SARS-CoV-2 infection and COVID-19 in women and their young infants in Kampala, Uganda

Uganda's first confirmed COVID-19 case was recently identified by our collaborating partner in Entebbe. By 29th of March, 33 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 young 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 also have a particular focus on the large vulnerable group of HIV-positive women and their babies. By including data from a large ongoing randomized controlled trial, an interrupted time-series analysis in both HIV-1 positive mothers and their young infants will describe the impact not only of COVID-19 but also of the recently implemented restrictions on people's movement. We will also examine how these and other measures to contain the epidemic are understood and experienced by women and their families, and explore possible implications for health seeking behaviors. We will also examine the health consequences, beyond that of COVID-19, with the intention of helping to realign the implemented actions to balance their population benefits and risks and suggest strategies to mitigate the latter. 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 Infection but also against COVID-19.