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A national household SARS CoV-2 seroprevalence survey in South Africa, 2020-2021
No full textPoster presented at the Conference on Retroviruses and Opportunistic Infections (CROI) 12 - 16 February 2022, Virtual.South Africa is one of the African countries most affected by the COVID-19 pandemic. SARS-CoV-2 seroprevalence surveys provide valuable epidemiological information given the existence of asymptomatic cases. We report the findings of the first nationwide household-based population estimates of SARS-CoV-2 seroprevalence among people aged 12 years and older in South Africa.
The survey used a cross-sectional multi-stage stratified cluster design undertaken over two separate time periods (November 2020 – February 2021 and April – June 2021) which coincided with the second and third waves of the pandemic in South Africa. The Abbott® and Euroimmun® ani-SARS CoV-2 antibody assays were used to test for SARS-CoV-2 antibodies, the latter being the final result. The survey data was weighted with final individual weights benchmarked against 2020 mid-year population estimates by age, race, sex, and province. Frequencies were used to describe characteristics of the study population and SARS-CoV-2 seroprevalence. Bivariate and multivariate logistics regression analysis were used to identify factors associated with SARS-CoV-2 seropositivity.
13640 participants gave a blood sample. The SARS-CoV-2 seroprevalence using the Euroimmun assay was 19.6% (95% CI 17.9–21.3) over the study period, translating to an estimated 8 675 265 (95% CI 7 508 393 – 9 842 137) estimated infections among people aged 12 years and older across South Africa by June 2021. Seroprevalence was higher in the Free State (26.8%), and Eastern Cape (26.0%) provinces (Figure). Increased odds of seropositivity were associated with prior PCR testing [aOR=1.29 (95% CI: 0.99-1.66)], being female [aOR=1.28 (95% CI 1.00-1.64), p=0.048] and hypertension, [aOR=1.28 (95% CI 1.00-1.640, p=0.048].
These findings highlight the burden of infection in South Africa by June 2021, and support testing strategies that focus on individuals with known exposure or symptoms since universal testing is not feasible. Females and younger people were more likely to be infected suggesting need for additional strategies targeting these populations. The estimated number of infections was 6.5 times higher than the number of SARS-CoV-2 cases reported nationally, suggesting that the country’s testing strategy and capacity partly explain the dynamics of the pandemic. It is therefore essential to bolster testing capacity and to rapidly scale up vaccinations in order to contain the spread of the virus in the country
Performance of three SARS-CoV-2 serology assays in a household serosurvey in South Africa
No full textPoster presented at the Conference on Retroviruses and Opportunistic Infections (CROI), 12-16 February 2022.In this paper we present results from the first national house-hold based SARS CoV- 2 sero-prevalence survey conducted in South Africa in 2020-21. The survey used a cross-sectional multi-stage stratified cluster design. The data was collected over two separate time periods (November 2020 - February 2021 and April - June 2021). This periods coincided with the second and third waves of the pandemic in South Africa. In this paper we compare the performance of the The Abbott® and Euroimmun® ani-SARS CoV- 2 antibody assays
Utility of Covid-19 point of care antigen tests in low-middle income settings
No full textPoster-T05 presented at the 29th Conference on Retroviruses and Opportunistic Infections (CROI), 12–16 February 2022: Virtual.Background:
Access to SARS-CoV-2 polymerase chain reaction (PCR) testing is a bottleneck globally, especially in low-and middle-income countries (LMICs). Reliable point-of-care (POC) diagnostics for coronavirus disease 2019 (COVID-19) are cheaper and easier to scale-up than PCR especially in LMICs, and will facilitate interruption of transmission. We report the field-based effectiveness of rapid point-of-care (POC) antigen COVID-19 tests during the beta and delta waves, in South Africa.
Methods:
We enrolled symptomatic, ambulatory persons under investigation (PUIs) aged 18 years and older, presenting for SARS-CoV-2 diagnosis at public health facilities in three provinces, South Africa. All patients completed a questionnaire regarding symptoms. Nasopharyngeal swabs were taken and processed for SARS-CoV-2 PCR testing using either GeneXpert (Cepheid, USA), or with a manual assay (ThermoFisher TaqPath assay or Seegene Allplex assay) on a real-time PCR platform at routine, accredited National Health Laboratory Service laboratories, as per routine national protocols. Concomitantly, trained study staff performed three facility-based POC antigen tests on a nasal/nasopharyngeal swab, as recommended by the manufacturer. Asymptomatic contacts of people with confirmed COVID-19 were recruited into the asymptomatic study arm and rapid tests and PCR were performed. The sensitivity (S), specificity (Sp), positive (PPV) and negative predictive (NPV) values of tests for PUIs and contacts were calculated using PCR as the reference standard.
Results:
Between Oct 2020-2021 1816 participants were enrolled;472 (26%) tested PCR or rapid test positive;235 positives (49.8%) and 532 negatives were followed up at 5-14 days;574 asymptomatic contacts were enrolled, of which 21 (3.7%) were PCR positive. Performance of the three antigen tests are shown in Table 1∗.
Conclusion:
In a real world setting, during the beta and delta waves, compared with PCR the sensitivity of rapid antigen tests ranged from 35-68%. This may reflect low viral loads at diagnosis. Further work will compare antigen test performance in patients with high versus lower cycle threshold (Ct) values. Meanwhile, PCR testing capacity needs urgent scale-up in LMICs and improved POC diagnostics are needed to facilitate COVID-19 diagnosis in LMICs
Perceptions and experiences of quality improvement teams and their advisors seeking to improve maternal and neonatal health services before and during COVID-19 in South Africa
No full textPoster presentation at 38TH International Society for Quality in Health Care (ISQUA). AUSTRALIA, 18-20 October 2022.Synopsis of poster
Introduction: SA Department of Health leads a multi-partner MNH quality improvement (QI) programme (2018-2022), called Mphatlalatsane, to reduce maternal - and neonatal mortality and stillbirth rates in three provinces. Objective: To identify the facility level implementation processes and contextual factors, including COVID-19, that explain variation in the uptake and outcomes of Mphatlalatsane, and their implications for scale-up. Results: The following contextual factors, in order of importance, are shaping the uptake of the QI methodology. (1) Lead time before COVID-19 (2) Leadership (3) Embedding QI work in standard care Conclusion: Taking Mphatlalatsane to scale will require identifying team leaders who buy into QI methodology and have the skills to foster teamwork. The programme should be introduced as supporting staff to do what they are supposed to do, and not as external to standard care
Alcohol, violence against women and girls alcohol: Pooled analyses from low-middle income settings
No full textWestern Cape Provincial Research Day, 4 November 2022
Reflections on conducting remote qualitative interviews on intimate partner violence during the COVID-19 pandemic and hard lockdown
No full textSVRI Forum September 2022, Cancún, Mexico
Breaking the silence - Disability inclusive sexual and reproductive health services and comprehensive sexuality education
No full textUNFPA 2gether4SRHR Knowledge Sharing Meeting 24-25 July 2022