Factors associated with severe SARSCOV- 2 infection in people of Black ethnicities living with HIV in the UK

Background: The COVID-19 pandemic has disproportionally affected people of black ethnicities, who have been at greater risk of SARS-CoV-2 acquisition, morbidity and mortality than those of white ethnicity. We describe factors associated with severe COVID-19 infection in the GEN-AFRICA cohort of people of black ethnicities living with HIV in the U.K. Method(s): First reported episodes of COVID-19 up to October 2022 were ascertained by direct questioning and/or medical records review. Pre-pandemic immune-virological and comorbidity status was based on measurements obtained prior to 01/2020 and used to identify risk factors for severe (requiring hospitalisation or resulting in death) COVID-19, using logistic regression Results: COVID-19 status was available for 1806 (72%) of 2503 GEN-AFRICA participants (mean age 49.2 [SD 10.2] years;56% female;80% sub-Saharan African and 14% Caribbean ancestry, median CD4 count 555 [IQR 400-733] cells/mm3;93% undetectable HIV RNA [<200 copies/ mL]);573 (32%) reported a clinical illness consistent with COVID-19;63 (3.5%) experienced severe COVID-19 (hospitalisation 59;death 4). Those who experienced severe COVID-19 were older, more often male, had lower CD4 counts and fewer had undetectable HIV RNA;they more often had prior AIDS, hypertension, diabetes mellitus and chronic kidney disease. Region of ancestry, nadir CD4 count, and obesity were not associated with severe COVID-19. In multivariable analysis, CD4 count <350 cells/mm3, diabetes mellitus and chronic kidney disease were associated with increased odds of severe COVID-19 (Table). Sex and a pre-pandemic HIV RNA were associated with severe disease although this did not reach statistical significance. By October 2022, 1534 (88%) of this sample had received >=1 dose of SARS-CoV-2 vaccine;those who experienced severe COVID-19 were less likely to report vaccination (77% vs. 89%, p=0.01). Conclusion(s): By the end of October 2022, nearly onethird of people of Black ethnicities with HIV in this sample had experienced COVID-19;3.5% had developed severe COVID-19 disease. Pre-pandemic immunovirological and comorbidity status were associated with severe COVID-19. Black populations with less favourable HIV control than observed for GEN-AFRICA participants may have suffered greater COVID-19 morbidity and mortality. (Table Presented).

Incidence, Risk Factors and Outcome of Acute Kidney Injury (Aki) in Covid-19 Patients in a Sub-Saharan African Intensive Care Unit: A Prospective Cohort Study

Introduction: Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). kidney damage linked to COVID-19 could take on specific characteristics by genetic, environmental and socio-cultural factors. This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in COVID-19 patients at Centre Medical de Kinshasa (CMK). Method(s): In a prospective cohort study carried out at the Kinshasa Medical Center (KMC), consecutive patients admitted to the ICU were screened for the presence of AKI from March 1st, 2020 to January 1st, 2022 period covered the first 4 waves of the Covid-19 pandemic. We included all adult inpatients (>=18 years old) with a positive COVID-19 PCR result. Patients on chronic dialysis (hemodialysis or peritoneal dialysis) and those with less than two creatinine measurements were excluded. Aki was defined according KDIGO guidelines. Univariate and multivariate analysis were performed by Cox regression to identify risk factors for AKI and association between AKI and in-hospital mortality. The significance level of p value was set at 0.05. Result(s): A total of 217 patients were included in the study of which most were males (77.0%) and blacks (80.2%). AKI was diagnosed in 63 out of 217 (29%) COVID-19 patients after a median time of 2 days (0-7). Stages 1, 2, or 3 AKI accounted for 39.7%, 11.1% and 49.2%, respectively. Hemodialysis was performed in 7.8% of the subjects and 69.8% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were first COVID-19 wave (HR: 3.1 [1.2-8.4] p=0.022), obesity (HR: 1.2 [1.02-6.7] p=0.046), higher SOFA score (HR: 6.1 [2.1-17.3] p=0.001) and CRP at day 7 (HR: 1.9 [1.1-10.0] p=0.023). Patients with AKI had a mortality rate of 57.1%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (HR:2.96 [1.93-4.65] p=0.013) compared to non-AKI patients. Conclusion(s): AKI was present in three out of ten COVID-19 patients. The most significant risk factors for AKI were first wave, obesity, higher SOFA score and CRP. Despite dialysis, AKI has been associated with almost threefold increase in overall mortality and seven out of ten survivors did not recover kidney function after AKI. No conflict of interestCopyright © 2023

