Uganda's first confirmed COVID-19 case was identified on the 22nd of March, 2020, and by mid-November 2022, 170,000 cases had been confirmed. The high urban population density and extensive and necessary social interaction, which in some areas are compounded by challenging hygienic conditions, have represented challenges to the country's containment of the COVID-19 epidemic.
To describe the evolving epidemic, we are enrolling women giving birth at three health clinics in and close to Kampala and follow them and their infants for at least half a year. We also identify aspects that may have an impact on the mothers' and babies' risk of becoming infected with the SARS-CoV-2 virus and of getting the COVID-19 illness. The project has a particular focus on HIV-1 positive women and their babies in that almost two-thirds of the enrolled women are HIV-1-positive.
By including data from a prospective study in which we over the last years have enrolled these vulnerable mothers and babies, we will try to describe the impact that the COVID-19 epidemic and the necessary restrictions have had on their access to health care and on their health. We hope that our findings will help authorities balance the benefits and risks of necessary preventive measures against the spread of the virus. We also examine how measures to contain the epidemic are understood and experienced by women and their families.
The project also encompasses a randomized controlled trial, were we examine if BCG vaccination can protect babies of mothers who are HIV-positive against SARS-CoV-2 infection and COVID-19.
So far (i.e. by mid-November 2022) we have enrolled all the planned 1,825 (of whom 1150 are HIV-1 positive) women and their babies. Our follow-up percentages exceed even our own ambitious targets and are above 97% at 14 weeks and above 90% at 26 weeks of baby age. Our first enrolled mother-baby dyads completed the study in January 2022.
Uganda’s first confirmed COVID-19 case was recently identified by our collaborating partner in Entebbe. By mid-May, 260 cases had been confirmed. The high urban population density, extensive and unavoidable social interaction in urban and rural areas, in some areas compounded by challenging hygienic conditions, represent major challenges to the containment of the COVID-19 epidemic in the country.
To obtain a population-based description of the evolving COVID-19 epidemic, we will enroll women in labor, and follow them and their infants for 14 weeks. Concretely, we will describe the evolving epidemic in three neighborhoods in Kampala and identify risk factors for SARS-CoV-2 infection and for COVID-19 as well as its health consequences in our study participants. While the women are likely to mirror the general young adult population with respect to the infection and the disease, the study will have a particular focus on the large vulnerable group of HIV-positive women and their babies.
We will describe the impact of the COVID-19 epidemic and the effect of the restrictions on people’s movement for mothers and their infants. We will also examine how these and other measures to contain the epidemic are understood and experienced by the women and their families, and explore possible implications for health seeking behaviors. We will also examine the health consequences of interventions put in place to contain the epidemic, information which governments can use to realign restrictions in order to properly balance benefits and risks of such interventions.
The proposed project also encompasses an expansion of a large ongoing randomized controlled trial to examine if BCG vaccination protects HIV-1 exposed young infants not only against possible severe bacterial infections but also against SARS-CoV-2 infection and COVID-19.