A prospective randomised controlled trial investigating household SARS-CoV-2 transmission in a densely populated community in Cape Town, South Africa - the transmission of COVID-19 in crowded environments (TRACE) study.
COVID-19
Community health workers
Household transmission
Infection mitigation
SARS-CoV-2
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
17 Jul 2024
17 Jul 2024
Historique:
received:
06
09
2023
accepted:
12
07
2024
medline:
18
7
2024
pubmed:
18
7
2024
entrez:
17
7
2024
Statut:
epublish
Résumé
South Africa's first SARS-CoV-2 case was identified 5th March 2020 and national lockdown followed March 26th. Households are an important location for secondary SARS-CoV-2 infection. Physical distancing and sanitation - infection mitigation recommended by the World Health Organization (WHO) at the time - are difficult to implement in limited-resource settings because of overcrowded living conditions. This study (ClinicalTrials.gov NCT05119348) was conducted from August 2020 to September 2021 in two densely populated, low socioeconomic Cape Town community sub-districts. New COVID-19 index cases (ICs) identified at public clinics were randomised to an infection mitigation intervention (STOPCOV) delivered by lay community health workers (CHWs) or standard of care group. STOPCOV mitigation measures included one initial household assessment conducted by a CHW in which face masks, sanitiser, bleach and written information on managing and preventing spread were provided. This was followed by regular telephonic follow-up from CHWs. SARS-CoV-2 PCR and IgM/IgG serology was performed at baseline, weeks 1, 2, 3 and 4 of follow-up. The study randomised 81 ICs with 245 HHCs. At baseline, no HHCs in the control and 7 (5%) in the intervention group had prevalent SARS-CoV-2. The secondary infection rate (SIR) based on SARS-CoV-2 PCR testing was 1.9% (n = 2) in control and 2.9% (n = 4) in intervention HHCs (p = 0.598). At baseline, SARS-CoV-2 antibodies were present in 15% (16/108) of control and 38% (52/137) of intervention participants. At study end incidence was 8.3% (9/108) and 8.03% (11/137) in the intervention and control groups respectively. Antibodies were present in 23% (25/108) of control HHCs over the course of the study vs. 46% (63/137) in the intervention arm. CHWs made twelve clinic and 47 food parcel referrals for individuals in intervention households in need. Participants had significant exposure to SARS-CoV-2 infections prior to the study. In this setting, household transmission mitigation was ineffective. However, CHWs may have facilitated other important healthcare and social referrals.
Sections du résumé
BACKGROUND
BACKGROUND
South Africa's first SARS-CoV-2 case was identified 5th March 2020 and national lockdown followed March 26th. Households are an important location for secondary SARS-CoV-2 infection. Physical distancing and sanitation - infection mitigation recommended by the World Health Organization (WHO) at the time - are difficult to implement in limited-resource settings because of overcrowded living conditions.
METHODS
METHODS
This study (ClinicalTrials.gov NCT05119348) was conducted from August 2020 to September 2021 in two densely populated, low socioeconomic Cape Town community sub-districts. New COVID-19 index cases (ICs) identified at public clinics were randomised to an infection mitigation intervention (STOPCOV) delivered by lay community health workers (CHWs) or standard of care group. STOPCOV mitigation measures included one initial household assessment conducted by a CHW in which face masks, sanitiser, bleach and written information on managing and preventing spread were provided. This was followed by regular telephonic follow-up from CHWs. SARS-CoV-2 PCR and IgM/IgG serology was performed at baseline, weeks 1, 2, 3 and 4 of follow-up.
RESULTS
RESULTS
The study randomised 81 ICs with 245 HHCs. At baseline, no HHCs in the control and 7 (5%) in the intervention group had prevalent SARS-CoV-2. The secondary infection rate (SIR) based on SARS-CoV-2 PCR testing was 1.9% (n = 2) in control and 2.9% (n = 4) in intervention HHCs (p = 0.598). At baseline, SARS-CoV-2 antibodies were present in 15% (16/108) of control and 38% (52/137) of intervention participants. At study end incidence was 8.3% (9/108) and 8.03% (11/137) in the intervention and control groups respectively. Antibodies were present in 23% (25/108) of control HHCs over the course of the study vs. 46% (63/137) in the intervention arm. CHWs made twelve clinic and 47 food parcel referrals for individuals in intervention households in need.
