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Background: Accommodations with shared washing facilities increase the risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for people experiencing rough sleeping and evidence on what interventions are effective in reducing these risks needs to be understood., Methods: Systematic review, search date 6 December 2022 with methods published a priori. Electronic searches were conducted in MEDLINE, PubMed, Cochrane Library, CINAHL and the World Health Organization (WHO) COVID-19 Database and supplemented with grey literature searches, hand searches of reference lists and publication lists of known experts. Observational, interventional and modelling studies were included; screening, data extraction and risk of bias assessment were done in duplicate and narrative analyses were conducted., Results: Fourteen studies from five countries (USA, England, France, Singapore and Canada) were included. Ten studies were surveillance reports, one was an uncontrolled pilot intervention, and three were modelling studies. Only two studies were longitudinal. All studies described the effectiveness of different individual or packages of mitigation measures., Conclusions: Despite a weak evidence base, the research suggests that combined mitigation measures can help to reduce SARS-CoV-2 transmission but are unlikely to prevent outbreaks entirely. Evidence suggests that community prevalence may modify the effectiveness of mitigation measures. More longitudinal research is needed., Systematic Review Registration: PROSPERO CRD42021292803., (© The Author(s) 2023. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Competing Interests: Competing interests: Diane Kelsall was the interim editor-in-chief of CMAJ until October 2019, and is currently editor for CMAJ Open and consulting editor for CMAJ. Gillian Leng is an executive director of the National Institute for Health and Care Excellence, which also has a policy on declaring and managing conflicts of interest, and is the chair of the Guidelines International Network, which provides advice on managing potential conflicts of interest. Brett Thombs, Ainsley Moore and Navindra Persaud are, respectively, chair, vice-chair and a member of the Canadian Task Force on Preventive Healthcare, which develops clinical practice guidelines and also has a policy on declaring and managing conflicts of interests. Navindra Persaud reports receiving research funding from the Canadian Institutes of Health Research, the Ontario SPOR Support Unit, and the Canada Research Chairs program, outside of the submitted work. Holger Schünemann is a member of the GRADE working group and was the lead author on the Guidelines International Network principles for disclosure of interests, and is the corresponding author on the manuscript describing the PANELVIEW instrument. Rachel Rodin and Marcello Tonelli report receiving funding from the Canadian Institutes of Health Research to host the Best Brains Exchange referred to in the article. Elie Akl reports contributing to a number of studies on conflicts of interest. G. Michael Allan reports being an author of guidelines, who has received travel support, honoraria for speaking at conferences, and research support. The supports have been from nonprofit sources. Dr. Allan has received no funding from the pharmaceutical industry. Isabelle Ganache reports receiving personal fees from Institut national d’excellence santé et en services sociaux (INESSS), as director of the Bureau – Methodologies and Ethics (which is responsible for the institutional policy on declaring and managing conflicts of interest), during the conduct of the study. Quinn Grundy reports receiving grants from the Social Science and Humanities Research Council and a Connaught New Research Award from the University of Toronto, outside of the submitted work. No other competing interests were declared.