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. 2021 Feb 11;104(4):1179-1187.
doi: 10.4269/ajtmh.21-0033.

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

Jean B Nachega  1   2   3   4 , Rhoda Atteh  5 , Chikwe Ihekweazu  6 , Nadia A Sam-Agudu  7   8   9 , Prisca Adejumo  10 , Sabin Nsanzimana  11 , Edson Rwagasore  11 , Jeanine Condo  12   13 , Masudah Paleker  14   15 , Hassan Mahomed  14   15 , Fatima Suleman  16 , Alex Riolexus Ario  17 , Elsie Kiguli-Malwadde  18 , Francis G Omaswa  18 , Nelson K Sewankambo  19 , Cecile Viboud  20 , Michael J A Reid  21 , Alimuddin Zumla  22   23 , Peter H Kilmarx  20
Affiliations

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

Jean B Nachega et al. Am J Trop Med Hyg. .

Abstract

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.

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Conflict of interest statement

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.

Figures

Figure 1.
Figure 1.
Epidemic curve for confirmed COVID-19 cases in Nigeria, as of December 30, 2020. Source: Nigeria CDC. This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Epidemic curve for confirmed COVID-19 cases in Rwanda, as of December 30, 2020. Source: Ministry of Health, Rwanda Biomedical Centre. This figure appears in color at www.ajtmh.org.
Figure 3.
Figure 3.
(A) Epidemic curve and contact tracing program. The start dates of the different phases of the lockdown are indicated (phases 5 to 1, 5 being the most stringent). Source: South African Department of Health (SA-DOH). (B) Contact tracing program. The start dates of the different phases of the lockdown are indicated (phases 5 to 1, 5 being the most stringent). Source: SA-DOH. This figure appears in color at www.ajtmh.org.
Figure 4.
Figure 4.
Epidemic curve for confirmed COVID-19 cases in Uganda, as of December 30, 2020. This figure appears in color at www.ajtmh.org.
See this image and copyright information in PMC

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