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

Uganda's first confirmed COVID-19 patient was identified on March 22, 2020. By the end of 2022, over 170,000 people had been ill with COVID-19. Uganda is estimated to have had 3,600 COVID-19 deaths (https://coronavirus.jhu.edu/map.html), most among people with known risk factors for severe COVID-19. The high population density and the extensive social interaction in the country's cities and villages have created challenges for the country's measures to limit the spread of SARS-CoV-2 infection, the virus that causes COVID-19. It should be emphasized that, on the whole, Uganda handled the pandemic in a good way. To describe the epidemic as it unfolded in Uganda, starting in early 2021, we enrolled women who gave birth in three health clinics in and near the Ugandan capital, Kampala, and followed them until their infants were one year old. We will also try to describe whether some of the mothers and their infants were at higher risk than others of being infected with SARS-CoV-2 and of developing COVID-19. We have a special focus on the vulnerable group of HIV-1 positive women and their babies, therefore we recruited approx. 2/3 of the study participants from this category. By including data from an ongoing prospective study that began before the COVID-19 epidemic arrived in the country, we will be able to form a picture of how the epidemic and the restrictions with e.g. social distancing and limited public transport may have affected the health of these vulnerable mothers and their infants. Our findings will help the authorities to balance the benefits and risks of necessary preventive measures against the spread of SARS-CoV-2 and other pandemic viruses. We also examine how the measures to keep the epidemic in check were understood and experienced by women and their families, and to what extent the measures made it more difficult for them to seek health care. For this work, we have recruited a Ugandan researcher who has applied for admission to a master's degree program at the University of Bergen (UIB) to analyze the extensive qualitative data material she has been instrumental in collecting. If she is accepted at UiB, she will be supported by the HK-Dir-funded project HepEd to complete her 2-year master's degree. The project also includes a randomized controlled trial, where we will investigate whether BCG vaccination can protect less than 14-week-old babies of HIV-positive mothers against SARS-CoV-2 infection and COVID-19. By November 2022, we had enrolled all the planned 1,825 (of whom 1,150 are HIV-1 positive) women and their infants. Our follow-up percentages meet or exceed our own ambitious targets, exceeding 97% at 14 weeks and 90% at 1 year of child age. Our first enrolled mother-baby dyads completed the study in January 2022. The project is carried out as a collaboration between the Makerere University School of Public Health in Kampala and the Center for Intervention Science in Maternal and Child Health (www.cismac.org) at UiB and is financed through the Research Council's GLOBVAC initiative, with co-financing from CISMAC (which is financed by The Research Council and UiB) and the EU's EDCTP2 programme.