top of page


Collision of three global pandemics: the effect of tuberculosis and HIV on the epidemiological, clinical, virological, and immunological trajectory of COVID-19 in Botswana and Namibia at primary healthcare facilities

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

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

Covid-19 emerged as global pandemic during the past three years, 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. 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 are shown for the PHC attendees. To note: (i) the high TB infection rate in Namibia (72%, 95%UI 67-76) vs. Botswana (44%, 95%UI 41-47, p<0.001), (ii) the high TB disease rate in Namibia (3.8%, 95UI 2.4-5.9) vs. Botswana (1.6%, 95UI 0.8-2.8, p=0.01), and (iii) the proportion of the total number of participants who had TB and SARS-CoV-2 co-infection (155/1500, 10.3%).

Future analyses will include investigating risk factors associated with these differential rates. We believe our findings will contribute to the growing literature on enhanced case finding at PHC through universal TB screening, and to the understanding of the interaction between Covid-19, TB, and HIV.

bottom of page