Digital contact tracing and case investigation application on the Navajo Nation

PROJECT Summary: The COVID-19 pandemic has had a disproportionate effect on the Navajo Nation, in which there is a higher prevalence of health complications such as diabetes, heart and lung disease. Overall living conditions and a long history of inequities resulting in a distrust of western medicine and health systems are believed to contribute to the spread of the virus. This project is an urgent competitive revision to an existing project in response to PA-18-935. The project supplements an ongoing SBIR Phase I project to study the feasibility and acceptability of COPECare, a novel digital system to support care coordination on the Navajo Nation, particularly those who have or are at high risk of cancer. COPECare is designed to facilitate the work of community health representatives (CHRs) who play a critical role in delivering health education and guidance to members of the Navajo Nation. Since the outbreak of COVID-19 on the Navajo Nation, CHRs and other trained and lay workers have been tasked to support contact tracing efforts throughout the community using a digital contact tracing and case investigation tool. The goal of this urgent supplement is to study the process and early outcomes of a digital contact tracing and case investigation tool that was customized for use on the Navajo Nation and rapidly deployed to support efforts to manage and control the COVID-19 outbreak. We will address this goal in the following two specific aims: In Aim 1, we will evaluate the digital tool using key metrics to gauge program performance for case interviewing and measures of system efficiency. In Aim 2, we will conduct a formative assessment consisting of qualitative one-on-one and group interviews with cadres of contact tracers (CHRs,public health officials, and hospital staff at two large hospitals serving the Navajo Nation) and cancer survivors and their families directly or indirectly affected by COVID-19. Results of this supplement work will directly inform the design and development of COPECare and contribute to a broader understanding of how to develop effective community-based digital solutions to support and promote health on Navajo Nation and potentially other tribal communities across the US.