Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From Adult Index Cases With and Without Human Immunodeficiency Virus in South Africa, 2020–2021: A Case-Ascertained, Prospective, Observational Household Transmission Study
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Abstract
Background
In South Africa, 19% of adults are living with human immunodeficiency virus (HIV; LWH). Few data on the influence of HIV on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) household transmission are available.
Methods
We performed a case-ascertained, prospective household transmission study of symptomatic adult index SARS-CoV-2 cases LWH and not living with HIV (NLWH) and their contacts from October 2020 to September 2021. Households were followed up 3 times a week for 6 weeks to collect nasal swabs for SARS-CoV-2 testing. We estimated household cumulative infection risk (HCIR) and duration of SARS-CoV-2 positivity (at a cycle threshold value <30 as proxy for high viral load).
Results
HCIR was 59% (220 of 373), not differing by index HIV status (60% LWH vs 58% NLWH). HCIR increased with index case age (35–59 years: adjusted OR [aOR], 3.4; 95% CI, 1.5–7.8 and ≥60 years: aOR, 3.1; 95% CI, 1.0–10.1) compared with 18–34 years and with contacts’ age, 13–17 years (aOR, 7.1; 95% CI, 1.5–33.9) and 18–34 years (aOR, 4.4; 95% CI, 1.0–18.4) compared with <5 years. Mean positivity was longer in cases LWH (adjusted hazard ratio, 0.4; 95% CI, .1–.9).
Conclusions
Index HIV status was not associated with higher HCIR, but cases LWH had longer positivity duration. Adults aged >35 years were more likely to transmit and individuals aged 13–34 to be infected SARS-CoV-2 in the household. As HIV infection may increase transmission, health services must maintain HIV testing and antiretroviral therapy initiation.
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SciScore for 10.1101/2022.04.08.22273160: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethics: The study protocol was approved by the University of Witwatersrand Human Research Ethics Committee (Reference M2008114). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis Sample size calculation is detailed in the supplementary methods. Table 2: Resources
Antibodies Sentences Resources Serology: We used an in-house ELISA to detect antibodies against SARS-CoV-2 spike protein[16] and nucleocapsid protein using the Roche Elecsys anti-SARS-CoV-2 assay. SARS-CoV-2 spike protein[16suggested: NoneSoftware and Algorithms Sentences Resources All data collected during screening and follow up visits were captured in real-time using tablets onto … SciScore for 10.1101/2022.04.08.22273160: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethics: The study protocol was approved by the University of Witwatersrand Human Research Ethics Committee (Reference M2008114). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis Sample size calculation is detailed in the supplementary methods. Table 2: Resources
Antibodies Sentences Resources Serology: We used an in-house ELISA to detect antibodies against SARS-CoV-2 spike protein[16] and nucleocapsid protein using the Roche Elecsys anti-SARS-CoV-2 assay. SARS-CoV-2 spike protein[16suggested: NoneSoftware and Algorithms Sentences Resources All data collected during screening and follow up visits were captured in real-time using tablets onto Research Electronic Data Capture (REDCap) databases hosted at the University of the Witwatersrand[15]. REDCapsuggested: (REDCap, RRID:SCR_003445)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study had limitations. We assumed the first household member presenting with symptoms was the index case. If the true index cases were asymptomatic, we would have underestimated the serial interval, although HCIR estimates should not be greatly affected. By excluding individuals seropositive at baseline with no SARS-CoV-2 infection during follow-up, we assumed a 100% protection from previous infections, which is likely not correct, and in turn may have overestimated the HCIR. When including these individuals, the HCIR reduced by 8%. We were unable to reach the planned sample size for contacts of index cases LWH, and may have been underpowered to detect some differences, especially when stratifying by immunocompromised status. In conclusion, in two communities in South African households, HCIR was higher than in previous studies[14] but was not influenced by HIV status. Episode duration at high viral loads and serial interval was increased for people LWH. Although HIV may not be the primary driver in SARS-CoV-2 transmission, it may still play a role, especially if PLWH are not virally suppressed. The SARS-CoV-2 pandemic impacted several health programs, including HIV testing and care. During initial lockdowns there was a decline in HIV testing and antiretroviral therapy (ART) initiations, which gradually returned to pre-lockdown levels after the lockdown in South Africa[31] and other Sub-Saharan African countries.[32] Sustaining and strengthening HIV treatment and care pro...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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