, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by WHO, there were comparatively few cases reported from Africa. 1 Our Comment draws on early imported COVID-19 cases in South Africa, Senegal, Democratic Republic of the Congo, and Egypt as case studies to discuss important mitigation strategies of COVID-19 in Africa.Early COVID-19 cases in Africa were mostly imported from Europe, due to the higher volume of business and tourism airline traffic between African countries and Europe, and less from China. 2 The first confirmed case was reported in Egypt on Feb 14, 2020, (an adult male whose 17 contacts tested negative) and prompted African preparedness efforts. 3,4 In South Africa, on Feb 29, 2020, a group of nine adult travellers returned from a skiing holiday in Italy, where the COVID-19 epidemic was rampant. After developing a flu-like illness, one traveller tested positive for COVID-19, which was confirmed by RT-PCR on March 5, 2020; his wife was asymptomatic but tested positive on March 8, 2020. Overall, seven of the nine travellers were positive for COVID-19, five of whom were asymptomatic. In Senegal, the first COVID-19 case was reported on March 7, 2020, in a traveller returning from Italy. Contact tracing identified a cluster of transmission of 20 cases within his immediate household. Democratic Republic of the Congo confirmed its first case of COVID-19 on March 10, 2020: an adult male who tested positive in the capital city of Kinshasa after developing a cough and fever, 2 days after returning from France. These early index cases show the imported nature of the epidemic in Africa among young affluent adult travellers from Europe. However, the majority of COVID-19 cases currently being identified and reported from African countries are due to local transmission.Early estimates of case fatality rates (CFRs) also seem to vary substantially. As of April 24, 2020, South Africa had reported 3635 cases with 65 deaths (CFR 1•8%) and Senegal had reported 442 cases with 6 deaths (CFR 1•3%). These CFRs seem lower than in most European countries (eg, Italy had reported 187 327 cases

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Highlights d Defective viral genomes predominate in treated SIV mac and HIV-2 infection d Significantly more SIV proviruses are intact compared to HIV-1 in treated humans d Compared to HIV, clonal sequences and deleted genomes are less frequent in SIV infection d An assay to directly enumerate intact SIV genomes was developed

BackgroundMalnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes.MethodsWe conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review.ResultsOne hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01).ConclusionsSevere food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population.

The novel coronavirus disease 2019 has rapidly spread to all 7 continents. Due to yet unknown reasons, the African continent has remained relatively unaffected. We discuss the importance of mitigating pan-continental spread in light of the fragile healthcare systems.