Individual and household risk factors for COVID-19 infection among household members of COVID-19 patients in home-based care in western Uganda, 2020

OBJECTIVE: To investigate factors associated with COVID-19 among household members of patients in home-based care (HBC) in western Uganda. METHODS: We conducted a case-control and cohort study. Cases were reverse transcriptase–polymerase chain reaction-confirmed SARS-CoV-2 diagnosed 1−30 November 2020 among persons in HBC in Kasese or Kabarole districts. We compared 78 case-households (≥1 secondary case) with 59 control-households (no secondary cases). The cohort included all case-household members. Data were captured by in-person questionnaire. We used bivariate regression to calculate odds and risk ratios. RESULTS: Case-households were larger than control-households (mean 5.8 vs 4.3 members, P<0.0001). Having ≥1 household member per room (adjusted odds ratio (aOR)=4.5, 95% CI 2.0−9.9), symptom development (aOR=2.3, 95% CI 1.1−5.0), or interaction with primary case-patient (aOR=4.6, 95% CI 1.4−14.7) increased odds of case-household status. Households assessed for suitability for HBC reduced odds of case-household status (aOR=0.4, 95% CI=0.2−0.8). Interacting with a primary case-patient increased the risk of individual infection among household members (adjusted risk ratio=1.7, 95% CI 1.1−2.8). CONCLUSION: Household and individual factors influence secondary infection risk in HBC. Decisions about HBC should be made with these in mind.