Factors associated with SARS-CoV-2 among persons living with HIV in Zambia: Analysis of three concurrent SARS-CoV-2 prevalence surveys conducted in July 2020 in six districts of Zambia (preprint)

People living with HIV (PLHIV) are a unique population because of their altered immune systems and taking antiretroviral therapy (ART) that may modify risk of SARS-CoV-2. Evidence from sub-Saharan African countries suggests that, despite not having higher SARS-CoV-2 infection prevalence than HIV-negative persons, PLHIV suffer worse COVID-19 outcomes. We assessed the prevalence of SARS-COV-2 infection by HIV status in Zambia in July 2020. We analyzed data from three different concurrent SARS-CoV-2 prevalence surveys (household, outpatient-department, and health-worker) conducted in six districts of Zambia in July 2020. Information on demographics and medical history was collected. Nasopharyngeal swabs were used to screen for SARS-CoV-2 RNA using polymerase-chain-reaction (PCR) and blood specimens were screened for SARS-CoV-2 virus-specific antibodies using an enzyme-linked-immunosorbent-assay (ELISA). Test-specific SARS-CoV-2 prevalence was calculated. Multilevel logistic regression models were used to measure test-specific adjusted odd ratios (aORs) of SARS-CoV-2 positivity by HIV status, controlling for demographic and medical history. We analysed the outcomes of the two different tests separately. Among 7,092 participants, 4,717 (66.5%) consented to blood-draw and 4,642 (65.5%) consented to nasopharyngeal swab. Overall SARS-CoV-2 positivity was 9.4% by PCR and 3.8% by ELISA. SARS-CoV-2 prevalence detected by PCR was higher among PLHIV than HIV-negative respondents (12.4% vs 9.1%, respectively, OR: 1.4, 95% confidence intervals [CI]: 1.0-1.9) and lower by ELISA (1.9% vs 3.9%, respectively, OR: 0.5, 95%CI: 0.2-0.9). Among PLHIV, not being on ART was an independent predictor of SARS-CoV-2 PCR positivity (aOR: 5.24,95% CI: 1.19-22.22) but did not have a significant effect on ELISA results. During the first COVID-19 wave in Zambia, PLHIV were more likely to be acutely infected with SARS-CoV-2 but less likely to be seropositive than participants without HIV. Intervention programs could focus on early access to COVID-19 vaccinations, testing and ART might reduce COVID-19 morbidity among PLHIV.

Two-Month Follow-up of Persons with SARS-CoV-2 Infection: Zambia, September 2020 (preprint)

BackgroundCOVID-19 is often characterized by an acute upper respiratory tract infection. However, information on longer-term clinical sequelae following acute COVID-19 is emerging. We followed a group of persons with COVID-19 in Zambia at two months to assess persistent symptoms. MethodsIn September 2020, we re-contacted participants from SARS-CoV-2 prevalence studies conducted in Zambia in July 2020 whose PCR tests were positive. Participants with valid contact information were interviewed using a structured questionnaire that captured demographics, pre-existing conditions, and types and duration of symptoms. We describe the frequency and duration of reported symptoms and used chi-square tests to explore variability of symptoms by age group, gender, and underlying conditions. ResultsOf 302 participants, 155 (51%) reported one or more acute COVID-19-related symptoms in July 2020. Cough (50%), rhinorrhoea (36%) and headache (34%) were the most frequently reported symptoms proximal to diagnosis. The median symptom duration was 7 days (IQR: 3-9 days). At a median follow up of 54 days (IQR: 46-59 day), 27 (17%) symptomatic participants had not yet returned to their pre-COVID-19 health status. These participants most commonly reported cough (37%), headache (26%) and chest pain (22%). Age, sex, and pre-existing health conditions were not associated with persistent symptoms. ConclusionA notable percentage of persons with SARS-CoV-2 infection in July still had symptoms nearly two months after their diagnosis. Zambia is implementing post-acute COVID-19 clinics to care for patients with prolonged symptoms of COVID-19, to address their needs and better understand how the disease will impact the population over time.