Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran.
Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
PLoS One. 2020 Sep 29;15(9):e0239554. doi: 10.1371/journal.pone.0239554. eCollection 2020.
Without any pharmaceutical intervention and vaccination, the only way to combat Coronavirus Disease 2019 (COVID-19) is to slow down the spread of the disease by adopting non-pharmaceutical public health interventions (PHIs). Patient isolation, lockdown, quarantine, social distancing, changes in health care provision, and mass screening are the most common non-pharmaceutical PHIs to cope with the epidemic. However, there is neither systematic evidence on the effectiveness of non-pharmaceutical PHIs in controlling the COVID-19 nor on how these interventions work in different contexts. Therefore, in this study we will address two main objectives: 1) to assess the effectiveness of the non-pharmaceutical PHIs in controlling the spread of COVID-19 using a systematic review and meta-analyses; 2) to explore why, how, and for whom these interventions work using a realist review.
This review study has two main phases. In the first phase of this study, we will extract data from two main types of studies including quasi-experimental studies (such as quasi-randomized trials, controlled before-after studies (CBAs) and interrupted time series studies (ITSs)) and observational studies (such as cohort, case-control, and cross-sectional studies), written in the English language. We will explore effectiveness of the non-pharmaceutical PHIs targeted either suppression or mitigation strategies (or a combination of both) in controlling the COVID-19 epidemics in the community level. Effectiveness will be considered as the changes in mortality rate, incidence rate, basic reproduction number rate, morbidity rate, rates of hospitalization, rates of intensive care unit (ICU) hospitalization, and other health outcomes where possible. We will perform random-effects meta-analyses, if possible, using CMA software. In the second phase, we will conduct a realist review to find out how, why, for whom, and in what circumstances the non-pharmaceutical PHIs work. At the realist review, we will identify and explore Context-Mechanism-Outcome configurations to provide a robust explanation on the effectiveness of the interventions in different contexts using Pawson's 5-step realist review template including: "clarify scope; search for evidence; appraise primary studies and extract data; synthesize evidence and draw conclusions; and disseminate, implement and evaluate". Although the steps are presented in a linear manner, in practice, we will follow them in iterative stages to fill any potential overlap.
The findings of this research will provide a crucial insight into how and in which context the non-pharmaceutical PHIs work in controlling the spread of COVID-19. Conducting a systematic review and meta-analysis in line with a realist review will allow us to draw a robust conclusion on the effects and the way in which the interventions work. Understanding the role of contextual factors in the effectiveness of non-pharmaceutical PHIs and the mechanism of this process could enable policymakers to implement appropriate policies and manage the COVID-19 epidemics more efficiently.
CRD42020186855.
在没有任何药物干预和疫苗接种的情况下，对抗 2019 年冠状病毒病（COVID-19）的唯一方法是通过采取非药物公共卫生干预措施（PHIs）来减缓疾病的传播。患者隔离、封锁、检疫、社会隔离、医疗服务提供的改变以及大规模筛查是应对疫情最常见的非药物 PHIs。然而，目前尚无关于非药物 PHIs 在控制 COVID-19 方面的有效性的系统证据，也没有关于这些干预措施在不同情况下如何发挥作用的证据。因此，在本研究中，我们将解决两个主要目标：1）使用系统评价和荟萃分析评估非药物 PHIs 控制 COVID-19 传播的有效性；2）使用现实主义审查探索这些干预措施为何、如何以及为谁发挥作用。
本综述研究有两个主要阶段。在本研究的第一阶段，我们将从两种主要类型的研究中提取数据，包括准实验研究（如准随机试验、对照前后研究（CBAs）和中断时间序列研究（ITSs））和观察性研究（如队列、病例对照和横断面研究），这些研究均以英文撰写。我们将探讨针对抑制或缓解策略（或两者结合）的非药物 PHIs 在控制社区层面 COVID-19 流行中的有效性。有效性将被视为死亡率、发病率、基本繁殖数率、发病率、住院率、重症监护病房（ICU）住院率和其他可能的健康结果的变化。如果可能，我们将使用 CMA 软件进行随机效应荟萃分析。在第二阶段，我们将进行现实主义审查，以找出非药物 PHIs 如何、为何、为谁以及在何种情况下发挥作用。在现实主义审查中，我们将确定并探索情境-机制-结果配置，以使用 Pawson 的 5 步现实主义审查模板提供干预措施在不同情境下有效性的有力解释，包括：“澄清范围；搜索证据；评估主要研究并提取数据；综合证据并得出结论；传播、实施和评估”。尽管步骤以线性方式呈现，但在实践中，我们将按照迭代阶段进行操作，以填补任何潜在的重叠。
本研究的结果将深入了解非药物 PHIs 在控制 COVID-19 传播方面的作用方式和作用方式。按照现实主义审查进行系统评价和荟萃分析，将使我们能够对干预措施的效果和作用方式得出有力的结论。了解情境因素在非药物 PHIs 有效性中的作用以及这一过程的机制，可以使政策制定者能够更有效地实施适当的政策并管理 COVID-19 疫情。
CRD42020186855。
