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. 2022 Nov 15;36(14):2045-2055.
doi: 10.1097/QAD.0000000000003365. Epub 2022 Aug 19.

Risk factors for pneumococcal carriage in adults living with HIV on antiretroviral therapy in the infant pneumococcal vaccine era in Malawi

Deus Thindwa  1   2 , Thandie S Mwalukomo  3 , Jacquline Msefula  2 , Kondwani C Jambo  2   4 , Comfort Brown  2 , Arox Kamng'ona  3 , Charles Mwansambo  5 , John Ojal  1   6 , Stefan Flasche  1 , Neil French  7 , Robert S Heyderman  8 , Todd D Swarthout  2   8
Affiliations

Risk factors for pneumococcal carriage in adults living with HIV on antiretroviral therapy in the infant pneumococcal vaccine era in Malawi

Deus Thindwa et al. AIDS. .

Abstract

Objective: Adults living with HIV (ALWHIV) on antiretroviral therapy (ART) are at high risk of pneumococcal carriage and disease. To help evaluate carriage risk in African ALWHIV at least 4 years after infant pneumococcal conjugate vaccination introduction in 2011, we assessed association between pneumococcal carriage and potential risk factors.

Methods: Nasopharyngeal swabs were collected from adults aged 18-40 years attending an ART clinic during rolling, cross-sectional surveys in Blantyre, Malawi between 2015 and 2019. We fitted generalized additive models to estimate the risk of sex, social economic status (SES), living with a child less than 5 years, and ART duration on carriage.

Results: Of 2067 adults, median age was 33 years (range 28-37), 1427 (69.0%) were women, 1087 (61.4%) were in low-middle socioeconomic-status (SES), 910 (44.0%) were living with a child less than 5 years, and median ART duration was 3 years (range 0.004-17). We estimated 38.2 and 60.6% reductions in overall and vaccine-serotype carriage prevalence. Overall carriage was associated with low SES, living with a child less than 5 years and shorter duration on ART. By contrast, vaccine-type carriage was associated with living without a child less than 5 years and male sex.

Conclusion: Despite temporal reductions in overall and vaccine-serotype carriage, there is evidence of incomplete vaccine-serotype indirect protection. A targeted-vaccination campaign should be considered for ALWHIV, along with other public health measures to further reduce vaccine-serotype carriage and therefore disease.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Demographics and clinical characteristics of participants using aggregated data across eight surveys.
Fig. 2
Fig. 2
Observed and fitted pneumococcal carriage prevalence curves using data from rolling, prospective cross-sectional surveys in Blantyre, Malawi 2015–2019.
Fig. 3
Fig. 3
P-spline generalized additive model: observed and fitted pneumococcal carriage prevalence curves for each potential risk factor category using data from rolling, prospective cross-sectional surveys in Blantyre, Malawi 2015–2019.
See this image and copyright information in PMC

References

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