DISCUSSION
CONCLUSIONS
Participants had significant exposure to SARS-CoV-2 infections prior to the study. In this setting, household transmission mitigation was ineffective. However, CHWs may have facilitated other important healthcare and social referrals.
Identifiants
pubmed: 39020307
doi: 10.1186/s12889-024-19462-1
pii: 10.1186/s12889-024-19462-1
doi:
Banques de données
ClinicalTrials.gov
['NCT05119348']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1924Subventions
Organisme : European and Developing Countries Clinical Trials Partnership
ID : RIA2020EF-2981
Organisme : European and Developing Countries Clinical Trials Partnership
ID : RIA2020EF-2981
Organisme : European and Developing Countries Clinical Trials Partnership
ID : RIA2020EF-2981
Organisme : European and Developing Countries Clinical Trials Partnership
ID : RIA2020EF-2981
Organisme : European and Developing Countries Clinical Trials Partnership
ID : RIA2020EF-2981
Organisme : European and Developing Countries Clinical Trials Partnership
ID : RIA2020EF-2981
Organisme : European and Developing Countries Clinical Trials Partnership
ID : RIA2020EF-2981
Organisme : European and Developing Countries Clinical Trials Partnership
ID : RIA2020EF-2981
Organisme : European and Developing Countries Clinical Trials Partnership
ID : RIA2020EF-2981
Organisme : European and Developing Countries Clinical Trials Partnership
ID : RIA2020EF-2981
Organisme : Medical Research Council
ID : RIA2020EF-2981
Pays : United Kingdom
Organisme : Medical Research Council
ID : RIA2020EF-2981
Pays : United Kingdom
Organisme : Medical Research Council
ID : RIA2020EF-2981
Pays : United Kingdom
Organisme : Medical Research Council
ID : RIA2020EF-2981
Pays : United Kingdom
Organisme : Medical Research Council
ID : RIA2020EF-2981
Pays : United Kingdom
Organisme : Medical Research Council
ID : RIA2020EF-2981
Pays : United Kingdom
Organisme : Medical Research Council
ID : RIA2020EF-2981
Pays : United Kingdom
Organisme : Medical Research Council
ID : RIA2020EF-2981
Pays : United Kingdom
Organisme : Medical Research Council
ID : RIA2020EF-2981
Pays : United Kingdom
Organisme : Medical Research Council
ID : RIA2020EF-2981
Pays : United Kingdom
Informations de copyright
© 2024. The Author(s).
Références
Stiegler N, Bouchard JP. South Africa: challenges and successes of the COVID-19 lockdown. Ann Méd-Psychol Rev Psychiatr. 2020;178(7):695–8.
Hatefi S, Smith F, Abou-El-Hossein K, Alizargar J. The pandemic of COVID-19: current Situation in South Africa. Disaster Med Public Health Prep. 2021;1–2.
Nyabadza F, Chirove F, Chukwu CW, Visaya MV. Modelling the potential impact of Social distancing on the COVID-19 epidemic in South Africa. Comput Math Methods Med. 2020;2020:e5379278.
doi: 10.1155/2020/5379278
Obasa AE, Singh S, Chivunze E, Burgess T, Masiye F, Mtande T, et al. Comparative strategic approaches to COVID-19 in Africa: balancing public interest with civil liberties. S Afr Med J. 2020;110(9):858–63.
doi: 10.7196/SAMJ.2020.v110i9.14934
pubmed: 32880268
pmcid: 8066401
Johnstone-Robertson SP, Mark D, Morrow C, Middelkoop K, Chiswell M, Aquino LDH, et al. Social mixing patterns within a South African Township Community: implications for respiratory disease transmission and control. Am J Epidemiol. 2011;174(11):1246–55.
doi: 10.1093/aje/kwr251
pubmed: 22071585
pmcid: 3224253
De Groot J, Lemanski C. COVID-19 responses: infrastructure inequality and privileged capacity to transform everyday life in South Africa. Environ Urban. 2021;33(1):255–72.
doi: 10.1177/0956247820970094
Joseph Davey D, Bekker LG, Coates TJ, Myer L. Contracting HIV or contracting SAR-CoV-2 (COVID- 19) in pregnancy? Balancing the risks and benefits. AIDS Behav. 2020;1–3.
