SARS-CoV-2 seroprevalence in Kenyan Children and Adolescents living with HIV

Background: SARS-CoV-2 seroprevalence, superior to standard diagnostic testing, can estimate cumulative disease incidence. Limited estimates demonstrate wide ranges in Kenyan populations, with geographic and temporal variabilities, and limited data in children and adolescents living with HIV (CALWH). Such data can inform clinical and public health recommendations in the context of SARS-CoV-2 transmission and future pandemics. Methods: During February to September 2021, before SARS-CoV-2 vaccine availability, we cross-sectionally enrolled perinatally-infected CALWH in western Kenya in four urban and peri-urban sites, determined seropositivity, and conducted a COVID-19-focused survey. We then used multiple logistic regression to measure associations of seropositivity with demographic, laboratory, enrollment month, and enrollment site. Results: Of 241 CALWH (Eldoret-129, Turbo-47, Kitale-30, Webuye-35; 50% male; median age 17 years, range 8-24), 29% were seropositive, 68% seronegative and 4% equivocal (removed from analyses). Seropositivity was associated with age 15-17 years vs <15 (Odds Ratio (OR), 2.57 [95% Confidence Interval (CI), 1.16-5.93]), and not associated with treatment failure or CD4. Temporal trends (linear relationship per subsequent enrollment month; OR 1.29 [95% CI, 1.06-1.58) and geographic variability (Eldoret-25%, Kitale-20%, Turbo-25%, Webuye-56%) were observed. Presumptive or laboratory-confirmed diagnosis, hospitalization, or death were absent. Conclusions: About a third of Kenyan CALWH were SARS-CoV-2 seropositive by August 2021, with minimal clinical disease and geographical, temporal, and age variations. Speculations on this somewhat low seropositivity compared to studies in other diverse populations, include factors like age, geography, and HIV status. These should be further investigated to inform messaging, interventions, and care models for this vulnerable cohort during future pandemics.