RESUMEN
Background: Confirmed COVID-19 case counts underestimate SARS-CoV-2 infections, particularly in countries with limited testing capacity. Pregnant women attending antenatal care (ANC) clinics have served as healthy population surrogates to monitor diseases like HIV and malaria. We measured SARS-CoV-2 seroprevalence among women attending ANC clinics to assess infection trends over time in Zambia. Method(s): We conducted repeated cross-sectional surveys among pregnant women aged 15-49 years attending their first ANC visits in 3 districts of Zambia during September 2021-September 2022. Up to 200 women per district were enrolled each month, completing a standardized questionnaire. Dried blood spot samples were collected for serologic testing for prior infection using the Tetracore FlexImmArrayTM SARS-CoV-2 Human IgG Antibody Test and HIV testing according to national guidelines. We calculated odds ratios (ORs) for SARS-CoV-2 seroprevalence by demographic characteristics, adjusting for the district. Result(s): A total of 5,351 women were enrolled at 29 study sites between September 2021 and September 2022. Participants' median age was 25 years (interquartile range: 21-30), 530 (9.9%) tested positive for HIV, and 101 (1.9%) reported a prior positive COVID-19 test. Overall, SARS-CoV-2 seroprevalence was 67%, and rose from 49% in September 2021 to 85% in September 2022 (Figure 1). The greatest increase in seroprevalence occurred during the 4th wave caused by the Omicron variant (48% in December 2021 to 63% in January 2022). Seroprevalence was significantly higher among women living in urban districts (Chipata and Lusaka) compared to rural Chongwe District (Chipata OR: 1.2, 95% confidence interval [CI]: 1.1-1.4;Lusaka OR: 1.7, 95% CI: 1.5-2.0). The age group was not significantly associated with seroprevalence after adjusting for the district (aOR: 1.1, 95% CI: 1.0-1.2). Seroprevalence was significantly lower among women living with HIV than women living without HIV (aOR: 0.8, 95% CI: 0.6-0.9). Conclusion(s): Overall, two-thirds of women in the three surveyed districts in Zambia had evidence of SARS-CoV-2 exposure, rising to 85% after the Omicron variant spread throughout the country. ANC clinics have a potential role in ongoing SARS-CoV-2 serosurveillance and can continue to provide insights into SARS-CoV-2 infection dynamics. Furthermore, they provide a platform for focused SARS-CoV-2 prevention messaging and COVID-19 management in pregnant women at higher risk of severe disease. (Figure Presented).
RESUMEN
Background: As of October 26, 2020, Malawi reported 5,894 confirmed COVID-19 cases with 183 deaths. A state of disaster was declared in March;however, a strict lockdown order was never issued. Malawi has implemented a testing strategy involving screening and testing only symptomatic persons due to limited availability of tests. Sentinel surveillance was conducted with the primary purpose of estimating the prevalence of symptomatic and asymptomatic SARS-CoV-2 infection among children >5 years and adults in Malawi health facilities (HF). Methods: SARS-CoV-2 surveillance was conducted at 14 purposively selected HFs across 8 districts in all 3 regions of Malawi from August 27 to October 14, 2020. Persons entering HFs were screened for COVID-19 symptoms;all those with symptoms suggestive of COVID-19 per Malawi guidelines and a systematic sample of asymptomatic individuals were invited to participate. Questionnaire data and nasopharyngeal swabs were collected from consenting persons. Infection was confirmed by SARS-CoV-2 RT-PCR assay (Abbott m2000). This preliminary analysis was restricted to those with test results. We performed chisquare tests to assess bivariate associations between demographic or behavioral characteristics and SARS-CoV-2 status stratified by symptom status. Results: A total of 8,169 (1,350 symptomatic, 6,819 asymptomatic) individuals were enrolled. Results are currently available for 1,300 (96%) symptomatic and 6,648 (97%) asymptomatic participants. A total of 30 (2%) symptomatic and 37 (0.6%) asymptomatic participants tested SARS-CoV-2 positive (Table). Most (67%) positive symptomatic participants were aged 15-49 years, followed by 50+ years (30%);a similar trend was seen for asymptomatic cases. A higher percentage of symptomatic cases reported being in contact with a confirmed or suspected COVID-19 case than symptomatic non-cases (p=.03). Among positive symptomatic individuals, the most common symptom was cough (70%);fever and loss of smell or taste were reported in 13% and 10% of individuals, respectively. Most COVID-19 cases in both symptom groups reported not adhering to social distancing guidelines. Conclusion: Based on preliminary data, asymptomatic SARS-CoV-2 infection in Malawians visiting HFs was relatively rare. This suggests a need for continued surveillance to ensure a better understanding of exposures as well as further monitoring of SARs-CoV-2 transmission in Malawi.
RESUMEN
Background: While little is known about the interaction of HIV and SARSCoV- 2, disruptions caused by the COVID-19 pandemic may impact the ability of people living with HIV (PLHIV) to access antiretroviral therapy (ART). We conducted syndromic surveillance to identify challenges in PLHIV's access to health care services in selected districts in Malawi. Methods: We conducted telephone-based syndromic surveillance among randomly selected PLHIV ≥18 years old who had a telephone number on file in 179 ART clinics across nine districts. Patients who answered the phone were asked to verify their identity and provide consent. Staff used a structured questionnaire to collect self-reported data on demographic characteristics, experience of COVID-19 symptoms (CS) within the past 14 days as defined by the World Health Organization, access to health services, and ART interruptions (≥1 dose missed in past week) during the pandemic. We summarized data using proportions and medians and used Chi-square tests to examine associations. Results: From August-October 2020, we dialed 17,944 numbers;26.1% (4,680) confirmed their identity, were on ART and were ≥18 years. Most (93.7%, n=4,385) eligible clients consented, and 98.6% (n=4323) completed interviews. Over half (53.8%) were female. The male median age was 42 years (interquartile range [IQR] 18 - 78) compared to 36 (IQR 18 -80) among females. Of 263 (6.1%) reporting at least one CS, persistent cough (35.7%), headache (40.3%) and fever (18.6%) were most common. Overall, 193 (4.5%) reported having been tested for SARS-CoV-2. Females were more likely to have missed school or work due to CS compared to males (37.3% vs. 21.8%, p=0.004), and were more likely to access medical care for CS (66.2% vs. 54.9%, p=0.048). Of all respondents, 17.6% reported not accessing health care services during the pandemic. Challenges included health facility closures (13.6%), no money for transport (13.9%) and fear of COVID-19 (45%). Few respondents (1.8%) reported missing ART doses. Conclusion: The telephone-based syndromic surveillance system proved to be feasible in monitoring the impact of COVID-19 among PLHIV in a resourcelimited setting. PLHIV reported missing school or work due to CS and not accessing health care services, though few missed their ART doses;these findings require further research. Similar systems can be used to rapidly identify and respond to COVID-19-related challenges with health care access for people on ART.