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Social vulnerability has been shown to be a strong predictor of disparities in health outcomes. A common approach to estimating social vulnerability is using a composite index, such as the social vulnerability index (SVI), which combines multiple factors corresponding to key social determinants of health. Lawal and Osayomi created an SVI to explore key social determinants of health-related COVID-19 infection among the Nigerian population. This study explored the association of COVID-19 SVI with COVID-19 seroprevalence using a large household survey in Nigeria. Weighted COVID-19 seroprevalence estimates at the Local Government Areas (LGA) were estimated and merged with the Lawal and Osayomi SVI, also at the LGA-level. Linear regression models were constructed to evaluate the relationship between the SVI and COVID-19 seroprevalence. The effect of SVI was evaluated both as a continuous variable and categorized into quintiles to evaluate dose–response effects. Our results confirmed a positive relationship between social vulnerability and COVID-19 infection in four states and the Federal Capital Territory in Nigeria. Compared to class 1 (the least vulnerable group), COVID-19 seroprevalence was, on average, 9.21% and 6.42% higher in classes 4 and 5 LGAs, respectively, after adjustment by phase of the survey. The effect was particularly strong farther into the pandemic (June 2021), when COVID-19 mitigation measures were relaxed. In conclusion, SVI can potentially be a useful tool to effectively prioritize communities for resource allocation as part of emergency response and preparedness in Africa. Paper Context: Main findings: A direct association between social vulnerability and COVID-19 infection was observed in four states and the Federal Capital Territory in Nigeria, particularly later in the pandemic when COVID-19 restrictive measures have been relaxed. Added knowledge: Our findings add to the limited literature describing this association in Africa, particularly in Nigeria, and using a more robust and representative large household COVID-19 seroprevalence survey. Global health impact for policy and action: Our findings suggest the need for developing and using social vulnerability indexes in Africa to inform decision and policy making when prioritizing communities for resource allocation as part of emergency response and preparedness. [ABSTRACT FROM AUTHOR]

Background Due to the high prevalence of resistance to NNRTI-based ART since 2018, consolidated recommendations from the WHO have indicated dolutegravir as the preferred drug of choice for HIV treatment globally. There is a paucity of resistance outcome data from HIV-1 non-B subtypes circulating across West Africa. Aims We characterized the mutational profiles of persons living with HIV from a cross-sectional cohort in North-East Nigeria failing a dolutegravir-based ART regimen. Methods WGS of plasma samples collected from 61 HIV-1-infected participants following virological failure of dolutegravir-based ART were sequenced using the Illumina platform. Sequencing was successfully completed for samples from 55 participants. Following quality control, 33 full genomes were analysed from participants with a median age of 40 years and median time on ART of 9 years. HIV-1 subtyping was performed using SNAPPy. Results Most participants had mutational profiles reflective of exposure to previous first- and second-line ART regimens comprised NRTIs and NNRTIs. More than half of participants had one or more drug resistance-associated mutations (DRMs) affecting susceptibility to NRTIs (17/33; 52%) and NNRTIs (24/33; 73%). Almost a quarter of participants (8/33; 24.4%) had one or more DRMs affecting tenofovir susceptibility. Only one participant, infected with HIV-1 subtype G, had evidence of DRMs affecting dolutegravir susceptibility—this was characterized by the T66A, G118R, E138K and R263K mutations. Conclusions This study found a low prevalence of resistance to dolutegravir; the data are therefore supportive of the continual rollout of dolutegravir as the primary first-line regimen for ART-naive participants and the preferred switch to second-line ART across the region. However, population-level, longer-term data collection on dolutegravir outcomes are required to further guide implementation and policy action across the region. [ABSTRACT FROM AUTHOR]