Groenewald P, Neethling I, Evans J, Azevedo V, Naledi T, Matzopoulos R, et al. Mortality trends in the City of Cape Town between 2001 and 2013: reducing inequities in health. S Afr Med J. 2017;107(12):1091–8.
doi: 10.7196/SAMJ.2017.v107i12.12458
pubmed: 29262963
Statistics South Africa. 2011 Census products | Statistics South Africa [Internet]. 2011 [cited 2017 Dec 20]. http://www.statssa.gov.za/?page_id=3955 .
Jassat W, Mudara C, Ozougwu L, Tempia S, Blumberg L, Davies MA, et al. Difference in mortality among individuals admitted to hospital with COVID-19 during the first and second waves in South Africa: a cohort study. Lancet Glob Health. 2021;9(9):e1216–25.
doi: 10.1016/S2214-109X(21)00289-8
pubmed: 34252381
pmcid: 8270522
Moodley K, Blockman M, Pienaar D, Hawkridge AJ, Meintjes J, Davies MA, et al. Hard choices: ethical challenges in phase 1 of COVID-19 vaccine roll-out in South Africa. S Afr Med J. 2021;111(6):554–8.
pubmed: 34382565
NICD. COVID-19 Weekly Epidemiological Brief [Internet]. NICD. 2022 [cited 2023 Jun 5]. https://www.nicd.ac.za/wp-content/uploads/2022/04/COVID-19-Weekly-Epidemiology-Brief-week-15-2022.pdf .
Landes SJ, McBain SA, Curran GM. Reprint of: an introduction to effectiveness-implementation hybrid designs. Psychiatry Res. 2020;283:112630.
doi: 10.1016/j.psychres.2019.112630
pubmed: 31722790
Kang M, Ragan BG, Park JH. Issues in Outcomes Research: an overview of randomization techniques for clinical trials. J Athl Train. 2008;43(2):215–21.
doi: 10.4085/1062-6050-43.2.215
pubmed: 18345348
pmcid: 2267325
Klinkenberg D, Fraser C, Heesterbeek H. The effectiveness of contact tracing in emerging epidemics. PLoS ONE. 2006;1(1):e12.
doi: 10.1371/journal.pone.0000012
pubmed: 17183638
pmcid: 1762362
Sykes W, Mhlanga L, Swanevelder R, Glatt TN, Grebe E, Coleman C et al. Prevalence of anti-SARS-CoV-2 antibodies among blood donors in Northern Cape, KwaZulu-Natal, Eastern Cape, and Free State provinces of South Africa in January 2021. Res Sq [Internet]. 2021 Feb 12 [cited 2021 Apr 16]; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885925/ .
Hsiao M, Davies MA, Kalk E, Hardie D, Naidoo M, Centner C et al. SARS-COV-2 Seroprevalence In The Cape Town Metropolitan Sub-Districts After The Peak Of Infections [Internet]. 2020 [cited 2021 Apr 16]. https://scholar.google.com/scholar_lookup?journal=NICD+COVID-19+Special+Public+Health+Surveill+Bull&title=SARS-CoV-2+seroprevalence+in+the+Cape+Town+Metropolitan+sub-districts+after+the+peak+of+infections&author=M+Hsiao&author=MA+Davies&author=E+Kalk&volume=18&publication_year=2020&pages=1-9& .
