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Background: South Africa experienced five COVID-19 waves and over 90% of the population have developed immunity. HIV prevalence among adults is 19% and over 2 million people have uncontrolled viral loads, posing a risk for poor COVID-19 outcomes. Using national hospital surveillance data, we aimed to investigate trends in admission and factors associated with in-hospital COVID-19 mortality among people with HIV (PWH) in South Africa. Method(s): Data between March 5, 2020 and May 28, 2022 from the national COVID-19 hospital surveillance system, SARS-CoV-2 case linelist and Electronic Vaccine Data System were linked and analysed. A wave was defined as the period for which weekly incidence was >=30 cases/100,000 people. Descriptive statistics were employed for admissions and mortality trends. Postimputation random effect multivariable logistic regression models compared (a) characteristics of PWH and HIV-uninfected individuals, and (b) factors associated with mortality among PWH. Result(s): 68.7% (272,287/396,328) of COVID-19 admissions had a documented HIV status. PWH accounted for 8.4% (22,978/272,287) of total admissions, and 9.8%, 8.0%, 6.8%, 12.2% and 6.7% of admissions in the D614G, Beta, Delta, Omicron BA.1 and Omicron BA.4/BA.5 waves respectively. The case fatality ratio (CFR) among PWH and HIV-uninfected was 24.3% (5,584/22,978) vs 21.7% (54,110/249,309) overall, and in the respective waves was 23.7% vs 20.4% (D614G), 27.9% vs 26.6% (Beta), 26.2% vs 24.5% (Delta), 18.2% vs 9.1% (Omicron BA.1) and 16.8% vs 5.5% (Omicron BA.4/BA.5). Chronic renal disease, malignancy and past TB were more likely, and hypertension and diabetes were less likely in PWH compared to HIV-uninfected individuals. Among PWH, along with older age, male sex and presence of a comorbidity, there was a lower odds of mortality among individuals with prior SARS-CoV-2 infection (aOR 0.6;95% CI 0.4-0.8);>=1 dose vaccination (aOR 0.1;95% CI 0.1-0.1);and those admitted in the Delta (aOR 0.9;95% CI 0.8-0.9), Omicron BA.1 (aOR 0.5;95% CI 0.5-0.6) and Omicron BA.4/BA.5 (aOR 0.5;95% CI 0.4-0.7) waves compared to the D614G wave. PWH with CD4< 200 had higher odds of in-hospital mortality (aOR 1.9;95% CI 1.8-2.1). Conclusion(s): In South Africa, mortality among PWH was less likely in the Delta and Omicron waves but PWH had a disproportionate burden of mortality during the two Omicron waves. Prior immunity protected against mortality, emphasizing the importance of COVID-19 vaccination among PWH, particularly PWH with immunosuppression.
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BACKGROUND AND AIM: The COVID-19 pandemic impacted high (HICs) and low to high- middle income countries (LHMICs) disproportionately. We sought to investigate factors contributing to disparate pediatric COVID-19 mortality. METHOD(S): We used the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) COVID-19 database, and stratified country group defined by World Bank criteria. All hospitalized patients aged less than 19 years with suspected or confirmed COVID-19 diagnosis from January 2020 through April 2021 were included. RESULT(S): A total of 12,860 patients with 3,819 cases from HICs and 9,041 cases from LHMICs were included in this study. Of these, 8,961 (73.8%) patiens were confirmed cases and 2444 (20.1%) were suspected COVID19. Overall in-hospital mortality was 425 (3.3%) patients, with 4.0% mortality in LHMICs (361/9041), which was higher than 1.7% mortality in HICs (64/3819);adjusted HR (aHR) 4.74, 95%CI 3.16-7.10, p<0.001. There were significant differences between country income groups in the use of interventions, with higher use of antibiotics, corticosteroid, prone position, high flow nasal cannula, and invasive mechanical ventilation in HICs, and higher use of anticoagulants and non-invasive ventilation in LHMICs. Infectious comorbidities such as tuberculosis and HIV/AIDS were shown to be more prevalent in LHMICs [2 (0.0%) vs 171 (1.9 %), 1 (0.0%) vs. 149 (1.6%) patients, respectively]. Mortality rates in children who received mechanical ventilation in LHMICs were higher compared with children in HICs [89 (43.6%) vs. 17 (7.2%) patients, aHR 12.0, CI95% 7.2-19.9, p<0.001]. CONCLUSION(S): Various contributing factors to COVID-19 mortality identified in this study may reflect management differences in HICs and LHMICs. (Figure Presented).
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BACKGROUND: Previous studies have reported comorbid disease, including hypertension, diabetes mellitus, chronic cardiac and renal disease, malignancy, HIV, tuberculosis (TB) and obesity, to be associated with COVID19 mortality. National demographic surveys have reported a high proportion of undiagnosed and untreated comorbid disease in South Africa (SA). OBJECTIVES: To determine the number of individuals with previously undiagnosed HIV, TB and non-communicable diseases (NCDs) among patients hospitalised with COVID19, and the level of medical control of these chronic diseases. METHODS: We conducted a sentinel surveillance study to collect enhanced data on HIV, TB and NCDs among individuals with COVID19 admitted to 16 secondary-level public hospitals in six of the nine provinces of SA. Trained surveillance officers approached all patients who met the surveillance case definition for inclusion in the study, and consenting patients were enrolled. The data collection instrument included questions on past medical history to determine the self-reported presence of comorbidities. The results of clinical and laboratory testing introduced as part of routine clinical care for hospitalised COVID19 patients were collected for the study, to objectively determine the presence of hypertension, diabetes, HIV and TB and the levels of control of diabetes and HIV. RESULTS: On self-reported history, the most prevalent comorbidities were hypertension (n=1 658; 51.5%), diabetes (n=855; 26.6%) and HIV (n=603; 18.7%). The prevalence of self-reported active TB was 3.1%, and that of previous TB 5.5%. There were 1 254 patients admitted with COVID19 (39.0%) who met the body mass index criteria for obesity. On clinical and laboratory testing, 87 patients were newly diagnosed with HIV, 29 with TB, 215 with diabetes and 40 with hypertension during their COVID19 admission. There were 151/521 patients living with HIV (29.0%) with a viral load >1 000 copies/mL and 309/570 (54.2%) with a CD4 count <200 cells/µL. Among 901 patients classified as having diabetes, 777 (86.2%) had a glycated haemoglobin (HbA1c) level ≥6.5%. CONCLUSION: The study revealed a high prevalence of comorbid conditions among individuals with COVID19 admitted to public hospitals in SA. In addition, a significant number of patients had previously undiagnosed hypertension, diabetes, HIV and active TB, and many and poorly controlled chronic disease, as evidenced by high HbA1c levels in patients with diabetes, and high viral loads and low CD4 levels in patients with HIV. The findings highlight the importance of strengthening health systems and care cascades for chronic disease management, which include prevention, screening for and effectively treating comorbidities, and ensuring secure and innovative supplies of medicines in primary healthcare during the COVID19 pandemic.