ABSTRACT
Background: There are limited studies evaluating the impact of COVID-19-related interruptions on hepatitis B virus (HBV) screening in endemic countries in Sub-Saharan Africa. Methods: We conducted a retrospective study of HBV testing in a community pharmacy in Freetown, Sierra Leone, from October 1, 2019, through September 30, 2022. We compared participant characteristics using Pearson's chi-square test. We evaluated trends in HBV screening and diagnosis using one-way ANOVA with Tukey's or Dunnett's post-test. Results: Of 920 individuals screened, 161 had detectable HBsAg (seroprevalence 17.5% [95% CI 14.9-20.4]). There was a 100% decrease in HBV screening during January-June of 2020; however, screening increased by 27% and 23% in the first and second year after COVID-19, respectively. Mean quarterly tests showed a significant upward trend: 55 - 6 tests during January-March (baseline), 74 - 16 tests during April-June, 101 - 3 tests during July-September, and 107 - 17 tests during October-December (one-way ANOVA test for trend, F = 7.7, p = 0.0254) but not the mean quarterly number of people diagnosed with HBV (F = 0.34, p = 0.7992). Conclusion: Community-based HBV screening dramatically improved following temporary disruptions related to COVID-19. Seasonal variation in HBV screening, but not HBV diagnosis, may have implications for HBV elimination efforts in Sierra Leone and other West African countries.
Subject(s)
COVID-19 , Hepatitis BABSTRACT
Objectives: People living with HIV (PWH) are at increased risk of COVID-19-related morbidity and mortality, yet less is known about COVID-19 vaccination uptake and hesitancy, especially in sub-Saharan Africa. We aimed to evaluate COVID-19 vaccine uptake and hesitancy among PWH in Sierra Leone. Methods: We conducted a cross-sectional study in a convenience sample of PWH in routine care at Connaught Hospital in Freetown, Sierra Leone from April through June 2022. We collected sociodemographic and health-related data. We used the VAX Scale, a validated instrument to assess attitudes towards COVID-19 vaccination. From the responses, we constructed hesitancy (VAX) scores, with higher scores implying negative attitudes toward vaccination. We used generalized linear models to identify factors associated with vaccine hesitancy. Results: A total of 490 PWH were enrolled (71.4% female, median age 38 years, median CD4 count 412 cells/mm3, 83.9% virologically suppressed). About 17.3% had received at least one dose of a COVID-19 vaccine. The mean VAX score was 43.14 {+/-} 7.05, corresponding to 59.9% of participants classified as vaccine-hesitant. Preference for natural immunity (65.8%) and concerns about commercial profiteering (64.4%) were the commonest reasons for hesitancy, followed by mistrust of vaccine benefits (61.4%) and worries about future side effects (48.0%). In adjusted regression analysis, being Muslim ({beta} = 2.563, p < 0.001) and residence in urban areas ({beta} = 1.709, p = 0.010) were associated with greater vaccine hesitancy, while having tested ever for COVID-19 was associated with lesser vaccine hesitancy ({beta} = -3.417, p = 0.027). Conclusion: We observed a low COVID-19 vaccine uptake and high hesitancy among PWH in Sierra Leone. Our findings underscore the need to address vaccine hesitancy as a critical element of efforts to boost COVID-19 vaccine uptake among this population in Sierra Leone.
Subject(s)
COVID-19 , HIV InfectionsABSTRACT
Background Sepsis is a major contributor to global mortality with an estimated 700, 000 sepsis-related deaths annually. As sepsis is an acute complication of COVID-19, the ongoing pandemic can increase its global burden. Despite this, there is still limited research evidence on COVID-19 and sepsis. In this scoping review, we described the research data on sepsis and septic shock among patients with COVID-19.Methods We adapted Arksey and O’Malley framework by reviewing relevant studies published on medRxiv, PubMed, and Google Scholar between January 01, 2020, and April 16, 2020, on sepsis and septic shock with the publication language restriction to English. The findings included the prevalence and outcome of COVID-19 patients with sepsis or septic shock, sepsis criteria, laboratory data, and the treatment given to COVID patients.Results Of the 16 eligible articles included in this review, 13 (81.2%) were conducted in China. With the exception of one article, the research work for all the articles was conducted in adult patients. The articles were retrospective studies (12, 75%), case reports (3, 18.8%) and prospective observational studies (1,6.2%). The estimated prevalence of sepsis and septic shock range from 6.8–100% and 4–28.9%, respectively. Serum lactate, platelets, C-reactive protein, white cell counts, and procalcitonin were elevated in 24.5%, 6.2%, 31.2%, 62.5%, 43.8% and 37.5% of the articles, respectively. Bacterial cultures were documented in 4(25%) of the eligible articles. 12 (75%) and 11 (68.8%) articles documented the use of antivirals and antibiotics, respectively. Other antimicrobials used among COVID-19 patients were hydroxychloroquine (1,6.3%), chloroquine (1, 6.3%), and unspecified antifungal drugs (2, 12.5%). Supportive therapies like oxygen therapy, mechanical ventilation, and fluid therapy were documented in 12(75%), 13 (81.3%), and 2 (12.5%) articles, respectively. The highest and lowest mortality among the study participants is 29.8% (134) and 5.4% (12), respectively.Conclusion There is a paucity of data in the literature on sepsis in COVID-19 despite its high burden among the COVID-19 patient population resulting in a high rate of antimicrobial use that is not backed by clearly documented microbiology laboratory support. Research is needed to understand the burden of sepsis in COVID-19.