The identification and follow-up of persons who have come in close contact with an infected person, called “contact tracing,” enables fast identification of new Ebola cases. Once identified, infected individuals can be isolated and given supportive treatment before spreading the infection. However, the current paper-based reporting system that contact tracers are using is inefficient. It requires phone calls to relay key information, and requires pen and paper reporting, both of which are slow and prone to error. Entering data on mobile devices—rather than on paper and by telephone—has the potential to improve contact tracing. Increasing overall efficiency, most importantly by allowing symptomatic contacts to enter the healthcare system immediately, may reduce transmission rates. An electronic system can also allow for remote monitoring of the performance of contact tracers and provide real-time statistics on the contacts of Ebola patients. This evaluation, the first of its kind, will provide information to policymakers on the impact of using mobile technology for disease surveillance in an emergency setting. If it proves effective, the system could be rapidly expanded to improve the contact tracing process in Ebola-affected countries.
Since its initial appearance in March 2014 in rural Guinea, the Ebola virus has spread to five other West African countries. As of January 6, 2015, Sierra Leone has had roughly 7,800 confirmed cases and nearly 3,000 confirmed deaths. According to the U.S. Centers for disease Control and Prevention (CDC), a priority in the strategy for containing the Ebola outbreak in West Africa is to isolate at least 70 percent of infected persons before they can transmit the disease to others.
To help reduce the transmission of the Ebola virus, a team comprised of experts from the London School of Hygiene and Tropical Medicine, Innovations for Poverty Action (IPA) Sierra Leone, and the International Medical Corps (IMC) seeks to improve key elements of the contact tracing strategy in Sierra Leone.
The proposed site for this intervention and its evaluation is the newly established 50-bed Ebola treatment center just outside Lunsar, in Port Loko District in the north of Sierra Leone. The treatment center is run by our partner, International Medical Corps and opened in December 2014 serving Port Loko, Kambia, and Bombali Districts, with a catchment population of approximately 1 million.
This eight-month project will involve both the implementation and the rigorous evaluation of an electronic system that captures and transmits data about Ebola contacts with mobile technology. The project also aims to improve the completeness of the identification of Ebola contacts through an expanded interview of people with suspected Ebola illness.
Using a cluster randomized trial design, the study will assess the acceptability, feasibility and effectiveness of the new mobile-based system. One randomly-selected group of contact tracing supervisors will receive smart phones with an application (“app”) designed by IPA, that captures and manages data. The group will be trained to use the phones to receive forms, and to enter and transmit data to the District Health Management Team. In a second similar group, both the supervisors and their teams of contact tracers will be provided with smart phones and the app, while a third similar group will continue to use the current paper-based system. Researchers will measure the amount of time it takes for Ebola contacts to be isolated and offered treatment after developing symptoms of Ebola.
The mobile phone app will allow contact tracers to receive lists of contacts and their addresses and to directly enter and securely transmit daily information (e.g. reported symptoms, clinical measurements, and GPS coordinates) from the contacts of Ebola cases that they are following for the stipulated period of 21 days. Contacts themselves may send an SMS to report symptoms before a contact tracer visits and this SMS will be automatically linked to their patient record, allowing early response. Contacts with Ebola symptoms will be automatically flagged, so that a response team can be sent immediately to isolate the contact. Furthermore, the system will automatically generate statistics and maps.
Researchers estimate the data collection will take three months from February 2015. To help ensure that lessons learned are integrated into the Ebola response while the evaluation is in progress, an IPA staff member will provide updates to government officials during weekly meetings.
The study was designed in close collaboration with the surveillance pillar of the national Ebola response in Sierra Leone, and the the UN Mission for Ebola Emergency Response (UNMEER). The intervention and its evaluation are made possible through funding from the German Agency for International Cooperation (GIZ).
Results forthcoming. The research team will discuss results with key stakeholders at the earliest stage possible and make recommendations on whether the system, or aspects of it, should be scaled-up countrywide.
