监狱监管领导、管理人员、警官、维修工人、佐治亚州卫生部的新冠检测承包商、监狱医疗保健领导、护理人员、实验室领导和工作人员。访谈指南和分析以实施研究综合框架（CFIR）为依据。我们运用应用主题分析法，在CFIR中确定反映大城市监狱环境中WBS结合NST的障碍和促进因素的领域。
2022年7月至2022年11月期间，我们对行政、医疗、维修、监管和实验室人员进行了12次访谈。确定了七个CFIR构建因素为WBS结合NST实施的障碍，十六个为促进因素，一个为中性因素。监狱利益相关者强调了自我检测的相对优势，突出了资源有限的问题，并对由于优先事项相互竞争导致的WBS可持续性表示担忧。接受访谈的许多监狱环境中的利益相关者具有层级组织结构，这使得关于WBS和NST的决策过程复杂且难以实施。
鉴于监狱环境中的政治、结构和组织因素，诸如NST和WBS等创新需要一项严格的实施策略，并通过与众多利益相关者持续接触与合作来提供支持。
