UNASSIGNED: Provider-initiated contact tracing (CT) is an important measure to slow down the spread of infectious diseases such as COVID-19. However, carrying out effective CT depends on the collaboration between the patient and the contact tracer. To improve CT, it is important to understand which factors influence contact tracers in being able to carry out CT during large pandemics.
UNASSIGNED: We performed individual semi-structured interviews with nine contact tracers working for the COVID-19 unit of the Public Health Service (PHS) Rotterdam-Rijnmond, the Netherlands, to explore their experiences with carrying out CT. Data were collected between July 2020 and December 2020. The interview protocol was structured based on the CT tasks and guided by the literature and the framework explaining adherence to clinical practice guidelines.
UNASSIGNED: In general, CT seemed to be carried out satisfactorily. Individual factors (interviewing techniques and skills, attitude towards the patient and attitude towards CT), factors related to the patient (cooperativeness and engagement, emotions, language and culture and (mis)information), guideline-related factors (characteristics) and factors related to the organisation (interactions with colleagues, support from management, workload and training) were found to influence the carrying out of CT.
UNASSIGNED: To be well prepared for future pandemics, it is important to explore strategies that can be effective to support the contact tracer in performing CT, support patients in feeling comfortable to be engaged and ways to reach more consistency in policies and protocols.

Smear-positive adults with tuberculosis are the main source of childhood tuberculosis. The evaluation of children exposed to tuberculosis and determination of the disease stages are the cornerstones of managing childhood tuberculosis.
To determine the frequency of tuberculous contact, latent tuberculosis infection and tuberculosis disease in children who were in contact with smear-positive adults.
This is a single-centre, retrospective study. The medical records of children exposed to tuberculosis (<18 years old) between 2014 and 2018 were investigated. After diagnosing the index cases, the children were referred to the hospital. To identify the children in contact with adults with tuberculosis, a careful medical history, demographic features and physical examination, tuberculin skin test, postero-anterior and lateral chest radiographs, and, if necessary, chest computed tomography and microbiological tests were undertaken. The children\'s final diagnosis, treatment regimens and follow-up were documented. The sensitivity, specificity and positive and negative predictive values, tuberculin skin test and chest radiograph imaging were assessed and compared with computed tomography results.
A total of 150 paediatric patients were exposed to 88 index cases. These were fathers in 29.3% of cases and mothers in 10% of cases. Of the children, 131 (87.3%) were asymptomatic, and physical examination was normal in all children, apart from one who had respiratory symptoms. The tuberculin skin test results were positive in 60 (43%) patients and chest radiograph was abnormal in 100 (66%) children. Findings were consistent with tuberculosis in 34 (40%) of the 84 patients who underwent computed tomography. Fifty (38.5%) of the remaining children were defined as having been in contact with a case of tuberculosis, 41 (31.5%) had latent tuberculous infection and 39 (30%) had tuberculosis disease.
Pulmonary tuberculosis is asymptomatic in most children but with meticulous use of computed tomography it can be detected in asymptomatic children who have had close contact with tuberculosis.Abbreviation: AFB: acid-fast bacilli; AUC: area under the curve; BCG: bacillus Calmette-Guérin; CI: confidence interval; CT: computed tomography; CXR: chest radiograph; HIV: human immunodeficiency virus; ICD-10: International Classification of Diseases 10; LTBI: latent tuberculosis infection; MDR-TB: multi-drug-resistant tuberculosis; NPV: negative predictive value; PCR: polymerase chain reaction; PPV: positive predictive value; ROC: receiver operating characteristics; SD: standard deviation; TB: tuberculosis; TST: tuberculin skin test; XDR-TB: extensively drug-resistant tuberculosis.

