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

在美国的COVID 19大流行期间，监狱中的人患病比例为三倍或更多 比一般人群中看到的要多。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快速的室内传播，特别是因为在监狱中进行的检测 稀疏。工作人员和被拘留者的疫苗犹豫意味着人口对新的浪潮准备不足 感染的可能性，也许是病毒的变种。更好的监控可以更早地警告系统，并允许监狱停止 新一轮疫情的浪潮。至少有一半（如果不是更多的话）的感染者在粪便中排出冠状病毒。 监测废水是一种很有前途的做法，只有少数监狱采用了这种做法。我们的首要目标是 引入或改进废水监测（WBS），作为SARS-CoV-2循证战略 在亚特兰大、芝加哥、波士顿郊区和华盛顿特区的监狱里进行监视。我们会根据需要进行调整 在监狱设置方面，并根据执行情况研究综合框架评估执行情况。 执行小组将由惩教工作人员和以前被监禁的个人组成。我们的目标： (1)评估在4所监狱实施工作分解结构检测SARS-CoV-2的障碍和促进因素 示范点。在CFIR的指导下，我们举办了一个信息网络研讨会，然后进行焦点小组讨论。四个将 与每个监狱的领导人会面;他们将讨论引入工作分解结构的具体地点， 完善.第五，监狱工作人员的跨站点焦点组，和第六，生活在监狱中的人的跨站点组 经验，将反映工作分解结构方法的特点和在监狱环境中的实施战略。 (2)衡量与工作分解结构相关的实施成果，并利用这些成果为关键 利益攸关方，使用知识到行动框架。我们将研究吸收，可接受性，适当性和 WBS作为敏感预警系统的可行性，以及量化SARS-CoV-2水平以监测 COVID 19流行趋势。可行性，即如何对WBS数据采取行动的适用性，将是最重要的 重要性我们将使用知识到行动的过程模型，利用实施成果， 让利益相关者参与进来，并描述在监狱中成功实施工作分解结构所需的适应措施。 （3，试点）研究吸收不同利益攸关方的过程和预期效果，包括 以前被监禁的人，在WBS实施团队。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，对实施情况进行调查 有监狱生活经历的团队;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工作分解结构实施以改善疾病的因素 监狱里的监控通过让最近从监狱释放的人加入执行小组，我们希望 向研究人员和政策制定者介绍实施过程中的道德规范和协作过程。

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.