Conducting Correctional COVID Research and Implementing Novel, Ethically Sound, Sustainable Surveillance Systems (CRAINES)

Background: The overarching goal of this study was 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. The approach was adapted to the needs of jail settings and evaluated using the Consolidated Framework for Implementation Research. Implementation teams included both correctional staff and incarcerated individuals.

Materials/Methods: The study had three aims. Aim 1 assessed barriers and facilitators of WBS implementation at four jail demonstration sites. Aim 2 measured implementation outcomes associated with WBS, examining uptake, acceptability, appropriateness, and feasibility of WBS as an early warning system and a way to quantify SARS-CoV-2 levels to monitor trends. Aim 3, a pilot, studied the process and perceived effectiveness of incorporating diverse stakeholders into WBS implementation teams. The Research Engagement Survey Tool (REST) was used to survey team members with lived jail experience early and again at eight months, while all other consenting team members were surveyed once early in the implementation process.

Outcome/Impact: The study demonstrated how diverse stakeholder engagement, including formerly incarcerated individuals, could inform and strengthen adoption of wastewater surveillance. The intended outcome was to establish WBS as a sensitive early warning system to improve detection and monitoring of COVID-19 in jail settings and to guide strategies for controlling outbreaks in these high-risk environments.