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Determining the epidemiological paramters of  Covid-19 through a household transmission study in a rural area of South Africa and Kenya

Acronym: COREP

Coordinator: Prof. Till Winfred Bärnighausen

Funding:  The European & Developing Countries Clinical Trials Partnership (EDCTP; Grant RIA2020EF-3026)

Participating Organisations: 

Fundación Privada Instituto de Salud Global Barcelona (ISGLobal), Spain

The Aga Khan University (AKU) - Kenya, Kenya

Department of Health, Kilifi County-Kenya, Kenya

Wits Reproductive Health and HIV Institute (WRHI), South Africa

Burnet Institute, Australia

University of Washington, United States

List of the other investigators

  1. Prof. Stanley Luchters, Aga Khan University, Nairobi, Kenya.
  2. Prof. Matthew F. Chersich, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
  3. Prof Gijs Walraven, Aga Khan Development Network
  4. Prof. Emilio Letang, Fundación Privada Instituto de Salud Global Barcelona (ISGLobal), Spain
  5. Professor David Anderson, Burnet Institute, Australia.
  6. Prof. Jennifer Balkus, University of Washington, United States.
  7. A/Prof Anthony Ngugi, Aga Khan University, Nairobi, Kenya.
  8. A/Prof Shaheen Sayed, Aga Khan University, Nairobi, Kenya.
  9. Dr Gloria Maimela, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
  10. Dr Alain Vandormael, Heidelberg University Medical School, Germany.
  11. Dr Julia Katherine Rohr, Harvard University, United States.
  12. Mrs Evaline Lang'at, Department of Health, Kilifi County, Kenya.

Research team members

  1. Dr Maureen Kimani, Kenya Ministry of Health, Department of Community Health Sciences, Kenya
  2. Dr John Kiiru, Kenya Ministry of Health, Department of Laboratory Sciences, Kenya
  3. Dr Francis Ndungu, KEMRI Kilifi, Kenya
  4. Mr Ben Kitole, Kilifi County Health Department, Kenya
  5. Mrs Caroline Gichuki, Aga Khan University, Kenya
  6. Mrs Eunice Irungu, Aga Khan University, Kenya
  7. Ms. Joy Mauti, Heidelberg University, Germany
  8. Dr Catherine Martin, Wits Reproductive and HIV Institute, Faculty of Health Sciences, University of Witwatersrand
  9. Ms. Dieyna Drame, Harvard University, USA

Summary

There are major gaps in knowledge about the epidemiological and clinical factors that determine COVID-19 transmission particularly in rural households in Sub-Saharan Africa. To explore this, we will perform study activities in Matjhabeng sub-district, Lejweleputswa district in South Africa and Kaloleni/Rabai Community Health and Demographic Surveillance Site (KR-HDSS) in Kilifi county in Kenya. The specific objectives of this study are to:

  1. Define epidemiological parameters of SARS-CoV-2 infection, including the reproductive number, transmissibility and clinical disease spectrum.
  2. Assess demographic, behavioural and household-level risk factors for infection and transmission, and the feasibility of implementing preventive behaviours.
  3. Assess potential vaccine uptake and hesitancy.
  4. Assessment of diagnostic performance of the VL-Plasma plasma separation device for COVID-19 serology testing.

Use of standardized international tools, such as the WHO COVID-19 study protocol will facilitate comparisons of findings across the two sites. Assumed-primary COVID-19 cases, confirmed through molecular testing done at a public or private sector laboratory, will be enrolled in a household-cluster investigation together with their consenting household members. For cases who test positive for COVID-19, we will contact the cases telephonically and invite them to participate in the study. If they agree, we will then seek permission from the primary case to contact household members and invite them to participate in the study. Informed consent will be obtained from the primary case and household members, and from parents or guardians in the case of children under 18 years.

Molecular and serology assessments will be done on household members on day 1, 7, 14 and 28 post-enrolment. Household members will be asked to complete symptom diaries daily from day 1 to 28 day where they record whatever symptoms or lack thereof, they have experienced that day. Data collected will be used to calculate the length of the period of transmissibility and reproductive number, and investigate the disease spectrum, especially rates of asymptomatic infections. Risk groups for infection and for disease will be assessed. Data will also provide estimates of the understanding and implementation of preventative behaviours and on potential vaccine uptake and hesitancy. 

Documenting COVID-19 disease in rural areas will serve to highlight the need for resources to target these areas, which have largely been neglected in discourse around COVID-19. Alternatively, should the study show that COVID-19 prevalence is presently low in rural areas and few transmissions are occurring within households, this information would support the targeting of resources at areas with a higher disease burden.

 

Time frame: 12 months

Contact Person: Dr. Alain Vandormael (alain.vandormael(at)uni-heidelberg.de)