JMIR Publications

ABSTRACT

Background:

During the COVID-19 pandemic, over 100 countries successfully deployed smartphone-based exposure notification applications alongside conventional contact tracing to mitigate the transmission of SARS-CoV-2. These systems enabled millions of COVID-19-positive individuals to anonymously alert community members of a potential exposure. Although evidence on exposure notification program implementation is limited, leveraging expertise from public health professionals, academics, and global implementers from various disciplines can contribute to addressing this research gap.

Objective:

To explore barriers and facilitators to the adoption of Exposure Notification (EN) systems, identify optimal use cases for them, and understand how advancements in technology and policy might maximize EN utility for mitigating other infectious outbreaks,

Methods:

We employed the Delphi method to develop a comprehensive online survey comprising closed-ended and open-ended questions. We considered consensus was reached if items or statements were “agreed” or “strongly agreed” by at least 75% of respondents. More than 30 global exposure notification experts known to the investigators were invited to participate in the survey, and those who participated were asked to nominate or recruit others deemed eligible via a peer-to-peer method. We used descriptive and content analyses to summarize key findings from the survey. We invited the same experts to attend virtual focus groups to further probe their insight on survey findings.

Results:

Twenty-two experts from six countries, including 10 from the United States, representing three continents, participated. Respondents were involved in the implementation of different exposure notification technologies that encompassed different levels of integration with existing public health agencies’ infrastructure. Consensus was reached concerning the development of additional functionalities of the system, such as the ability for users to self-report a positive SARS-CoV-2 at-home test, get additional public health information from the app (i.e., testing and social services information), and receive general venue-based notifications concerning superspreader events. Other items that reached consensus included how the tool could be used for additional epidemiological purposes, such as expanding the technology to other airborne diseases, and the need for integration with surveillance data streams to augment analytics and forecasting.

Conclusions:

Global exposure notification systems have the potential to be optimized for public health emergencies beyond COVID-19 and can be used as epidemiological surveillance tools in future disease outbreaks. Decision makers and experts should revise existing protocols and seek to incorporate new functionalities to ease the disease burden for both users and public health agencies. Clinical Trial: UCSF Human Research Protection Program Institutional Review Board study number: 23-39886