SARS-CoV-2 in Correctional Populations: A collaborative, ethical approach to application of wastewater-based surveillance

在美国新冠病毒大流行期间，监狱里的人感染疾病的比例是原来的三倍或更多 比在一般人群中看到的情况。虽然许多病例是从周边社区输入的， 这些聚集场所的拥挤导致了内部的快速传播，特别是因为监狱中的检测已经 稀疏。工作人员和被拘留者对疫苗犹豫不决，意味着人们没有为新一波疫情做好准备 感染，可能来自病毒变种。更好的监控可以更早地向系统发出警告，并允许监狱阻止 新一轮疫情爆发的浪潮。至少有一半（如果不是更多）感染者通过粪便排出冠状病毒。 监测废水是一种很有前途的做法，但只有少数监狱采用了。我们的总体目标是 引入或完善废水监测 (WBS) 作为针对 SARS-CoV-2 的循证策略 亚特兰大、芝加哥、波士顿郊区和华盛顿特区的监狱都受到监视。我们将根据需要进行调整 监狱设置并通过实施研究综合框架评估实施情况。 实施小组将由惩教人员和曾经被监禁的人员组成。我们的目标： (1) 评估在 4 个监狱实施 SARS-CoV-2 检测 WBS 的障碍和促进因素 示范点。在 CFIR 的指导下，我们举办了一次信息网络研讨会，然后进行焦点小组讨论。四会 与每个监狱的领导在一起；这些将讨论将引入 WBS 的特定地点环境，或者 精炼。第五个跨地点焦点小组由监狱工作人员组成，第六个跨地点小组由居住在监狱中的人组成 经验，将反思 WBS 方法的特点和监狱环境中的实施策略。 (2) 衡量与 WBS 相关的实施结果，并利用这些结果为关键的信息提供信息 利益相关者，使用知识到行动框架。我们将研究吸收率、可接受性、适当性和 WBS 作为敏感预警系统和量化 SARS-CoV-2 水平以进行监测的方法的可行性 COVID19 流行趋势。可行性、WBS 数据的适用性将是最重要的 重要性。我们将使用“知识到行动”流程模型，利用实施成果进一步推动 让利益相关者参与进来，并描述在监狱中成功实施 WBS 所需的调整。 （3，试点）研究纳入不同利益相关者的过程和感知有效性，包括 曾被监禁的 WBS 实施团队成员。我们将使用研究参与度调查工具 （REST），在实施过程的早期和八个月后调查个人的实施情况 有监狱生活经验的团队；所有其他同意的实施团队成员将接受一次调查 在实施过程的早期。 成功完成目标将决定促进 WBS 实施以改善疾病的因素 监狱里的监控。通过将最近从监狱释放的人员纳入实施团队，我们希望 向研究人员和政策制定者通报实施过程中的道德规范和合作流程。

Throughout the COVID19 pandemic in the U.S., persons in jails have borne a share of disease 3-fold or greater than that seen in the general population. While many cases have been imported from surrounding communities, crowding in these congregate settings has led to rapid in-house transmission, especially since testing in jails has been sparse. Vaccine hesitancy among staff and those detained mean the population is ill prepared for new waves of infection, perhaps from virus variants. Better surveillance could warn systems earlier, and allow jails to stem the tide of a new outbreak. At least half, if not more, of infected persons shed coronavirus in their stool. Monitoring wastewater is a promising practice that only a few jails have adopted. Our overarching goal is to introduce or refine Wastewater Based Surveillance (WBS) as an evidence-based strategy for SARS-CoV-2 surveillance in the jails of Atlanta, Chicago, suburban Boston and Washington DC. We will adapt it to the needs of jail settings and evaluate the implementation with the Consolidated Framework for Implementation Research. Implementation teams will be formed of both correctional staff and formerly incarcerated individuals. Our aims: (1) To assess the barriers to and facilitators of implementing WBS for SARS-CoV-2 detection in 4 jail demonstration sites. Guided by CFIR, we hold an informational webinar, then conduct focus groups. Four will be with leaders at each of the jails; these will discuss the site-specific context in which WBS will be introduced or refined. A fifth, cross-site focus group of jail workers, and a sixth, cross-site group of persons with lived jail experience, will reflect on characteristics of WBS approaches and implementation strategies in jail settings. (2) To measure implementation outcomes associated with WBS and use these outcomes to inform key stakeholders, using a knowledge to action framework. We will study uptake, acceptability, appropriateness and feasibility of WBS as a sensitive early warning system and a way of quantifying SARS-CoV-2 levels to monitor trends in COVID19 prevalence. Feasibility, the suitability of how WBS data are acted upon, will be of utmost importance. We will use the Knowledge to Action process model, leveraging implementation outcomes to further engage stakeholders and characterize the adaptions needed to successfully implement WBS in jails. (3, Pilot) To study the process and the perceived effectiveness of incorporating diverse stakeholders, including the formerly incarcerated, on the WBS implementation team. We will use the Research Engagement Survey Tool (REST), to survey early in the implementation process and eight months later, individuals on the implementation team who have lived experience in jail; all other consenting implementation team members will be surveyed once early in the implementation process. Successfully completing the aims will determine factors that promote WBS implementation to improve disease monitoring in jails. By including persons recently released from jail on the implementation teams, we hope to inform researchers and policy makers about the ethics and process of collaboration in implementation.