Sub-Saharan African communities' experiences and engagement with COVID-19 and the related control strategies in Antwerp, Belgium.

BACKGROUND: Pre-existing racial/ethnic disparities in health, sustained by intersecting socio-economic and structural inequities, have widened due to the COVID-19 pandemic. Yet, little attention has been paid to the lived experiences of people in ethnic/racialised minority communities, and to the causes and effects underlying the COVID-19-related burden. This hinders tailored responses. This study explores Sub-Saharan African (SSA) communities' needs, perceptions, and experiences of the COVID-19 pandemic and its control measures in Antwerp (Belgium) in 2020. METHODS: This qualitative study using an interpretative ethnographical approach adopted an iterative and participatory methodology: a community advisory board advised on all stages of the research process. Interviews and a group discussion were conducted online, through telephone, and face-to-face. We analysed the data inductively using a thematic analytical approach. RESULTS: Our respondents, who mostly used social media for information, struggled with misinformation about the new virus and prevention measures. They reported to be vulnerable to misinformation about the origin of the pandemic, risk of infection with SARS-CoV-2, and the prevention measures. Not only did the epidemic affect SSA communities, but to a larger extent, the control strategies did-especially the lockdown. Respondents perceived the interaction of social factors (i.e. being migrants, being undocumented, having experienced racism and discrimination) and economic factors (i.e. working in temporary and precarious jobs, not being able to apply for unemployment benefit, crowded housing conditions) as increasing the burden of COVID-19 control measures. In turn, these experiences influenced people's perceptions and attitudes, and may have partially impaired them to follow some public health COVID-19 prevention guidelines. Despite these challenges, communities developed bottom-up initiatives to react quickly to the epidemic, including translation of prevention messages, food distribution, and online spiritual support. CONCLUSION: Pre-existing disparities influenced the perceptions of and attitudes towards COVID-19 and its control strategies among SSA communities. To better design support and control strategies targeted to specific groups, we need to not only involve communities and address their specific needs and concerns, but also build on their strengths and resilience. This will remain important in the context of widening disparities and future epidemics.

Safe management of COVID-19 dead bodies in sub-Saharan Africa: could families be allowed to bury their dead?.

Sub-Saharan African countries have been hit by the Coronavirus 2019 pandemic (COVID-19) since March 2020. Besides the resulting health and economic disasters is the psycho-socio-cultural problem related with the management of corpses of people dead from the disease, which might hinder the implementation of the response strategy. In Cameroon for instance, the current corpse management policy is very disputed. In fact, although they were recently made more flexible, the restrictions applied to burials still ban any transfer of dead bodies between cities. In light of the African cultural considerations of dead persons, the disputes observed between the families and the health personnel, the legislation and the available scientific evidence, this article analyses the risks and benefits of allowing families to bury their relatives. It thereafter suggests solutions that reconcile dignity (by allowing families to bury their dead relatives in their homes) and safety (by ensuring a sealed handling and the surveillance by a judiciary police officer). Applying these solutions could improve the population's trust towards the health system, and positively contribute to COVID-19 case prevention, identification and management. Copyright © 2020, African Field Epidemiology Network. All rights reserved.