Davies MA, Kassanjee R, Rousseau P, Morden E, Johnson L, Solomon W, et al. Outcomes of laboratory-confirmed SARS-CoV-2 infection in the Omicron-driven fourth wave compared with previous waves in the Western Cape Province, South Africa. Trop Med Int Health. 2022;27(6):564–73.
doi: 10.1111/tmi.13752
pubmed: 35411997
pmcid: 9115442
Bae S, Lim JS, Kim JY, Jung J, Kim SH. Transmission characteristics of SARS-CoV-2 that Hinder Effective Control. Immune Netw. 2021;21(1):e9.
doi: 10.4110/in.2021.21.e9
pubmed: 33728102
pmcid: 7937505
Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, et al. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS ONE. 2020;15(10):e0240205.
doi: 10.1371/journal.pone.0240205
pubmed: 33031427
pmcid: 7544065
Thompson HA, Mousa A, Dighe A, Fu H, Arnedo-Pena A, Barrett P et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Setting-specific Transmission Rates: A Systematic Review and Meta-analysis. Clin Infect Dis [Internet]. 2021 Feb 9 [cited 2021 Apr 16];(ciab100). https://doi.org/10.1093/cid/ciab100 .
Maimela G, Martin CE, Chersich M, Bello B, Mauti J, Barnighausen T, et al. Household transmission of SARS-CoV-2 in a rural area in South Africa. SAMJ South Afr Med J. 2024;114(2):64–71.
Cohen C, Kleynhans J, von Gottberg A, McMorrow ML, Wolter N, Bhiman JN, et al. SARS-CoV-2 incidence, transmission, and reinfection in a rural and an urban setting: results of the PHIRST-C cohort study, South Africa, 2020-21. Lancet Infect Dis. 2022;22(6):821–34.
doi: 10.1016/S1473-3099(22)00069-X
pubmed: 35298900
pmcid: 8920516
Kretzschmar ME, Rozhnova G, Bootsma MCJ, van Boven M, van de Wijgert JHHM, Bonten MJM. Impact of delays on effectiveness of contact tracing strategies for COVID-19: a modelling study. Lancet Public Health. 2020;5(8):e452–9.
doi: 10.1016/S2468-2667(20)30157-2
pubmed: 32682487
pmcid: 7365652
Hossain AD, Jarolimova J, Elnaiem A, Huang CX, Richterman A, Ivers LC. Effectiveness of contact tracing in the control of infectious diseases: a systematic review. Lancet Public Health. 2022;7(3):e259–73.
doi: 10.1016/S2468-2667(22)00001-9
pubmed: 35180434
pmcid: 8847088
Lunz D, Batt G, Ruess J. To quarantine, or not to quarantine: a theoretical framework for disease control via contact tracing. Epidemics. 2021;34:100428.
doi: 10.1016/j.epidem.2020.100428
pubmed: 33444928
Harling G, Gómez-Olivé FX, Tlouyamma J, Mutevedzi T, Kabudula CW, Mahlako R, et al. Protective behaviors and secondary Harms resulting from nonpharmaceutical interventions during the COVID-19 epidemic in South Africa: Multisite, prospective longitudinal study. JMIR Public Health Surveill. 2021;7(5):e26073.
doi: 10.2196/26073
pubmed: 33827046
pmcid: 8121138
Pillay Y, Pienaar S, Barron P, Zondi T. Impact of COVID-19 on routine primary healthcare services in South Africa. S Afr Med J. 2021;111(8):714–9.
doi: 10.7196/SAMJ.2021.v111i8.15786
pubmed: 35227349
El-Sadr WM, Platt J, Bernitz M, Reyes M. Contact tracing: barriers and facilitators. Am J Public Health. 2022;112(7):1025–33.
doi: 10.2105/AJPH.2022.306842
pubmed: 35653650
pmcid: 9222465
Dowthwaite L, Wagner HG, Babbage CM, Fischer JE, Barnard P, Nichele E, et al. The relationship between trust and attitudes towards the COVID-19 digital contact-tracing app in the UK. PLoS ONE. 2022;17(10):e0276661.
doi: 10.1371/journal.pone.0276661
pubmed: 36301881
pmcid: 9612492
Shelby T, Hennein R, Schenck C, Clark K, Meyer AJ, Goodwin J, et al. Implementation of a volunteer contact tracing program for COVID-19 in the United States: a qualitative focus group study. PLoS ONE. 2021;16(5):e0251033.
doi: 10.1371/journal.pone.0251033
pubmed: 33951107
pmcid: 8099418
Vallabhjee K, Gilson L, Davies MA, Boulle A, Pienaar D, Reagon G, et al. Reflections on the health system response to COVID-19 in the Western Cape Province. South Afr Health Rev. 2021;2021(1):173–87.