The Relative Importance of Equity and Efficiency in the Design and Performance Management of COVID-19 Contact Tracing Programmes: A Discrete Choice Experiment

Background: Contact tracing is an important tool to control the spread of infectious diseases, including COVID-19. This study aims to assess the trade-offs between efficiency and equity attributes of contact tracing programmes based on preferences of COVID-19 contact tracing practitioners, researchers and other relevant stakeholders.Methods: We conducted an online discrete choice experiment (DCE). The DCE attributes represented efficiency (timeliness, completeness, number of contacts), equity (vulnerability), cooperation, and privacy. Respondents were recruited globally to explore preferences according to country income level and the prevailing epidemiology of COVID-19 in the local setting. Data from the DCE were analysed using mixed-logit modelling and latent-class analysis.Findings: Results from the best fitting mixed logit model showed that timeliness is the most important attribute regardless of country income level and COVID-19 epidemiological condition. Vulnerability of contacts is the second most important attribute for low-to-low-middle-income countries and third for upper-middle-to-high income countries. When normalised against conditional relative importance of timeliness, conditional relative importance of vulnerability ranged from 0·38 to 0·42. This means that timeliness attribute is roughly 2·6 times more important than vulnerability attribute.Interpretation: Equity and efficiency criteria were both considered to be important attributes of contact tracing programmes. However, the relative values placed on these criteria varied significantly between epidemiological and economic context. Contact tracing design, incentivizing schemes, and performance evaluation must account for this heterogeneity.Funding Information: The study is supported by the World Health Organisation Southeast Asia Regional Office (WHO SEARO) and the International Decision Support Initiative (iDSI).Declaration of Interests: The authors have no competing interests to declare. Ethics Approval Statement: Ethics approval was received from the Institute for the Development of Human Research Protections (IHRP) in Thailand, the Saw Swee Hock School of Public Health Departmental Ethics Review Committee (SSHSPH-DERC) in Singapore and the WHO SEARO Regional Review Committee (RRC). An exemption from the Ad Hoc COVID-19 Research Ethics Review Committee at WHO Headquarters was also received. Written informed consent was taken from all respondents.