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Abstract：
We conducted a systematic literature review of general population testing, contact tracing, case isolation and contact quarantine interventions to assess their effectiveness in reducing SARS-CoV-2 transmission, as implemented in real-world settings. We designed a broad search strategy and aimed to identify peer-reviewed studies of any design provided there was a quantitative measure of effectiveness on a transmission outcome. Studies that assessed the effect of testing or diagnosis on disease outcomes via treatment, but did not assess a transmission outcome, were not included. We focused on interventions implemented among the general population rather than in specific settings; these were from anywhere in the world and published any time after 1 January 2020 until the end of 2022. From 26 720 titles and abstracts, 1181 were reviewed as full text, and 25 met our inclusion criteria. These 25 studies included one randomized control trial (RCT) and the remaining 24 analysed empirical data and made some attempt to control for confounding. Studies included were categorized by the type of intervention: contact tracing (seven studies); specific testing strategies (12 studies); strategies for isolating cases/contacts (four studies); and \'test, trace, isolate\' (TTI) as a part of a package of interventions (two studies). None of the 25 studies were rated at low risk of bias and many were rated as serious risk of bias, particularly due to the likely presence of uncontrolled confounding factors, which was a major challenge in assessing the independent effects of TTI in observational studies. These confounding factors are to be expected from observational studies during an on-going pandemic, when the emphasis was on reducing the epidemic burden rather than trial design. Findings from these 25 studies suggested an important public health role for testing followed by isolation, especially where mass and serial testing was used to reduce transmission. Some of the most compelling analyses came from examining fine-grained within-country data on contact tracing; while broader studies which compared behaviour between countries also often found TTI led to reduced transmission and mortality, this was not universal. There was limited evidence for the benefit of isolation of cases/contacts away from the home environment. One study, an RCT, showed that daily testing of contacts could be a viable strategy to replace lengthy quarantine of contacts. Based on the scarcity of robust empirical evidence, we were not able to draw any firm quantitative conclusions about the quantitative impact of TTI interventions in different epidemic contexts. While the majority of studies found that testing, tracing and isolation reduced transmission, evidence for the scale of this impact is only available for specific scenarios and hence is not necessarily generalizable. Our review therefore emphasizes the need to conduct robust experimental studies that help inform the likely quantitative impact of different TTI interventions on transmission and their optimal design. Work is needed to support such studies in the context of future emerging epidemics, along with assessments of the cost-effectiveness of TTI interventions, which was beyond the scope of this review but will be critical to decision-making. This article is part of the theme issue \'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence\'.
摘要：
我们对一般人群测试进行了系统的文献综述，接触追踪,病例隔离和接触隔离干预措施，以评估其减少SARS-CoV-2传播的有效性，在现实世界中实现。我们设计了一个广泛的搜索策略，旨在确定任何设计的同行评审研究，前提是对传播结果的有效性进行定量测量。通过治疗评估测试或诊断对疾病结果的影响的研究，但没有评估传播结果，不包括在内。我们关注的是在普通人群中实施的干预措施，而不是在特定环境中实施的干预措施；这些干预措施来自世界任何地方，并在2020年1月1日之后的任何时间发布，直到2022年底。从26720个标题和摘要中，1181作为全文进行了审查，和25符合我们的纳入标准。这25项研究包括一项随机对照试验（RCT），其余24项分析了经验数据，并尝试控制混杂因素。纳入的研究按干预类型分类：接触者追踪（7项研究）；具体测试策略（12项研究）；隔离病例/接触者的策略（4项研究）；trace,隔离（TTI）作为一揽子干预措施的一部分（两项研究）。25项研究中没有一项被评为低偏倚风险，许多被评为严重偏倚风险。特别是由于可能存在不受控制的混杂因素，这是评估TTI在观察性研究中的独立影响的主要挑战.这些混杂因素是在持续大流行期间的观察研究中可以预期的，当时的重点是减轻流行病负担，而不是试验设计。这25项研究的结果表明，在隔离之后进行测试具有重要的公共卫生作用。特别是在质量和串行测试被用来减少传输。一些最令人信服的分析来自对接触者追踪的细粒度国内数据的审查；虽然比较国家之间行为的更广泛的研究也经常发现TTI导致传播和死亡率降低，这不是普遍的。关于将病例/接触者隔离在家庭环境之外的好处的证据有限。一项研究,RCT,表明，每天对接触者进行测试可能是替代长期接触者隔离的可行策略。基于缺乏稳健的经验证据，对于TTI干预措施在不同疫情环境下的定量影响,我们未能得出任何确切的定量结论.虽然大多数研究发现测试，跟踪和隔离减少了传输，这种影响规模的证据仅适用于特定场景，因此不一定可以推广。因此，我们的审查强调需要进行强有力的实验研究，以帮助告知不同TTI干预措施对传输及其最佳设计的可能定量影响。在未来新出现的流行病的背景下，需要开展工作来支持此类研究，连同TTI干预措施的成本效益评估，这超出了本次审查的范围，但对决策至关重要。本文是“非药物干预对COVID-19大流行的有效性：证据”主题的一部分。
