Estimating the contribution of HIV-infected adults to household pneumococcal transmission in South Africa, 2016–2018: A hidden Markov modelling study

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dc.contributor.authorDeus Thindwa
dc.contributor.authorNicole Wolter
dc.contributor.authorAmy Pinsent
dc.contributor.authorMaimuna CarrimI
dc.contributor.authorJohn Ojal
dc.contributor.authorStefano Tempia
dc.contributor.authorJocelyn Moyes
dc.contributor.authorMeredith McMorrow
dc.contributor.authorJackie Kleynhans
dc.contributor.authorAnne von Gottberg
dc.contributor.authorNeil French
dc.contributor.authorPHIRST group
dc.contributor.authorCheryl Cohen
dc.contributor.authorStefan Flasche
dc.date.accessioned2023-10-05T08:55:21Z
dc.date.available2023-10-05T08:55:21Z
dc.date.issued2021-12-23
dc.departmentSA-MRC/Wits Agincourt UnitE
dc.description.abstractHuman immunodeficiency virus (HIV) infected adults are at a higher risk of pneumococcal colonisation and disease, even while receiving antiretroviral therapy (ART). To help evaluate potential indirect effects of vaccination of HIV-infected adults, we assessed whether HIV-infected adults disproportionately contribute to household transmission of pneumococci. We constructed a hidden Markov model to capture the dynamics of pneumococcal carriage acquisition and clearance observed during a longitudinal household-based nasopharyngeal swabbing study, while accounting for sample misclassifications. Households were followed-up twice weekly for approximately 10 months each year during a three-year study period for nasopharyngeal carriage detection via real-time PCR. We estimated the effect of participant’s age, HIV status, presence of a HIV-infected adult within the household and other covariates on pneumococcal acquisition and clearance probabilities. Of 1,684 individuals enrolled, 279 (16.6%) were younger children (<5 years-old) of whom 4 (1.5%) were HIV-infected and 726 (43.1%) were adults (�18 years-old) of whom 214 (30.4%) were HIV-infected, most (173, 81.2%) with high CD4+ count. The observed range of pneumococcal carriage prevalence across visits was substantially higher in younger children (56.9– 80.5%) than older children (5–17 years-old) (31.7–50.0%) or adults (11.5–23.5%). We estimate that 14.4% (95% Confidence Interval [CI]: 13.7–15.0) of pneumococcal-negative swabs were false negatives. Daily carriage acquisition probabilities among HIV-uninfected younger children were similar in households with and without HIV-infected adults (hazard ratio: 0.95, 95%CI: 0.91–1.01). Longer average carriage duration (11.4 days, 95%CI: 10.2– 12.8 vs 6.0 days, 95%CI: 5.6–6.3) and higher median carriage density (622 genome equivalents per millilitre, 95%CI: 507–714 vs 389, 95%CI: 311.1–435.5) were estimated in HIVinfected vs HIV-uninfected adults. The use of ART and antibiotics substantially reduced carriage duration in all age groups, and acquisition rates increased with household size. Although South African HIV-infected adults on ART have longer carriage duration and density than their HIV-uninfected counterparts, they show similar patterns of pneumococcal acquisition and onward transmission.
dc.description.librarianPM2023
dc.identifier.urihttps://hdl.handle.net/10539/36353
dc.language.isoen
dc.schoolPublic HealthE
dc.titleEstimating the contribution of HIV-infected adults to household pneumococcal transmission in South Africa, 2016–2018: A hidden Markov modelling study
dc.typeArticle
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