Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America.
PLoS One. 2024 Oct 4;19(10):e0311198. doi: 10.1371/journal.pone.0311198. eCollection 2024.
Places of worship serve as a venue for both mass and routine gathering around the world, and therefore are associated with risk of large-scale SARS-CoV-2 transmission. However, such routine gatherings also offer an opportunity to distribute self-tests to members of the community to potentially help mitigate transmission and reduce broader community spread of SARS-CoV-2. Over the past four years, self-testing strategies have been an impactful tool for countries' response to the COVID-19 pandemic, especially early on to mitigate the spread when vaccination and treatment options were limited. We used an agent-based mathematical model to estimate the impact of various strategies of symptomatic and asymptomatic self-testing for a fixed percentage of weekly routine gatherings at places of worship on community transmission of SARS-CoV-2 in Brazil, Georgia, and Zambia. Testing strategies assessed included weekly and bi-weekly self-testing across varying levels of vaccine effectiveness, vaccine coverage, and reproductive numbers to simulate developing stages of the COVID-19 pandemic. Self-testing symptomatic people attending routine gatherings can cost-effectively reduce the spread of SARS-CoV-2 within places of worship and the community, resulting in incremental cost-effectiveness ratios of $69-$303 USD. This trend is especially true in contexts where population level attendance at such gatherings is high, demonstrating that a distribution approach is more impactful when a greater proportion of the population is reached. Asymptomatic self-testing of attendees at 100% of places of worship in a country results in the greatest percent of infections averted and is consistently cost-effective but remains costly. Budgetary needs for asymptomatic testing are expensive and likely unaffordable for lower-middle income countries (520-1550x greater than that of symptomatic testing alone), promoting that strategies to strengthen symptomatic testing should remain a higher priority.
礼拜场所是全球范围内进行大规模集会和日常聚会的场所，因此与 SARS-CoV-2 大规模传播的风险相关。然而，这些日常聚会也提供了一个向社区成员分发自我检测的机会，这可能有助于减轻传播并减少 SARS-CoV-2 在更广泛社区的传播。在过去的四年中，自我检测策略一直是应对 COVID-19 大流行的有效工具，尤其是在疫苗和治疗选择有限的早期，以减轻传播。我们使用基于代理的数学模型来估计在巴西、格鲁吉亚和赞比亚，针对礼拜场所的每周例行聚会中固定比例的人群进行症状和无症状自我检测的各种策略对 SARS-CoV-2 社区传播的影响。评估的检测策略包括在不同疫苗效力、疫苗覆盖率和繁殖数水平下进行每周和每两周一次的自我检测，以模拟 COVID-19 大流行的不同发展阶段。对参加日常聚会的有症状人群进行自我检测可以有效地降低礼拜场所和社区内 SARS-CoV-2 的传播，增量成本效益比为 69-303 美元。在这种情况下，当更多的人参与到检测中时，这种趋势更加明显，这表明当更多的人参与到检测中时，分发方法更加有效。对该国 100%的礼拜场所的参与者进行无症状自我检测，可以避免最大比例的感染，并且始终具有成本效益，但仍然成本高昂。无症状检测的预算需求昂贵，可能超出中下收入国家的承受能力（比单独进行症状检测高出 520-1550 倍），这表明加强症状检测的策略应仍然是更高的优先事项。
