Document resource
Introduction People living with HIV (PLHIV) are at increased risk of COVID-19-related mortality. However, the burden of and immune response to SARS-CoV-2 infection among PLHIV, particularly in sub-Saharan Africa, remains poorly understood.Methods We conducted a four-round serial cross-sectional surveillance survey using HIV viral load testing remnant samples from PLHIV on antiretroviral treatment (ART) in Kenya to assess trends in SARS-CoV-2 antibody seroprevalence from February 2021 to October 2022. SARS-CoV-2 IgG antibodies were detected using a validated two-assay ELISA serial algorithm. Samples with ELISA-positive or borderline result samples were further tested using a multiplex bead assay (MBA) to distinguish potential infection and/or vaccination status.Results National SARS-CoV-2 antibody seroprevalence among PLHIV on ART increased from 16.1% in round 1 to 91.7% in round 4: round 1: 16.1% (95% CI 6.9% to 33.1%), round 2: 29.6% (95% CI 13.7% to 52.7%), round 3: 84.2% (95% CI 67.7% to 93.1%) and round 4: 91.7% (95% CI 86.5% to 95.0%). These estimates corresponded to approximately 186 891 (95% CI 38 639 to 3 35 143), 363 590 (95% CI 114 267 to 612 913), 1 072 496 (95% CI 914 449 to 1 230 452) and 1 173 399 (95% CI 1 120 224 to 1 226 574) PLHIV on ART with SARS-CoV-2 antibodies across the four rounds. MBA testing of ELISA-positive and borderline samples showed that 97% had evidence of probable infection and/or vaccination while 3% tested negative by MBA.Conclusions Monitoring SARS-CoV-2 infection in PLHIV is essential. Seroprevalence among PLHIV on ART in Kenya increased substantially during 2021–2022, reflecting both infection and vaccination. Protecting the health of PLHIV through sustained prevention, treatment and vaccination strategies remains critical in mitigating the threat of COVID-19.