Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda

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  • 1 Department of Medicine and Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa;
  • 2 Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania;
  • 3 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
  • 4 Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland;
  • 5 Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria;
  • 6 Office of the Director-General, Nigeria Centre for Disease Control, Abuja, Nigeria;
  • 7 International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria;
  • 8 Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland;
  • 9 Department of Pediatrics and Child Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana;
  • 10 Department of Nursing, University of Ibadan, Ibadan, Nigeria;
  • 11 Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda;
  • 12 University of Rwanda, School of Public Health, Kigali, Rwanda;
  • 13 School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana;
  • 14 South African Department of Health, Western Cape Province, Cape Town, South Africa;
  • 15 Division of Health Systems and Public Health, Department of Global Health, Stellenbosch Faculty of Medicine and Health Sciences and Western Cape Department of Health, Cape Town, South Africa;
  • 16 Discipline of Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa;
  • 17 Uganda National Institute of Public Health, Ministry of Health, Kampala, Uganda;
  • 18 African Centre for Global Health and Social Transformation, Kampala, Uganda;
  • 19 Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda;
  • 20 Fogarty International Center, National Institutes of Health, Bethesda, Maryland;
  • 21 University of California San Francisco, San Francisco, California;
  • 22 Division of Infection and Immunity, University College London, London, United Kingdom;
  • 23 NIHR Biomedical Research Centre, University College London Hospitals, London, United Kingdom

Most African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload.

Author Notes

Address correspondence to Jean B. Nachega, Stellenbosch University Faculty of Medicine and Health Science Department of Medicine and Centre for Infectious Diseases, Clinical Bldg, Rm 3149, Francie Van Zjil Drive 1, Parow 7505 Cape Town, South Africa, E-mail: jnachega@sun.ac.za or Peter H. Kilmarx, Fogarty International Center/National Institutes of Health, 31 Center Dr., Bethesda, MD 20892, E-mail: peter.kilmarx@nih.gov.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the official positions of their institutions.

Disclosure: Nachega is an infectious disease internist and epidemiologist and, along with Prisca Adejumo, Fatima Suleman, and Nelson K. Sewankambo, is supported by the NIH/FIC grant number 1R25TW011217-01 (African Association for Health Professions Education and Research). Nachega is also supported by NIH/ FIC grants 1D43TW010937-01A1 (the University of Pittsburgh HIV-Comorbidities Research Training Program in South Africa); and 1R21TW011706-01 (Cardiometabolic Outcomes, Mechanisms, and approach to prevention of Dolutegravir Associated Weight Gain in South Africa). He serves on the scientific program committee of the American Society of Tropical Medicine and Hygiene (ASTMH) and is a senior fellow alumnus of the European Developing Countries Clinical Trial Partnership (EDCTP). Sam-Agudu is a clinician-scientist and implementation researcher in Pediatric Infectious Diseases, supported by the NIH National Institute of Child Health and Human Development (NICHD) grant R01HD089866 and by an NIH/Fogarty International Center (FIC) award through the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA), for the Central and West Africa Implementation Science Alliance (CAWISA). Sir Zumla is an AFREhealth Member and co-Principal Investigator of the Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET–https://www.pandora-id.net/) funded by the European and Developing Countries Clinical Trials Partnership the EU Horizon 2020 Framework Program. Also, Sir Zumla is in receipt of a UK-National Institutes of Health Research senior investigator award and is a 2020 Mahathir Science Award Laureate. Omaswa is Chair of the Uganda National Community Engagement Strategy for COVID-19 and is the recipient of the 2019 Hideyo Noguchi Africa Prize for Medical Services in recognition for his dedication to addressing the global health workforce crisis including education, training, retention, and migration of healthcare workers and for building pro-people health and medical systems across Africa.

Authors’ addresses: Jean B. Nachega, Department of Medicine, Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: jbn16@pitt.edu. Rhoda Atteh, National Coronavirus Preparedness Group, Nigeria Centre for Disease Control, Abuja, Nigeria, E-mail: rhoda.atteh@ncdc.gov.ng. Chikwe Ihekweazu, Office of the Director-General, Nigeria Centre for Disease Control, Abuja, Nigeria, E-mail: chikwe.ihekweazu@ncdc.gov.ng. Nadia A. Sam-Agudu, International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria, Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, E-mail: nsamagudu@ihvnigeria.org. Prisca Adejumo, Department of Nursing, University of Ibadan, Ibadan, Nigeria, E-mail: bisiandbayo@yahoo.com. Sabin Nsanzimana and Edson Rwagasore, Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda, E-mails: sabin.nsanzimana@rbc.gov.rw and rwagasoredson@gmail.com. Jeanine Condo, School of Public Health, University of Rwanda, Kigali, Rwanda, E-mail: jennycondo@gmail.com. Masudah Paleker, COVID-19 Western Cape Province Response Team, School of Public Health and Tropical Medicine, Cape Town, South Africa, and Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa. E-mail: masudah.paleker@westerncape.gov.za. Hassan Mahomed, COVID-19 Western Cape Province Response Team, South African Department of Health, Cape Town, South Africa, and Division of Health Systems and Public Health, Department of Global Health, Stellenbosch Faculty of Medicine and Health Sciences, Cape Town, South Africa, E-mail: hassan.mahomed@westerncape.gov.za. Fatima Suleman, Discipline of Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa, E-mail: sulemanf@ukzn.ac.za. Alex Riolexus Ario, Uganda National Institute of Public Health, Ministry of Health, Kampala, Uganda, E-mail: riolexus@musph.ac.ug. Francis Omaswa and Elsie Kiguli-Malwadde, African Centre for Global Health and Social Transformation, Kampala, Uganda, E-mails: kigulimalwadde@gmail.com and omaswaf@yahoo.co.uk. Nelson K. Sewankambo, Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala Uganda, E-mail: sewankam@infocom.co.ug. Cecile Viboud and Peter H. Kilmarx, John E Fogarty International Center, National Institutes of Health, Bethesda, MD, E-mails: viboudc@mail.nih.gov and peter.kilmarx@nih.gov. Michael J. A. Reid, Department of Medicine, UCSF Medical Center, University of California San Francisco, San Francisco, CA, E-mail: michael.reid@ucsf.edu. Alimuddin Zumla, Division of Infection and Immunity, University College London, London, United Kingdom, E-mail: a.zumla@ucl.ac.uk.

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