Abstract / Summary
Abstract Background As part of Uganda’s COVID-19 emergency response, two districts along high-volume trucker routes linked to early clusters, Amuru and Tororo, were prioritized for hand hygiene (HH) interventions. While HH is a critical non-pharmaceutical intervention, tools to efficiently identify high-risk community locations during outbreaks are limited. Methods We adapted the Population Connectivity Across Borders (PopCAB) tool, developed by the U.S. Centers for Disease Control and Prevention, to identify and prioritize high-risk community locations and healthcare facilities (HCF) and inform targeted HH interventions, including provision of alcohol-based hand rub (ABHR), handwashing stations (HWS), and site-level support. Additional questions assessed HH infrastructure and ABHR perceptions. A mixed-methods baseline assessment was followed by implementation and post-intervention assessments. Quantitative indicators were compared using chi-square tests. Qualitative data were analyzed using deductive thematic analysis. Results Between 2020 and 2021, four focus group discussions and 17 key informant interviews with 56 participants identified 734 locations. Fifty-nine community sites and 21 HCF were prioritized. At baseline, HWS availability varied, and community members often preferred ABHR over shared stations. Between baseline and follow-up, HWS and ABHR availability in community locations increased from 63 to 85% and 40 to 83%, respectively. In HCF, sufficient ABHR availability increased from 9 to 91%. However, consistent access was constrained by theft, breakage, supply shortages, and limited maintenance systems. Conclusion PopCAB identified high-risk locations often overlooked by routine WASH programming and informed targeted HH interventions. While access improved, sustainability challenges highlight the need for strengthened operational and maintenance strategies in emergency response settings.