Sustainable Development and SDG-7 in Sub-Saharan Africa: Balancing Energy Access, Economic Growth, and Carbon Emissions.

The Covid-19 pandemic has shocked the global energy system. It has resulted in tremendous uncertainty and diminished the recent advances to increase access to affordable, reliable, sustainable and modern energy-an objective preserved in the UN Sustainable Development Goal 7 (SDG-7). According to the IEA, attaining universal electricity access in Africa in line with SDG-7 entails annual investments of approximately $20 billion over the next decade. Given the sizeable magnitudes involved, it is inevitable that energy projects will need to rely on richer nations for energy aid. This paper explores the linkages between energy-related external aid, carbon emissions, per capita GDP, and electricity access for a sample of 30 low-income SSA countries over 1995 to 2016. Our econometric analysis reveals that while all types of energy aid facilitate economic growth in the long run, there is no direct impact of energy-related aid on electricity access. However, an increase in per capita GDP is positively associated with electricity access in both rural and urban areas. We also find that energy-related aid helps mitigate carbon emissions as well as contribute to GDP. Taken together, our results suggest that enhanced energy-related aid to low-income SSA countries can directly facilitate climate compatible growth and indirectly impel improvements in electricity access thereby helping with poverty reduction. We also advocate regional cooperation among SSA countries as a collective effort to confront shared energy challenges.

La pandémie de Covid-19 a bouleversé le système énergétique mondial. Cela a entraîné une très grande incertitude et a fait reculer les progrès réalisés récemment pour accroître l'accès à une énergie abordable, fiable, durable et moderne­un objectif qui fait partie de l'Objectif de développement durable 7 (ODD 7) des Nations Unies. Selon l'AIE, pour atteindre l'accès universel à l'électricité en Afrique, conformément à l'ODD 7, il faut des investissements annuels d'environ 20 milliards de dollars au cours de la prochaine décennie. Compte tenu de l'ampleur considérable de ce qui est en jeu, il est inévitable que les projets énergétiques aient besoin de s'appuyer sur les pays les plus riches pour obtenir une aide énergétique. Cet article explore les liens entre l'aide extérieure liée à l'énergie, les émissions de carbone, le PIB par habitant et l'accès à l'électricité, sur un échantillon de 30 pays à faible revenu d'Afrique subsaharienne de 1995 à 2016. Notre analyse économétrique révèle que même si tous les types d'aide énergétique contribuent à la croissance à long terme, il n'y a pas d'impact direct des aides liées à l'énergie sur l'accès à l'électricité. Cependant, il existe un lien entre l'augmentation du PIB par habitant et l'accès à l'électricité dans les zones rurales et urbaines. Nous constatons également que l'aide liée à l'énergie permet d'atténuer les émissions de carbone et contribue au PIB. Lorsqu'on les considère dans leur globalité, nos résultats suggèrent qu'une aide énergétique accrue auprès des pays à faible revenu d'Afrique subsaharienne peut directement faciliter une croissance respectueuse du climat et favoriser indirectement l'amélioration de l'accès à l'électricité, contribuant ainsi à la réduction de la pauvreté. Nous préconisons également la coopération régionale entre les pays d'Afrique sub-saharienne en tant qu'effort collectif pour relever des défis énergétiques communs.

Fragility of FDI flows in sub-Saharan Africa region: does the paradox persist?

The circumstances of the SSA region regarding the inflow of foreign direct investment (FDI) present a puzzle. In spite of the high rate of return on investment, the inflow of foreign investments keeps eluding the region, and the COVID-19 pandemic even perplexes the flow fragility the more. What factors then determine FDI flows aside from return on investment? Could there be more persuasive relative cost complexes? The study aimed at testing the effects of determining factors that influence FDI flows and their impact on economic development, considering the COVID-19 period. The study used cross-country pooled data from 30 SSA countries collected between 2001 and 2020. The study utilized five panel estimation techniques, namely Pooled Regression, Fixed Effect (FE), Random Effect (RE), Panel Two-Stage Least Square and Differenced Generalized Moments of Method (DGMM). The study found that the inflow of FDI has significant positive impact on economic development in the sub-Saharan African region. It is also ascertained that the outflow of FDI, and political stability has an inverse relationship with economic development. The study recommends that governments of host economies should hence ensure an enabling framework for their economies, so as to improve infrastructure, political stability, and institutional quality, in order to sufficiently encourage the inflow of FDI into the SSA region and make the environment inviting, sustainable, and beneficial for foreign investors and host economies alike.

