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Background. Estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) for tracking the COVID-19 epidemic are lacking for most African countries. Objectives. To determine the prevalence of antibodies against SARS-CoV-2 in a sentinel cohort of patient samples received for routine testing at tertiary laboratories in Johannesburg, South Africa. Methods. This sentinel study was conducted using remnant serum samples received at three National Health Laboratory Service laboratories in the City of Johannesburg (CoJ) district. Collection was from 1 August to 31 October 2020. We extracted accompanying laboratory results for glycated haemoglobin (HbA1c), creatinine, HIV, viral load and CD4 T-cell count. An anti-SARS-CoV-2 targeting the nucleocapsid (N) protein of the coronavirus with higher affinity for IgM and IgG antibodies was used. We reported crude as well as population-weighted and test-adjusted seroprevalence. Multivariate logistic regression analysis was used to determine whether age, sex, HIV and diabetic status were associated with increased risk for seropositivity. Results. A total of 6 477 samples were analysed, the majority ( n =5 290) from the CoJ region. After excluding samples with no age or sex stated, the model population-weighted and test-adjusted seroprevalence for the CoJ ( n =4 393) was 27.0% (95% confidence interval (CI) 25.4 - 28.6). Seroprevalence was highest in those aged 45 - 49 years (29.8%; 95% CI 25.5 - 35.0) and in those from the most densely populated areas of the CoJ. Risk for seropositivity was highest in those aged 18 - 49 years (adjusted odds ratio (aOR) 1.52; 95% CI 1.13 - 2.13; p =0.0005) and in samples from diabetics (aOR 1.36; 95% CI 1.13 - 1.63; p =0.001). Conclusions. Our study conducted between the first and second waves of the pandemic shows high levels of current infection among patients attending public health facilities in Gauteng Province.

Letter by Omar on letter by Jassat et al . (Jassat W, Brey Z, Parker S, et al. A call to action: Temporal trends of COVID-19 deaths in the South African Muslim community. S Afr Med J 2021;111(8):692-694. https://doi.org/10.7196/SAMJ . 2021.v111i8.15878 ); and response by Jassat et al .

In South Africa, the incidence of HIV-associated cryptococcal meningitis remains high despite the increased coverage of antiretroviral treatment, and in routine care settings, the disease is associated with a case-fatality ratio of more than 50%. Laboratory-based screening and pre-emptive antifungal treatment of cryptococcal disease have been suggested for routine implementation as part of the National Strategic Plan for HIV, STIs and TB, 2012 - 2016. In the first phase of a national screening programme, screening will begin at almost 500 healthcare facilities in the Gauteng and Free State provinces, and NHLS laboratories will reflexively test the remnant specimen of any blood sample with a CD4+ T-lymphocyte count