Factors associated with response to a phone-administered alcohol and substance use survey during the COVID-19 pandemic among women in the MACS/WIHS Combined Cohort Study: Who are we missing?

Background. Early in the COVID-19 pandemic, many clinical studies pivoted to remote research visits, which have a higher non-response rate compared to in-person assessments. Survey non-response can bias estimates of alcohol and substance use prevalence. Our objective was to identify factors associated with responding to an alcohol and substance use phone survey administered during the COVID-19 pandemic to women enrolled in the MACS/WIHS Combined Cohort Study, a multicenter U.S. prospective cohort of adults living with and without HIV. Methods. We assessed associations of pre-pandemic (April-Sept. 2019) sociodemographic factors, HIV status, housing status, depressive symptoms, alcohol use, and substance use measures with response to a pandemic (Aug.-Sept. 2020) phone survey using multivariable logistic regression. Response probability weights generated from the regression model were applied to the sample and prevalence estimates of risky drinking (> 7 drinks/week or > 3 drinks/day) and substance use (opioids, stimulants, sedatives) in the COVID-19 pandemic were compared to the unweighted sample. Results. Of 1,834 women with pre-pandemic data, 62% were of Black race, 46% had an annual income < $12K, 71% were living with HIV and the mean age was 52.4 (SD 9.3) years. The phone survey response rate was 77.5%. In the adjusted model, the odds of responding were lower at research sites in the Western (aOR 0.35 95% CI 0.21-0.57) and Southern US (aOR 0.29 95% CI 0.19-0.44, ref=Midwest), in women of Hispanic ethnicity (aOR 0.47 95% CI 0.33-0.66, ref=Black race), and in those who reported substance use (aOR 0.62 95% CI 0.40-0.95). By contrast, the odds were higher for women of white race (aOR 1.63 95% CI 1.02-2.70) and those with stable housing (aOR 1.71 95% CI 1.22-2.39). Un weighted versus weighted prevalence estimates were 11.1% vs. 11.6% for risky drinking and 6.1% vs. 6.9% for substance use. Conclusion. Among a sample of socioeconomically disadvantaged women, women of Hispanic ethnicity, and those who were unstably housed and reported substance use at baseline had lower odds of responding to an alcohol and substance use phone survey conducted early in the COVID-19 pandemic. As remote survey methods become more common, investigators should ensure that data remain representative of the target population.

City-wide wastewater genomic surveillance through the successive emergence of SARS-CoV-2 Alpha and Delta variants.

Genomic surveillance of SARS-CoV-2 has provided a critical evidence base for public health decisions throughout the pandemic. Sequencing data from clinical cases has helped to understand disease transmission and the spread of novel variants. Genomic wastewater surveillance can offer important, complementary information by providing frequency estimates of all variants circulating in a population without sampling biases. Here we show that genomic SARS-CoV-2 wastewater surveillance can detect fine-scale differences within urban centres, specifically within the city of Liverpool, UK, during the emergence of Alpha and Delta variants between November 2020 and June 2021. Furthermore, wastewater and clinical sequencing match well in the estimated timing of new variant rises and the first detection of a new variant in a given area may occur in either clinical or wastewater samples. The study's main limitation was sample quality when infection prevalence was low in spring 2021, resulting in a lower resolution of the rise of the Delta variant compared to the rise of the Alpha variant in the previous winter. The correspondence between wastewater and clinical variant frequencies demonstrates the reliability of wastewater surveillance. However, discrepancies in the first detection of the Alpha variant between the two approaches highlight that wastewater monitoring can also capture missing information, possibly resulting from asymptomatic cases or communities less engaged with testing programmes, as found by a simultaneous surge testing effort across the city.

Establishment of local wastewater-based surveillance programmes in response to the spread and infection of COVID-19 - case studies from South Africa, the Netherlands, Turkey and England.

The COVID-19 pandemic has resulted in over 340 million infection cases (as of 21 January 2022) and more than 5.57 million deaths globally. In reaction, science, technology and innovation communities across the globe have organised themselves to contribute to national responses to COVID-19 disease. A significant contribution has been from the establishment of wastewater-based epidemiological (WBE) surveillance interventions and programmes for monitoring the spread of COVID-19 in at least 55 countries. Here, we examine and share experiences and lessons learnt in establishing such surveillance programmes. We use case studies to highlight testing methods and logistics considerations associated in scaling the implementing of such programmes in South Africa, the Netherlands, Turkey and England. The four countries were selected to represent different regions of the world and the perspective based on the considerable progress made in establishing and implementing their national WBE programmes. The selected countries also represent different climatic zones, economies, and development stages, which influence the implementation of national programmes of this nature and magnitude. In addition, the four countries' programmes offer good experiences and lessons learnt since they are systematic, and cover extensive areas, disseminate knowledge locally and internationally and partnered with authorities (government). The programmes also strengthened working relations and partnerships between and among local and global organisations. This paper shares these experiences and lessons to encourage others in the water and public health sectors on the benefits and value of WBE in tackling SARS-CoV-2 and related future circumstances.