Understanding the blended impacts of COVID-19 and systemic inequalities on sub-Saharan African immigrants in Canada.

The COVID-19 pandemic poses a grave health threat and has serious socio-economic implications for all. However, crises are not experienced equally; the pandemic has disproportionately affected immigrants in several countries, including Canada and the United States. The effects of COVID-19 have exposed the realities of societal and structural inequities, worsened the socio-economic status of many immigrants, and placed them at higher risks of poor health outcomes. Emerging research on COVID-19 and race in Canada addresses the structural inequities that shape the disproportionate harms of COVID-19 on immigrants. For sub-Saharan African immigrants, these inequities are worse due to the intersecting systems of race, gender, and class marginalization. They tend to be more exposed and less protected amid the pandemic. Given the lack of research on sub-Saharan African immigrants' experiences in Canada, this paper discusses how multiple axes of inequities shape their health and livelihood during COVID-19. The objective is to provide a broader scientific understanding of issues related to systemic inequities and health for sub-Saharan African immigrants in Canada and the related implications for public health advocates, policymakers, and the public.

RéSUMé: La pandémie de COVID-19 pose une grave menace pour la santé et a de graves conséquences socioéconomiques pour tous. Les crises ne touchent cependant pas tout le monde également; la pandémie a démesurément touché les immigrants dans plusieurs pays, entre autres au Canada et aux États-Unis. Les effets de la COVID-19 ont mis au jour la réalité des iniquités sociétales et structurelles, réduit le statut socioéconomique de nombreux immigrants et exposé ces immigrants à de plus grands risques de mauvais résultats cliniques. Des études émergentes sur la COVID-19 et la race au Canada abordent les iniquités structurelles qui déterminent les préjudices disproportionnés causés par la COVID-19 aux immigrants. Pour les immigrants d'Afrique subsaharienne, ces iniquités sont pires en raison de l'entrecroisement des systèmes de marginalisation fondés sur la race, le sexe et la classe sociale. Ces immigrants tendent à être plus exposés et moins protégés au milieu de la pandémie. Étant donné le manque d'études sur les expériences des immigrants d'Afrique subsaharienne au Canada, nous abordons ici l'influence des nombreux axes de l'iniquité sur leur santé et leurs moyens de subsistance durant la COVID-19. Notre objectif est de présenter une interprétation scientifique plus vaste des problèmes liés aux iniquités systémiques et à la santé chez les immigrants d'Afrique subsaharienne au Canada et des conséquences qui en découlent pour les défenseurs de la santé publique, les responsables des politiques et le grand public.

A SARS-CoV-2 Surveillance System in Sub-Saharan Africa: Modeling Study for Persistence and Transmission to Inform Policy.

