Ssuna Bashir, Armstrong-Hough Mari, Block Ngaybe Maiya G, Kalibbala Dennis, Kalyango Joan N, Kiweewa Flavia Matovu
Makerere College of Health Sciences, Department of Epidemiology and Biostatistics, Kampala, Uganda; Uganda Tuberculosis Implementation Research Collaboration (U-TIRC), Kampala, Uganda.
Uganda Tuberculosis Implementation Research Collaboration (U-TIRC), Kampala, Uganda; New York University School of Global Public Health, Department of Social and Behavioral Sciences, Department of Epidemiology, New York, United States.
Res Sq. 2024 Sep 26:rs.3.rs-4943952. doi: 10.21203/rs.3.rs-4943952/v1.
Preexposure prophylaxis (PrEP) reduces new human immunodeficiency virus(HIV) infections by up to 96% and is recommended for key populations by the World Health Organization. Understanding the knowledge and willingness to use PrEP is essential for effective implementation. This study assessed these factors and identifiedcharacteristics associated with differences in knowledge among key populations in Kampala, Uganda.
We administered a cross-sectional survey to a systematic sample of 497 participants from fisherfolk (283, 56.9%), men who have sex with men (MSM) (93, 18.7%), and female sex worker (FSW) (121, 24.4%) communities in Kampala Central, where PrEP had not yet been rolled out. Data on sociodemographic characteristics, PrEP awareness, and HIV-related behavioralfactors were collected. Knowledge about PrEP was measured using an adopted questionnaire comprising five key questions about PrEP knowledge, graded as no knowledge, some knowledge and good knowledge. Ordered probit regression models were used to analyze the associations of independent factors with PrEP knowledge levels.
Participants had a mean age of 29±7.6 years. Ofthese, 257 (51.7%) reported having sex with women, 157 (31.6%) with men and 83 (16.7%) with both men and women. Self-reported HIV-positive status was 6.4% in fisherfolk, 11.8% in MSM and 27.3% in FSW. PrEP awareness stood at 62.4% overall, with the highest awareness in FSW (73.6%) and the lowest in fisherfolk (54.1%). Willingness to use PrEP was high across all groups (77.7%), although it was lower among FSW (66.9%). Multivariate probit analysis highlighted key independent factors associated with PrEP knowledge among fisherfolks and HIV-related concerns (Adj. Coeff = 0.54, 95% CI: 0.11, 0.97) and lack of PrEP awareness (Adj. Coeff = -0.99, 95% CI:-1.28, -0.70); among MSM, lack of PrEP awareness (Adj. Coeff = -1.74, 95% CI:-2.38, -1.10); and in FSW, tertiary education (Adj. Coeff = 1.53, 95% CI: 0.07, 2.99) and marital status (Adj. Coeff = 0.57, 95% CI=0.09, 1.05). MEshighlighted the influence of these independent factors at each knowledge level.
Despite the high willingness to use PrEP, significant knowledge gaps exist, particularly concerning dosage and use duration, which are influenced by factors such as HIV concern and educational attainment. Tailored educational initiatives may bridge these gaps and enhance willingness to use PrEP.
暴露前预防（PrEP）可将新发人类免疫缺陷病毒（HIV）感染率降低多达96%，世界卫生组织建议对重点人群采用该方法。了解PrEP相关知识及使用意愿对于有效实施该措施至关重要。本研究评估了这些因素，并确定了乌干达坎帕拉重点人群中与知识差异相关的特征。
我们对坎帕拉市中心渔民（283人，占56.9%）、男男性行为者（MSM，93人，占18.7%）和女性性工作者（FSW，121人，占24.4%）社区的497名参与者进行了系统抽样的横断面调查，这些社区尚未推行PrEP。收集了社会人口学特征、PrEP知晓情况及HIV相关行为因素的数据。使用一份采用的问卷来衡量对PrEP的了解程度，该问卷包含五个关于PrEP知识的关键问题，分为无知识、有一些知识和知识丰富三个等级。采用有序概率回归模型分析独立因素与PrEP知识水平之间的关联。
参与者的平均年龄为29±7.6岁。其中，257人（51.7%）报告与女性发生性行为，157人（31.6%）与男性发生性行为，83人（16.7%）与男性和女性都发生性行为。自我报告的HIV阳性率在渔民中为6.4%，在男男性行为者中为11.8%，在女性性工作者中为27.3%。PrEP总体知晓率为62.4%，女性性工作者知晓率最高（73.6%），渔民知晓率最低（54.1%）。所有群体使用PrEP的意愿都很高（77.7%），尽管女性性工作者中的意愿较低（66.9%）。多变量概率分析突出了与渔民PrEP知识相关的关键独立因素以及对HIV的担忧（调整系数=0.54，95%置信区间：0.11，0.97）和缺乏PrEP知晓情况（调整系数=-0.99，95%置信区间：-1.28，-0.70）；在男男性行为者中，缺乏PrEP知晓情况（调整系数=-1.74，95%置信区间：-2.38，-1.10）；在女性性工作者中，高等教育程度（调整系数=1.53，95%置信区间：0.07，2.99）和婚姻状况（调整系数=0.57，95%置信区间=0.09，1.05）。MEs突出了这些独立因素在每个知识水平上的影响。
尽管使用PrEP的意愿很高，但仍存在显著的知识差距，尤其是在剂量和使用持续时间方面，这些差距受到对HIV的担忧和教育程度等因素的影响。量身定制的教育举措可能会弥合这些差距并提高使用PrEP的意愿。
