Throughout the COVID19 pandemic in the U.S., persons in jails have borne a share of disease 3-fold or greater
than that seen in the general population. While many cases have been imported from surrounding communities,
crowding in these congregate settings has led to rapid in-house transmission, especially since testing in jails has
been sparse. Vaccine hesitancy among staff and those detained mean the population is ill prepared for new waves
of infection, perhaps from virus variants. Better surveillance could warn systems earlier, and allow jails to stem
the tide of a new outbreak. At least half, if not more, of infected persons shed coronavirus in their stool.
Monitoring wastewater is a promising practice that only a few jails have adopted. Our overarching goal is 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. We will adapt it to the needs
of jail settings and evaluate the implementation with the Consolidated Framework for Implementation Research.
Implementation teams will be formed of both correctional staff and formerly incarcerated individuals. Our aims:
(1) To assess the barriers to and facilitators of implementing WBS for SARS-CoV-2 detection in 4 jail
demonstration sites. Guided by CFIR, we hold an informational webinar, then conduct focus groups. Four will
be with leaders at each of the jails; these will discuss the site-specific context in which WBS will be introduced or
refined. A fifth, cross-site focus group of jail workers, and a sixth, cross-site group of persons with lived jail
experience, will reflect on characteristics of WBS approaches and implementation strategies in jail settings.
(2) To measure implementation outcomes associated with WBS and use these outcomes to inform key
stakeholders, using a knowledge to action framework. We will study uptake, acceptability, appropriateness and
feasibility of WBS as a sensitive early warning system and a way of quantifying SARS-CoV-2 levels to monitor
trends in COVID19 prevalence. Feasibility, the suitability of how WBS data are acted upon, will be of utmost
importance. We will use the Knowledge to Action process model, leveraging implementation outcomes to further
engage stakeholders and characterize the adaptions needed to successfully implement WBS in jails.
(3, Pilot) To study the process and the perceived effectiveness of incorporating diverse stakeholders, including
the formerly incarcerated, on the WBS implementation team. We will use the Research Engagement Survey Tool
(REST), to survey early in the implementation process and eight months later, individuals on the implementation
team who have lived experience in jail; all other consenting implementation team members will be surveyed once
early in the implementation process.
Successfully completing the aims will determine factors that promote WBS implementation to improve disease
monitoring in jails. By including persons recently released from jail on the implementation teams, we hope to
inform researchers and policy makers about the ethics and process of collaboration in implementation.