BACKGROUND: Since the novel coronavirus emerged in late 2019, the scientific and public health community around the world have sought to better understand, surveil, treat, and prevent the disease, COVID-19. In sub-Saharan Africa (SSA), many countries responded aggressively and decisively with lockdown measures and border closures. Such actions may have helped prevent large outbreaks throughout much of the region, though there is substantial variation in caseloads and mortality between nations. Additionally, the health system infrastructure remains a concern throughout much of SSA, and the lockdown measures threaten to increase poverty and food insecurity for the subcontinent's poorest residents. The lack of sufficient testing, asymptomatic infections, and poor reporting practices in many countries limit our understanding of the virus's impact, creating a need for better and more accurate surveillance metrics that account for underreporting and data contamination. OBJECTIVE: The goal of this study is to improve infectious disease surveillance by complementing standardized metrics with new and decomposable surveillance metrics of COVID-19 that overcome data limitations and contamination inherent in public health surveillance systems. In addition to prevalence of observed daily and cumulative testing, testing positivity rates, morbidity, and mortality, we derived COVID-19 transmission in terms of speed, acceleration or deceleration, change in acceleration or deceleration (jerk), and 7-day transmission rate persistence, which explains where and how rapidly COVID-19 is transmitting and quantifies shifts in the rate of acceleration or deceleration to inform policies to mitigate and prevent COVID-19 and food insecurity in SSA. METHODS: We extracted 60 days of COVID-19 data from public health registries and employed an empirical difference equation to measure daily case numbers in 47 sub-Saharan countries as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: Kenya, Ghana, Nigeria, Ethiopia, and South Africa have the most observed cases of COVID-19, and the Seychelles, Eritrea, Mauritius, Comoros, and Burundi have the fewest. In contrast, the speed, acceleration, jerk, and 7-day persistence indicate rates of COVID-19 transmissions differ from observed cases. In September 2020, Cape Verde, Namibia, Eswatini, and South Africa had the highest speed of COVID-19 transmissions at 13.1, 7.1, 3.6, and 3 infections per 100,0000, respectively; Zimbabwe had an acceleration rate of transmission, while Zambia had the largest rate of deceleration this week compared to last week, referred to as a jerk. Finally, the 7-day persistence rate indicates the number of cases on September 15, 2020, which are a function of new infections from September 8, 2020, decreased in South Africa from 216.7 to 173.2 and Ethiopia from 136.7 to 106.3 per 100,000. The statistical approach was validated based on the regression results; they determined recent changes in the pattern of infection, and during the weeks of September 1-8 and September 9-15, there were substantial country differences in the evolution of the SSA pandemic. This change represents a decrease in the transmission model R value for that week and is consistent with a de-escalation in the pandemic for the sub-Saharan African continent in general. CONCLUSIONS: Standard surveillance metrics such as daily observed new COVID-19 cases or deaths are necessary but insufficient to mitigate and prevent COVID-19 transmission. Public health leaders also need to know where COVID-19 transmission rates are accelerating or decelerating, whether those rates increase or decrease over short time frames because the pandemic can quickly escalate, and how many cases today are a function of new infections 7 days ago. Even though SSA is home to some of the poorest countries in the world, development and population size are not necessarily predictive of COVID-19 transmission, meaning higher income countries like the United States can learn from African countries on how best to implement mitigation and prevention efforts. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/21955.

Leveraging best practices: protecting sub-Saharan African prison detainees amid COVID-19.

The risk of infection and death from COVID-19 is higher among older prisoners with pre-existing health conditions especially in sub-Saharan African. Hawks L et al. raise four concerns that need to be considered when developing public health and clinical responses to COVID-19 to protect prisoners. This paper applies these concerns to the sub-Saharan African context. These focus areas include 1) challenges of social distancing; 2) higher risk of severe infection and death; 3) difficulties health care systems may face in the case of COVID-19 surge; and 4) recommended solutions to prevent harm and preventing a public health catastrophe. Prisoners are more vulnerable and the time to take immediate actions to minimize an imminent COVID-19 outbreak and its impacts is now.

Wastewater surveillance for Covid-19: An African perspective.

The COVID-19 pandemic has once again highlighted the importance of access to sufficient quantities of safe water and sanitation in public health. In the current COVID-19 pandemic, an early warning wastewater system has been proposed as a platform for SARS-CoV-2 surveillance, and a potentially important public health strategy to combat the disease. This short communication on wastewater surveillance in sub-Saharan Africa highlights challenges, opportunities and alternatives taken into account the local context.