Impact of COVID-19 Lockdown on HIV and Reproductive, Maternal, Neonatal and Child Health (RMNCH) Services in Maska Region, Uganda

Sara Rashidi, MSPH Class of 2023

Name: Sara Rashidi
School: Mailman School of Public Health, Class of 2023
Mentor: John Santelli, MD, MPH, Philip Kreniske, PhD, Fred Nalugoda, PhD, MHSc, Neema Nakyanjo, MA, and William Ddaaki, MSc

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During the COVID lockdown in Uganda, the effectiveness of emergency services for prevention of ART discontinuation, is poorly understood. The Goal of this study is to assess the impact of the COVID-19 lockdown on demand and utilization of RMNCH and HIV services and assess experiences and coping mechanisms in order to mitigate the impact of this and similar health emergencies in the future through evidence-based recommendations. The specific aims of the study were: 1. Determining the effect of COVID lockdown on discontinuation of ART among patients in 12 districts of Masaka, Uganda, 2. Determining the effect of COVID on attendance of antenatal care, HIV testing, immunization services, Early Infant Diagnosis (EID) and contraception, 3. Determining the effect of COVID on HIV viral load monitoring, intensive adherence counseling and HIV viral suppression, and 4. Exploring clients’, district, and health facility knowledge, attitude and experiences (KAE) and coping mechanisms for sustained ART, and RMNCH services. The overall project employs mixed-methods research design across the first three aims, nevertheless, this report is exclusively concerned the aim four and qualitative component. Three districts of Mpigi, Kyotera, and Kalangala to represent inland district, border district, and island district respectively were selected. The data collection method involved the use of Key Informant Interview, In-Depth Interview, and Focus Group Discussion. We analyzed each transcript through NVIVO open coding and Thematic Content Analysis. Concurrent with the data coding process, the codebook was developed and revised until no new information emerges. Our qualitative analysis identified participants experiencing delay or failure to reach health facilities, domestic violence, and child abuse, as well as shortage of healthcare workers and essential medicines/medical supplies as the result of COVID restrictions. Furthermore, we found that local partners were essential in providing fuel to support coordination of health care activities and delivery of ART. Additionally, clients on ART formed community support groups where members provided financial and transport services for each other’s. Overall, our results indicated that promoting social support models and health and social behavioral awareness (especially among men/heads of family) is vital in ensuring smooth transition to not only access to RMNCH services but also avoiding conflicts or family separation during emergencies.