Collision of Three Global Pandemics: The Effect of Tuberculosis and HIV on the Epidemiological, Clinical, Virological, and Immunological Trajectory of COVID-19 in Botswana and Namibia – a Protocol for a Prospective Case-ascertained and Surveillance Study (Preprint)

<sec> <title>UNSTRUCTURED</title> In December 2019, the emergence of Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to a global pandemic, impacting over 620 million people, including approximately nine million in Africa. The COVID-19 pandemic introduced uncertainties, especially regarding co-infections, such as tuberculosis (TB) and human immunodeficiency virus (HIV). TB and HIV, both global pandemics, disproportionately affect low and middle-income countries. Namibia and Botswana reported high mortality rates due to TB and HIV which highlights ongoing challenges. This paper outlines the protocol for a comprehensive research study addressing the gaps, focusing on Botswana and Namibia, to enhance disease management. The collision of three global pandemics: the effect of TB and HIV on the epidemiological, clinical, virological, and immunological trajectory of COVID-19 in Botswana and Namibia (Core-NB), is a clinical and epidemiological study of (i) individuals presenting to sentinel health facilities irrespective of any symptoms are tested for Covid-19, TB and HIV/AIDS , and (ii) identified confirmed COVID-19 patients and their household contacts. For (i), attendees of primary healthcare facilities independent of the reason for attending were enrolled. For (ii) participants were identified based on laboratory RT-PCR confirmation of their COVID-19 infection at Ministry of Health designated laboratories in each country. Primary health care participants and their household contacts who agreed to participate in the study had home visits, including an initial enrollment visit at Day 1 and three follow-up visits occurring within 28 days of enrollment. Additionally, there were telephonic follow-ups three months after enrollment. Researchers collected specimens and gathered information regarding risk factors and symptoms from COVID-19 cases as well as from all individuals living in the same households. Ethics approval was obtained from the University of Namibia Research Ethics Committee (HREC-H) and permission to conduct the study was granted by the Ministry of Health and Social Services (MoHSS) in Namibia and the Ministry of Health in Botswana (MoH). Participants gave informed consent. The consent forms were designed using plain language. The study was registered on Clinicaltrials.gov with number NCT05268380. Dissemination will be through scientific peer-reviewed papers and presentations at international meetings, and to study communities. </sec>