Understanding Covid-19 survivor experiences and Community attitude in Uganda: Lessons for Community reintegration

1) Project background, context and needs addressed As Covid-19 continues to ravage the world since its declaration as a pandemic, the average global fatality rate stands at 3.4%, and this is higher among adults aged 70 years and above ranging from 8% to 42.4%2. Despite this, the number of people recovering from the disease has increased over time. The mainstay approaches to management of Covid-19 are case identification, isolation and supportive care till recovery. It is also required that contacts of individuals who test positive for Coronavirus are quarantined for a minimum of 14 days. These long durations of isolation might increase anxiety and stress levels of individuals. Long durations in isolation are also likely to have a negative impact on the individuals' work, with many of the affected individuals likely to lose jobs in the aftermath of the infection because of long periods away from work and discrimination from employers and fellow employees. This, coupled with reports of disease reactivation in some individuals who have previously recovered from Covid-19 and associated disease severity and high mortality rates among adults and the way Covid-19 is portrayed by country leaderships stimulate more panic and fear in the general population. Fear during a disease outbreak can lead to stigma towards infected individuals, their families and communities even after recovery as noted during the Ebola outbreak in West Africa. The resulting stigma might persist for over two years following recovery affecting the individual socially, psychologically and economically for example physical or verbal assault, labelling and stereotyping in society, discrimination and loss of societal status previously held in community affecting the reintegration of recovered individuals into the community. There is currently little information on the impact of fear on community reintegration of patients following recovery from Covid-19 worldwide, and in Uganda in particular. However, there are cited cases of recovered patients in Uganda not wanting to be identified due to the fear of stigma in the community. There have also been cases of individuals who have completed quarantine being physically assaulted by locals accusing them of putting the community at risk of Coronavirus infection. It is predicted that due to such attitudes, many individuals in Uganda will lose the sources of livelihoods. It is also predicted that individuals may develop serious psychological conditions and if not identified and properly managed, victims are likely to suffer long-term mental and emotional issues including depression, suicidal tendencies, self-stigmatisation, anger, anxiety, worthlessness, substance addiction, grief, guilt among others. It is important, therefore, to understand community reintegration following recovery from Covid-19 from the policymakers, patients and community perspectives. This information will be used to better inform the design of community reintegration interventions that are specific to Covid-19 pandemic. 2) Aims or research questions being addressed With this study, we aim to; 1. Understand the community reintegration strategies that the Uganda government is employing for recovered Covid-19 patients 2. Understand the experiences community reintegration of Covid-19 survivors 3. Understand knowledge, attitudes and practices of the wider community towards Covid-19 survivors 4. Design and recommend an evidence-informed strategy for reintegration of Covid-19 survivors in the Uganda context 3) Study design This will be a cross-sectional study, utilising key informant interviews, in-depth interviews and an online survey to collect qualitative data. Study setting: The study will be carried out in Uganda. We will target communities that have had a case of Covid-19 and those without a case. This is aimed at comparing the knowledge and attitude of the two communities. Study Population: We will collect data from policymakers, individuals who have recovered from Covid-19, community leaders and the general public. Policymakers: We shall interview officials at the Ministry of health who are directly responsible for the community reintegration of covid-19 survivors. In responding to Covid-19 pandemic in Uganda, the Ministry of Health set up different teams to address different aspects of the pandemic. We shall identify the team or members directly responsible for reintegration. Covid-19 survivors: Uganda has had 75 cases of Covid-19 to date and over 40 individuals recovered and back to their communities. We shall sample from the recovered individuals for the interviews. Community/opinion leaders: These will be identified by the local leadership of communities where Covid-19 survivors hail from. These shall be identified by the local council one chairpersons and shall be approached for participation in the study. They will be selected conveniently based on whose contact we can get. Due to social distancing requirements and country-wide lockdown, we intend to collect data from the above participants via targeted phone calls for interviews. With some policymakers who prefer responding in writing, we shall email the interview questions and follow up with a phone to call to confirm receipt of the email. The responses shall be recorded and transcribed for analysis. General population: We shall conduct an online survey which seeks to identify the attitude of the community towards Covid-19 survivors. We shall use SurveyMonkey, an online survey platform. The survey shall be widely promoted to ensure that persons from different parts of Uganda respond to the questions. Analysis plan: We will use Dedoose software for the analysis of the data. Two independent individuals will code the same data sets, and we will use the codes to develop themes in the analysis using the framework analysis approach. Ethical Approval: We shall obtain ethical approval for the study from the School of Medicine Research and Ethics Committee (SOMREC) and the Uganda National Council of Science and Technology. We will also obtain written consent from all participants in the study. The data collected during the study will be anonymised and only accessible to the study team. 4) Approach used to maximise the impact of research outputs, to improve health and the research community The information from the study will be used to identify gaps and strengths in the community reintegration approach used by Uganda. We shall use these gaps to draw recommendations on how to improve the reintegration process and address the community fears and potential stigma towards Covid-19 recovered patients. The results will be shared in form of a report with decision-makers at the Ministry of Health with whom we have worked on different policy projects and the National Task Force for Covid-19. We shall also produce a two-page document that we shall share along with the report being cognisant of some policymakers not creating time to read the full report. These shall also be uploaded online so as to make them accessible to a wider audience. We shall also publish a paper in an open-access peer-reviewed journal to provide lessons for the world at large on the different things they need to consider during reintegration of recovered patients. Expected outcomes We expect that the study findings will be used by the policymakers to further refine the integration process. With a better reintegration strategy, it is expected that the patients will face less stigma in the community and thus reduced to no adverse effects on their social, psychological and economic aspects of life. My role in the project I will be the technical lead on this project. I will lead the protocol development process, data collection, analysis, report preparation and results dissemination.