Impact of COVID-19 on Well-Being and Physical Activity in Ugandan Children With and Without HIV Mina Milad, 1 Christine Karungi, 2 Abdus Sattar, 1 Victor Musiime, 2,3 Rashidah Nazzinda, 2 Grace A. McComsey, 1 and Sahera Dirajlal-Fargo 1 1 Case Western Reserve University, Cleveland, OH, USA; 2 Joint Clinical Research Center, Kampala, Uganda; 3 Makerere University, Kampala, Uganda Background: The present study aims to understand the socioeconomic and physical activity impact of the COVID-19 pandemic on children living with perinatally acquired HIV (PHIV) and without HIV (HIV-) in Kampala (Uganda). Methods: The authors included children aged 10–18 years who filled out questionnaires at baseline (2017–2018, prepandemic) and 2 years later (March 2020–January 2021, pandemic) in an observational cohort study at Joint Clinical Research Centre (Kampala). Physical activity energy expenditure was calculated using a youth compendium from the National Collaborative on Childhood Obesity Research. Descriptive and standard test statistics including Kruskal–Wallis were used. Results: One hundred and ninety-eight children from Kampala Uganda were included prepandemic (101 PHIV and 97 HIV-); 131 (71 PHIV and 60 HIV-) had information collected during the pandemic. At baseline, median and interquartile range age was 13 years (11; 15), and 52% were females. During the pandemic, overall weekly physical activity increased by a median of 854 minutes (interquartile range: 270–1890), and energy expenditures increased by 16% in both PHIV and in HIV- (P < .001 for groups overall prepandemic vs pandemic). Conclusions: The authors found in this Ugandan cohort of children that children engaged in more physical activity. Further research is warranted to understand the long-term effects of the pandemic on children’s well-being. Keywords: sub-Saharan Africa, perinatally acquired HIV, socioeconomic The spread of COVID-19 has impacted children’s education, emotional well-being, and physical activity worldwide. Since the onset of the pandemic, United Nations Educational, Scientific and Cultural Organization estimates that 138 countries have closed schools which likely exacerbated existing educational inequalities as children from low-income households have greater difficulty with homeschooling. 1 Children in the United States 2 and Europe 3 have demonstrated a decrease in physical activity since the pan- demic. However, there have not been any studies in Sub-Saharan Africa despite the increasing prevalence in obesity. 4 Moreover, a decline in psychological well-being has been evident in the pedi- atric population worldwide since the onset of COVID-19. 5 These adverse health outcomes are specifically worrisome for children with HIV. Four million children and adolescents live with HIV in Sub-Saharan Africa, and COVID-19 threatens to put them all at risk. The pandemic-related restrictions could affect their access to essential HIV services, including access to lifesaving antiretroviral therapy (ART), 6 and exacerbate preexisting barriers to care. 7 This study aims to understand the pandemic’s impact on physical activity, mental health, and socioeconomic factors on children living with perinatally acquired HIV (PHIV) and those without HIV (HIV-) in Uganda during the first wave of the pandemic. Methods This is a quantitative study making use of a longitudinal analysis of an observational cohort of PHIV and HIV- children (referred as participants) prospectively enrolled at the Joint Clinical Research Centre in Kampala, Uganda from September 2017 to January 2021. The study was approved by the research ethics committee in Uganda, the Ugandan National Council of Science and Technol- ogy, as well as the institutional review board of the University Hospitals Cleveland Medical Center, Cleveland, Ohio. Caregivers of the participants gave written informed consent, and assent was obtained from participants. Participants All participants were 10–18 years of age. PHIV participants were on ART for at least 2 years with a stable regimen for at least the last 6 months with HIV-1 RNA viral load <400 copies/mL. HIV- participants were sampled from 2 groups: They were family members of the PHIV participants, or they were recruited from the community using community liaison volunteers from the Joint Clinical Research Centre. Participants were matched by age and sex. All participants lived in Kampala or peri-urban surroundings. Participants were included if they filled out questionnaires at baseline (2017–2018, prepandemic) and 2 years later (March 2020–January 2021, pandemic). Participants were excluded if they had diarrhea or acute infection (malaria, tuberculosis, helminthiasis, pneumonia, and meningitis) in the last 3 months, as well as moderate or severe malnutrition. Adolescents with pregnancy or intent to become pregnant were excluded. Medications including ART were obtained from the partici- pants as well as abstracted from the medical charts. Research Instruments: Socioeconomic Measures and COVID Impact The primary parent or caregiver of the participants was given a 12- item questionnaire that incorporated the WHO STEPS instrument, 8 Musiime https://orcid.org/0000-0001-7472-9054 McComsey https://orcid.org/0000-0003-2690-8888 Dirajlal-Fargo (Sahera.dirajlal-fargo@uhhospitals.org) is corresponding author, https://orcid.org/0000-0001-9945-9062 638 Journal of Physical Activity and Health, 2022, 19, 638-641 https://doi.org/10.1123/jpah.2022-0061 © 2022 Human Kinetics, Inc. BRIEF REPORT Unauthenticated | Downloaded 11/02/22 12:51 PM UTC