The impact of the COVID-19 pandemic on the provision & utilisation of primary health care services in Goma, Democratic Republic of the Congo, Kambia district, Sierra Leone & Masaka district, Uganda.

INTRODUCTION: This study aimed to determine whether the COVID-19 pandemic had an impact on essential primary healthcare services at public primary healthcare facilities. METHODS: The number of weekly consultations for antenatal care (ANC), outpatient (OPD), immunisations (EPI), family planning (FP) and HIV services, between January 2018 and December 2020, were collected from 25 facilities in Masaka district, Uganda, 21 in Goma, and 29 in Kambia district, Sierra Leone. Negative binomial regression models accounting for clustering and season were used to analyse changes in activity levels between 2018, 2019 and 2020. RESULTS: In Goma, we found no change in OPD, EPI or ANC consultations, FP was 17% lower in March-July 2020 compared to 2019, but this recovered by December 2020. New diagnoses of HIV were 34% lower throughout 2020 compared to 2019. In Sierra Leone, compared to the same periods in 2019, facilities had 18-29% fewer OPD consultations throughout 2020, and 27% fewer DTP3 doses in March-July 2020. There was no evidence of differences in other services. In Uganda there were 20-35% fewer under-5 OPD consultations, 21-66% fewer MCV1 doses, and 48-51% fewer new diagnoses of HIV throughout 2020, compared to 2019. There was no difference in the number of HPV doses delivered. CONCLUSIONS: The level of disruption varied across the different settings and qualitatively appeared to correlate with the strength of lockdown measures and reported attitudes towards the risk posed by COVID-19. Mitigation strategies such as health communications campaigns and outreach services may be important to limit the impact of lockdowns on primary healthcare services.

Willingness to participate in COVID-19 vaccine trials;a survey among a population of healthcare workers in Uganda

Introduction/ Background: Healthcare workers (HCWs) are at high risk of acquiring SARS-CoV-2 and COVID-19 and may therefore be a suitable population for COVID-19 vaccine trials. We conducted a survey to evaluate willingness-to-participate in COVID-19 vaccine trials in a population of HCWs at three hospitals in Uganda. Methods: This cross-sectional survey was conducted between September and November 2020. Using a standardised face-to-face administered questionnaire loaded on encrypted electronic tablets, data were collected on socio-demographics, willingness-to-participate in COVID-19 vaccine trials, and motivators and barriers to participation. Data were analysed descriptively and a binomial generalised linear model with a log link function used to investigate factors associated with unwillingness to participate. A p-value cut off of 0.05 was used to determine statistical significance. Results: 657 HCWs (female, 63%) were enrolled (Mean age 33 years, SD 10). Overall willingness-to-participate was 70.2%. Key motivators for participation were expectation of protection against COVID-19 (81.1%) and altruism (73.3%). Selected hypothetical trial attributes reduced willingness-to-participate weekly-quarterly study visits across 12 months (70.2%-63.2%);risk of mildmoderate local adverse reactions (70.2%-60.3%, P<0.001);and delay of pregnancy: Female, 62.8%- 48.4% (P=0.002);Male, 82.5%-71.5% (P=0.003)]. Among individuals that were unwilling to participate, the commonest barrier was concern over vaccine safety (54.6%). Unwillingness to-participate was associated with being female (aRR 1.97, CI 1.46-2.67, P<0.001) and having university or other higher-level education (aRR 1.52, CI 1.05-2.2, P=0.026). Impact: Some of the findings from this study may inform uptake of approved vaccines, e.g., concerns about safety. In addition, in preparation for COVID-19 vaccine trials, extensive education for potential participants is needed. The reluctance of females to participate and the impact of the need to delay pregnancy need farther exploration. Conclusion: Willingness-to-participate in COVID-19 vaccine trials among HCWs in Uganda is high but may be affected by vaccine trial requirements and concerns about the safety of candidate vaccines. Preparation for COVID- 19 vaccine trials should include extensive education about vaccine research and vaccine research requirements for potential participants.