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      Risk factors for COVID-19 death in a population cohort study from the Western Cape Province, South Africa

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      Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America

      Oxford University Press

      COVID-19, HIV, tuberculosis, sub-Saharan Africa, antiretroviral

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          Abstract

          Background

          Risk factors for COVID-19 death in sub-Saharan Africa and the effects of HIV and tuberculosis on COVID-19 outcomes are unknown.

          Methods

          We conducted a population cohort study using linked data from adults attending public sector health facilities in the Western Cape, South Africa. We used Cox-proportional hazards models adjusted for age, sex, location and comorbidities to examine the association between HIV, tuberculosis and COVID-19 death from 1 March-9 June 2020 among (i) public sector “active patients” (≥1 visit in the 3 years before March 2020), (ii) laboratory-diagnosed COVID-19 cases and (iii) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19 comparing HIV positive vs. negative adults using modelled population estimates.

          Results

          Among 3,460,932 patients (16% HIV positive), 22,308 were diagnosed with COVID-19, of whom 625 died. COVID-19 death was associated with male sex, increasing age, diabetes, hypertension and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR] 2.14; 95% confidence interval [CI] 1.70-2.70), with similar risks across strata of viral load and immunosuppression. Current and previous tuberculosis were associated with COVID-19 death (aHR [95%CI] 2.70 [1.81-4.04] and 1.51 [1.18-1.93] respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95%CI 1.96-2.86); population attributable fraction 8.5% (95%CI 6.1-11.1).

          Conclusion

          While our findings may over-estimate HIV- and tuberculosis-associated COVID-19 mortality risks due to residual confounding, both HIV and current tuberculosis were independently associated with increased COVID-19 mortality. The associations between age, sex and other comorbidities and COVID-19 mortality were similar to other settings.

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          Author and article information

          Journal
          Clin Infect Dis
          Clin. Infect. Dis
          cid
          Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
          Oxford University Press (US )
          1058-4838
          1537-6591
          29 August 2020
          Affiliations
          [1 ] Health Impact Assessment, Western Cape Government: Health
          [2 ] Centre for Infectious Disease Epidemiology and Research , School of Public Health and Family Medicine, University of Cape Town
          [3 ] School of Public Health and Family Medicine, University of Cape Town
          [4 ] Division of Health Systems and Public Health , Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University
          [5 ] Metro Health Services, Western Cape Government: Health
          [6 ] Rural Health Services, Western Cape Government: Health
          [7 ] Communicable Disease Sub-Directorate, Western Cape Government: Health
          [8 ] National Institute for Communicable Diseases , National Health Laboratory Service, South Africa
          [9 ] Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town
          [10 ] Division of Computational Biology, University of Cape Town
          [11 ] Health Programmes Directorate , Western Cape Government: Health
          [12 ] Faculty of Health Sciences, North West University
          [13 ] George Hospital, Western Cape Government: Health
          [14 ] Groote Schuur Hospital, Western Cape Government: Health
          [15 ] Department of Medicine, University of Cape Town
          [16 ] Department of Surgery, University of Cape Town
          [17 ] Department of Radiology, University of Cape Town
          [18 ] Karl Bremer Hospital, Western Cape Government: Health
          [19 ] Khayelitsha District Hospital, Western Cape Government: Health
          [20 ] Mitchells Plain and Heideveld Hospitals, Western Cape Government: Health
          [21 ] Tygerberg Hospital, Western Cape Government: Health
          [22 ] Department of Medicine, Stellenbosch University
          [23 ] Department of Obstetrics and Gyneacology, Stellenbosch University
          [24 ] Emergency Medical Services, Western Cape Government
          [25 ] Western Cape Government : Health
          [26 ] City Health , Community Services and Health, City of Cape Town
          [27 ] South African Medical Research Council Burden of Disease Research Unit
          [28 ] School of Public Health, University of the Western Cape
          [29 ] School of Pathology , University of the Witwatersrand and School of Pathology , University of Cape Town
          [30 ] National Health Laboratory Service and Division of Virology , School of Pathology , University of Cape Town
          [31 ] Division of Emergency Medicine, University of Cape Town
          [32 ] Division of Immunology and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town
          [33 ] University of Pretoria
          [34 ] School of Public Health, University of Witwatersrand
          [35 ] University of Witwatersrand, South African Medical Research Council Antibody Immunity Research Unit and the Centre for the AIDS Programme in South Africa (CAPRISA)
          Author notes
          Corresponding author: Mary-Ann Davies, Affiliation: Health Impact Assessment Directorate, Western Cape Government: Health and Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa. Email: mary-ann.davies@ 123456uct.ac.za , Telephone: +27 21 4066051, Address: University of Cape Town, Faculty of Health Sciences, Anzio Road, Observatory, 7925, CAPE TOWN, SOUTH AFRICA
          Article
          ciaa1198
          10.1093/cid/ciaa1198
          7499501
          32860699
          © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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          AcademicSubjects/MED00290
          Custom metadata
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          accepted-manuscript

          Infectious disease & Microbiology

          hiv, sub-saharan africa, antiretroviral, tuberculosis, covid-19

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