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Seroprevalence of SARS-CoV-2 after the Second Wave in South Africa in HIV-Infected and Uninfected Persons: A Cross-Sectional Household Survey, November 2020 – April 2021

44 Pages Posted: 5 Nov 2021

See all articles by Nicole Wolter

Nicole Wolter

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis

Stefano Tempia

Government of the United States of America - Division of Influenza; Government of the United States of America - Influenza Program; National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis

Ann Von Gottberg

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis

Jinal N. Bhiman

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Sibongile Walaza

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Jackie Kleynhans

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis

Jocelyn Moyes

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis

Amelia Buys

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Meredith McMorrow

Centers for Disease Control and Prevention (CDC) - Influenza Division

Sue Aitken

Genesis Analytics

Sarah Magni

Genesis Analytics

Jessica Yun

Genesis Analytics

Tamika Fellows

Genesis Analytics

Tetelo Maakamedi

Genesis Analytics

Renay Weiner

University of the Witwatersrand

Cherie Cawood

Epicentre Health Research

Neil A. Martinson

University of the Witwatersrand - Perinatal HIV Research Unit

Limakatso Lebina

University of the Witwatersrand - Perinatal HIV Research Unit

Waasila Jassat

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases

Marieke Brauer

Ampath Pathology

Cheryl Cohen

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis

More...

Abstract

Background: Seroprevalence studies are important for quantifying the burden of SARS-CoV-2 infections in resource-constrained countries.

Methods: We conducted a cross-sectional household survey spanning the second pandemic wave (November 2020 – April 2021) in three communities. Blood was collected for SARS-CoV-2 antibody (two ELISA assays targeting spike and nucleocapsid) and HIV testing. An individual was considered seropositive if testing positive on ≥1 assay.  Factors associated with infection, and the age-standardised infection to case detection rate (ICR), infection hospitalisation rate (IHR) and infection fatality rate (IFR) were calculated.

Findings: Overall 7959 participants were enrolled, with a median age of 34 years and HIV prevalence of 22.7%. SARS-CoV-2 seroprevalence was 45.2% (95% confidence interval 43.7% - 46.7%), and increased from 26.9% among individuals enrolled in December 2020 to 47.1% among individuals in April 2021. On multivariable analysis, seropositivity was associated with age, sex, race, being overweight/obese, having respiratory symptoms, and low socioeconomic status. Persons living with HIV (PLWH) with high viral load were less likely to be seropositive compared to HIV-uninfected individuals. The site-specific ICR, IHR and IFR ranged across sites from 4.4% to 8.2%, 1.2% to 2.5% and 0.3% to 0.6%, respectively.

Interpretation: South Africa has experienced a large burden of SARS-CoV-2 infections, with <10% of infections diagnosed. Lower seroprevalence among non-virally suppressed PLWH, likely as a result of inadequate antibody production, highlights the need to prioritise this group for intervention.

Funding Information: This study was supported by the South African MRC, Wellcome Trust and UK Foreign, Commonwealth and Development Office, and US CDC.

Declaration of Interests: C. Cohen has received grant support from Sanofi Pasteur, Advanced Vaccine Initiative, and payment of travel costs from Parexel. NW and AvG have received grant support from Sanofi Pasteur. All other authors declare no conflict of interest.

Ethics Approval Statement: This study was approved by the University of the Witwatersrand (M200861) and by the respective community and provincial research committees.

Keywords: HIV, SARS-CoV-2, seroprevalence, COVID-19, South Africa

Suggested Citation

Wolter, Nicole and Tempia, Stefano and Von Gottberg, Ann and Bhiman, Jinal N. and Walaza, Sibongile and Kleynhans, Jackie and Moyes, Jocelyn and Buys, Amelia and McMorrow, Meredith and Aitken, Sue and Magni, Sarah and Yun, Jessica and Fellows, Tamika and Maakamedi, Tetelo and Weiner, Renay and Cawood, Cherie and Martinson, Neil A. and Lebina, Limakatso and Jassat, Waasila and Brauer, Marieke and Cohen, Cheryl, Seroprevalence of SARS-CoV-2 after the Second Wave in South Africa in HIV-Infected and Uninfected Persons: A Cross-Sectional Household Survey, November 2020 – April 2021. Available at SSRN: https://ssrn.com/abstract=3957112 or http://dx.doi.org/10.2139/ssrn.3957112

Nicole Wolter (Contact Author)

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis ( email )

Stefano Tempia

Government of the United States of America - Division of Influenza ( email )

Atlanta, GA
United States

Government of the United States of America - Influenza Program

Pretoria
South Africa

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis

Johannesburg
South Africa

Ann Von Gottberg

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis ( email )

Jinal N. Bhiman

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases ( email )

Sibongile Walaza

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases ( email )

Johannesburg
South Africa

Jackie Kleynhans

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis ( email )

Jocelyn Moyes

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis ( email )

Amelia Buys

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases ( email )

Johannesburg
South Africa

Meredith McMorrow

Centers for Disease Control and Prevention (CDC) - Influenza Division ( email )

Sue Aitken

Genesis Analytics ( email )

Suite 3 Genesis
Private Bag X1, Melrose Arch
Johannesburg, 2076
South Africa

Sarah Magni

Genesis Analytics ( email )

Suite 3 Genesis
Private Bag X1, Melrose Arch
Johannesburg, 2076
South Africa

Jessica Yun

Genesis Analytics ( email )

Suite 3 Genesis
Private Bag X1, Melrose Arch
Johannesburg, 2076
South Africa

Tamika Fellows

Genesis Analytics ( email )

Suite 3 Genesis
Private Bag X1, Melrose Arch
Johannesburg, 2076
South Africa

Tetelo Maakamedi

Genesis Analytics ( email )

Suite 3 Genesis
Private Bag X1, Melrose Arch
Johannesburg, 2076
South Africa

Renay Weiner

University of the Witwatersrand ( email )

1 Jan Smuts Avenue
Johannesburg, GA 2000
South Africa

Cherie Cawood

Epicentre Health Research ( email )

South Africa

Neil A. Martinson

University of the Witwatersrand - Perinatal HIV Research Unit ( email )

Limakatso Lebina

University of the Witwatersrand - Perinatal HIV Research Unit ( email )

Waasila Jassat

National Health Laboratory Services (NHLS) - National Institute for Communicable Diseases ( email )

Johannesburg
South Africa

Marieke Brauer

Ampath Pathology ( email )

Pretoria
South Africa

Cheryl Cohen

National Health Laboratory Services (NHLS) - Centre for Respiratory Diseases and Meningitis ( email )

Johannesburg
South Africa

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