SARS-CoV-2 antibody prevalence, correlates, and access to harm reduction services among people who inject drugs living with and without HIV and their partners in Kenya

Abstract

Background In sub-Saharan Africa many people who inject drugs (PWID) are living with undiagnosed or untreated HIV and experience high levels of poverty and conditions that can contribute to worse outcomes from SARS-CoV-2 infection. Identifying the burden of SARS-CoV-2 infection in marginalized populations like PWID may contribute to controlling the pandemic. Methods This is a nested cross-sectional study within an ongoing cohort study that recruits PWID living with HIV and their injecting and/or sexual partners at needle and syringe program sites and methadone clinics in Kenya. Blood samples were collected from consenting participants at enrollment to determine SARS-CoV-2 antibodies using a Platellia BioRad SARS-CoV-2 total antibody enzyme-linked immunosorbent assay. Baseline data were collected on HIV status, antiretroviral therapy and methadone adherence. We used logistic regression to identify factors associated with antibody positivity and descriptive statistics to report SARS-CoV-2 antibody prevalence. Results One thousand participants were enrolled between April and July 2021, of whom 323 (32.3%) were women and 677 (67.7%) were men. Median age of participants was 36 years (interquartile range: 30, 42). SARS-CoV-2 antibody positivity was found in 309 (30.9%) participants. Disruption in obtaining methadone service was reported by 106 (24.3%) of the participants. Men were significantly less likely than women to have SARS-CoV-2 antibodies (adjusted odds ratio [aOR] = 0.68, 95% confidence interval [CI] 0.51, 0.95; p < 0.01) Participants who reported a sexual or injecting partner diagnosed with SARS-CoV-2 were twofold more likely to have SARS-CoV-2 antibodies detected (aOR = 2.21, 95% CI 1.06, 4.58; p < 0.032). Living with HIV was not associated with presence of SARS-CoV-2 antibodies. Conclusion The seroprevalence of SARS-CoV-2 of 30.9% in this cohort suggests high transmission rates within this population. SARS-CoV-2 seroprevalence was similar for people living with and without HIV. A large portion of this population was noted to have had disruption in access to harm reduction services.

Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in Baltimore, Maryland

“…Although the prior study found positive associations between incarceration and engagement in sex work and infection-induced SARS-CoV-2 seroprevalence, our study was underpowered to detect these associations. It is notable that our study and two prior studies did not find associations between recent substance use behaviors and infection-induced SARS-CoV-2 seroprevalence ( Doshi et al., 2023 ; Strathdee et al., 2021 ). While substance use may play a role in the pathogenesis of COVID-19 ( Ao et al., 2022 ; Hasin et al., 2022 ; Krawczyk et al., 2023 ; Wang et al., 2021 ), it may not be a salient risk factor of SARS-CoV-2 infection among people who use drugs.…”

“…Prior to the introduction of the B.1.617.2 (Delta) and B.1.1.529 (Omicron) variants of SARS-CoV-2 and widespread availability of COVID-19 vaccines, a community-based study of people currently injecting drugs that was conducted between October 2020 and June 2021 in San Diego, California and Tijuana, Mexico found that the SARS-CoV-2 seroprevalence was 36%, which exceeded estimates from the general population in each city at that time ( Strathdee et al., 2021 ). In a mixed sample of PWID and their sexual or injecting partners recruited at needle and syringe service programs and methadone clinics in Kenya between April 2021 and July 2021, 31% had anti-N antibodies ( Doshi et al., 2023 ). Given that the spread of SARS-CoV-2 has been heterogeneous by population, geography, and time throughout the pandemic, these findings on infection risk may not be generalizable or transportable to other populations, settings, or points in time ( Rudolph et al., 2023 ).…”