The COVID-19 pandemic highlighted the impact of social inequalities in health (SIH). Various studies have shown significant inequalities in mortality and morbidity associated with COVID-19 and the influence of social determinants of health. The objective of this qualitative case study was to analyze the consideration of SIH in the design of two key COVID-19 prevention and control interventions in France: testing and contact tracing. Interviews were conducted with 36 key informants involved in the design of the intervention and/or the government response to the pandemic as well as relevant documents (n = 15) were reviewed. We applied data triangulation and a hybrid deductive and inductive analysis to analyze the data. Findings revealed the divergent understandings and perspectives about SIH, as well as the challenges associated with consideration for these at the beginning stages of the pandemic. Despite a shared concern for SIH between the participants, an epidemiological frame of reference dominated the design of the intervention. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission. Although the COVID-19 health crisis highlighted the importance of SIH, it did not appear to be an opportunity to further their consideration in response efforts. This article provides original insights into consideration for SIH in the design of testing and contact-tracing interventions based upon a qualitative investigation.
The COVID-19 pandemic has highlighted the importance of social inequalities in health (SIH) and the disproportionate burden of the pandemic and its consequences related to socioeconomic status, ethnicity and race, among other determinants of health. Public health interventions are likely to increase SIH when they are not considered in the design phase. Through a qualitative case study, we analyzed the design of one of the first local initiative providing testing and contact tracing offer to the general population in the Île-de-France region (Paris region, France) in response to the COVID-19 pandemic. This article discusses the uncertainty and challenges associated with consideration for SIH in the intervention design. It explores the diverse understandings of SIH among the actors and the complexities of cross-sectoral partnerships addressing SIH in times of health crisis. Despite a consensual concern for this issue among the respondents, an epidemiological frame of reference dominated the intervention design. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission.

BACKGROUND: The COVID-19 pandemic has caused changes in technology use worldwide, both socially and economically. This pandemic crisis has brought additional measures such as contact-tracing apps (CTAs) to help fight against spread of the virus. Unfortunately, the low adoption rate of these apps affected their success. There could be many reasons for the low adoption, including concerns of security and privacy, along with reported issues of trust in CTAs. Some concerns are related with how CTAs could be used as surveillance tools or their potential threats to privacy as they involve health data. For example, in Estonia, the CTA named HOIA had approximately 250,000 downloads in the middle of January 2021. However, in 2021, only 4.7% of the population used HOIA as a COVID-19 CTA. The reasons for the low adoption include lack of competency, and privacy and security concerns. This lower adoption and the lack of trustworthiness persist despite efforts of the European Union in building ethics and trustworthy artificial intelligence (AI)-based apps.
OBJECTIVE: The aim of this study was to understand how to measure trust in health technologies. Specifically, we assessed the usefulness of the Human-Computer Trust Scale (HCTS) to measure Estonians\' trust in the HOIA app and the causes for this lack of trust.
METHODS: The main research question was: Can the HCTS be used to assess citizens\' perception of trust in health technologies? We established four hypotheses that were tested with a survey. We used a convenience sample for data collection, including sharing the questionnaire on social network sites and using the snowball method to reach all potential HOIA users in the Estonian population.
RESULTS: Among the 78 respondents, 61 had downloaded the HOIA app with data on usage patterns. However, 20 of those who downloaded the app admitted that it was never opened despite most claiming to regularly use mobile apps. The main reasons included not understanding how it works, and privacy and security concerns. Significant correlations were found between participants\' trust in CTAs in general and their perceived trust in the HOIA app regarding three attributes: competency (P<.001), risk perception (P<.001), and reciprocity (P=.01).
CONCLUSIONS: This study shows that trust in the HOIA app among Estonian residents did affect their predisposition to use the app. Participants did not generally believe that HOIA could help to control the spread of the virus. The result of this work is limited to HOIA and health apps that use similar contact-tracing methods. However, the findings can contribute to gaining a broader understanding and awareness of the need for designing trustworthy technologies. Moreover, this work can help to provide design recommendations that ensure trustworthiness in CTAs, and the ability of AI to use highly sensitive data and serve society.