Experience of Public Health Departments in Implementation of COVID-19 Case Investigation and Contact Tracing Programs.

OBJECTIVE: Case investigation and contact tracing (CI/CT) are fundamental public health efforts widely used during the COVID-19 pandemic to mitigate transmission. This study investigated how state, local, and tribal public health departments used CI/CT during the COVID-19 pandemic, including CI/CT methodology, staffing models, training and support, and efforts to identify or prioritize populations disproportionately affected by COVID-19. METHODS: During March and April 2022, we conducted key informant interviews with up to 3 public health officials from 43 state, local, and tribal public health departments. From audio-recorded and transcribed interviews, we used the framework method to analyze key themes. RESULTS: Major adjustments to CI/CT protocols during the pandemic included (1) prioritizing populations for outreach; (2) implementing automated outreach for nonprioritized groups, particularly during COVID-19 surges; (3) discontinuing contact tracing and focusing exclusively on case investigation; and (4) adding innovations to provide additional support. Key informants also discussed the utility of having backup staffing to support overwhelmed public health departments and spoke to the difficulty in "right-sizing" the public health workforce, with COVID-19 surges leaving public health departments understaffed as case rates rose and overstaffed as case rates fell. CONCLUSIONS: When addressing future epidemics or outbreaks, public health officials should consider strategies that improve the effectiveness of CI/CT efforts over time, such as prioritizing populations based on disproportionate risk, implementing automated outreach, developing models that provide flexible additional staffing resources as cases rise and fall among local public health departments, incorporating demographic data in laboratory reporting, providing community connections and support, and having a system of self-notification of contacts.

Seeking the female (internal) condom in retail pharmacies: Experiences of adolescent mystery callers.

BACKGROUND: Female (internal) condoms could be viable alternatives to male (external) condoms. Our objective was to describe barriers that adolescent mystery callers encountered when trying to access female condoms in U.S. pharmacies. METHODS: In mid-2016, university students seeking "condoms for girls" called retail pharmacies in Arizona, California, New Mexico and Utah. We evaluated differences in product availability and callers' experiences by pharmacy type. RESULTS: Of our final sample (n=1475), only eight outlets (0.5%), all national chains, definitely stocked female condoms. Of those not (or probably not) stocking female condoms, 11% tried to be helpful (e.g., offered to special order), 59% made no substantive comment, and 30% were unhelpful (e.g., dismissive, rude, gave wrong information). National chain employees were significantly more unhelpful (34% vs 22%, p< .01). CONCLUSION: Almost no pharmacies in four southwestern states stocked female condoms in mid-2016. Pharmacy staff frequently were unhelpful, which could deter adolescent use of female condoms even if new types become available.

Availability and Accessibility of Emergency Contraception to Adolescent Callers in Pharmacies in Four Southwestern States.

PURPOSE: To evaluate the availability and accessibility of emergency contraception (EC) to adolescents in U.S. pharmacies across four Southwestern states, 3 years after the federal Food and Drug Administration (FDA) removed age restrictions for over-the-counter sales of levonorgestrel-only pills. METHODS: Using a mystery-caller approach, we trained male and female data collectors to phone pharmacies posing as 16-year-olds who wanted to prevent a pregnancy after recent unprotected sex. From April to May 2016, they called 1,475 randomly selected retail pharmacies in Arizona, California, New Mexico, and Utah and completed an online survey about their experience. Caller data were analyzed by state and pharmacy type (i.e., national chains, regional outlets, and individually owned outlets). RESULTS: Of pharmacies contacted, 80.6% had EC available at the time of the call. Availability of EC varied by state (p < .01) and pharmacy type (p < .01), but not by rural/urban location. Even where EC was available, pharmacy personnel often hindered youths' access to EC by mentioning incorrect point-of-sale restrictions, keeping EC in restrictive store locations, or asking personal questions. Individually owned outlets presented significantly more barriers than larger chains. Overall, EC was completely accessible to an adolescent caller in only 28% of pharmacies. Lower EC accessibility was found in states with higher teen pregnancy rates. CONCLUSIONS: This study found that EC is still not sufficiently available or accessible to adolescents in Southwestern states. Differences in accessibility vary significantly by state and pharmacy type and may be a contributor to teen pregnancy rates.