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Collision of three global pandemics: the effect of tuberculosis and HIV on the epidemiological, clinical, virological, and immunological trajectory of Covid-19 in household contacts

M M Claassens(1) C Modongo(5) T Kassaye(4) P Steenkamp(4) G Gunther(2) E Nepolo(1) B Kizito(5) S Niemann(3)

1:University of Namibia; 2:Inselspital Bern; 3:Research Center Borstel; 4:Health Poverty Action; 5:Victus Global Botswana Organisation

Covid-19 emerged as global pandemic with an unprecedented impact on public health. SARS-CoV-2 epidemiology was poorly understood, especially in the African context. A particular gap in knowledge was the effect of HIV and tuberculosis (TB) on the outcomes of Covid-19 disease. We implemented a research study that addressed critical questions concerning Covid-19 disease epidemiology in the context of low resource countries with high burden of poverty, and high rates of TB and HIV.

Recruitment commenced in July 2022; we followed a two-pronged approach: first, all primary healthcare facility (PHC) attendees were tested for TB infection, TB disease, Covid-19 and HIV screening. Second, we followed-up Covid-19 patients as diagnosed by the Ministries of Health, and tested these index cases and their households for TB infection, TB disease, Covid-19 and HIV.

Preliminary results for the household transmission component: we enrolled 197 participants of whom 64 are index cases and 133 household contacts. Of the index cases, 39/64 (61%) were male and 9/64 (14%) HIV infected. Of the household contacts, 72/133 (54%) were male and 15/113 (13%) HIV infected. The Covid-19 household secondary attack rate was 32% (95%CI 25-41). No-one had active TB but of the index cases 30/64 (47%) and 59/133 (44%) of the contacts had latent TB infection.

Future analyses will include investigating risk factors associated with these differential rates. Our findings will contribute to the growing literature on Covid-19 household transmission in high burden TB/HIV settings, and to the understanding of the interaction between Covid-19, TB, and HIV.

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