Background:Preventing HIV infections among adolescents and young adults (AYAs) is crucial for curtailing the epidemic. Oral pre-exposure prophylaxis (PrEP) is a highly effective prevention method increasingly available to this age group in sub-Saharan Africa but population-based data on awareness and use of PrEP among AYAs remains limited.Methods:Analyzing survey data from 2 rounds of the Rakai Community Cohort Study, an open, population-based cohort, we estimated prevalence ratios associating various sociodemographic characteristics with PrEP awareness and ever-use among 15- to 24-year-olds in south-central Uganda between 2018 and 2023.Results:Most (62.4%, N = 3308/5301) participants were aware of PrEP as an HIV prevention method but only 1.7% (N = 133/7999) of AYAs had ever used it. Among the 35.5% (N = 2838/7999) of participants meeting PrEP eligibility criteria, ever-use was similarly rare (2.6%, N = 75/2838). Compared with 20 to 24-year-olds, 15 to 19-year-olds were less likely to report awareness [fullyadjPR (prevalence ratio) = 0.82, 95%CI (confidence interval): 0.78, 0.86] or ever-use (fullyadjPR = 0.35, 95%CI: 0.21, 0.58). Participants from fishing communities were more likely to be PrEP-aware (fullyadjPR = 1.22, 95%CI: 1.16, 1.29) or have ever used the prevention method (fullyadjPR = 6.07, 95%CI: 4.10, 8.98) than those from non-fishing communities.Conclusions:In this cross-sectional study of AYAs in Uganda, awareness of PrEP was common but ever-use was rare, even among the third of respondents who were likely PrEP-eligible. This suggests that prevention policies and barriers besides unawareness of the method impede PrEP initiation. Efforts that target those barriers, particularly for adolescents, are critical for reducing HIV incidence among this priority population.
[1]Columbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, 722 West 168th St, New York, NY 10032 USA.
[2]New York State Psychiat Inst & Hosp, HIV Ctr Clin & Behav Studies, New York, NY USA.
[3]Columbia Univ, New York, NY 10032 USA.
[4]Frederick Natl Lab Canc Res, Clin Monitoring Res Program Directorate, Frederick, MD USA.
[5]Rakai Hlth Sci Program, Kalisizo, Uganda.
[6]Johns Hopkins Univ, Sch Med, Div Infect Dis, Baltimore, MD USA.
[7]Uganda Virus Res Inst, Entebbe, Uganda.
[8]Makerere Univ, Fac Med, Dept Med, Kampala, Uganda.
[9]Makerere Univ, Fac Med, Clin Epidemiol Unit, Kampala, Uganda.
[10]Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA.
[11]NIAID, Lab Immunoregulat, Div Intramural Res, NIH, Bethesda, MD USA.
[12]Columbia Univ, Mailman Sch Publ Hlth, Heilbrunn Dept Populat & Family Hlth, New York, NY 10032 USA.
[13]City Univ New York CUNY, Grad Sch Publ Hlth & Hlth Policy, Community Hlth & Social Sci Dept, New York, NY USA.
[14]City Univ New York CUNY, Inst Implementat Sci Populat Hlth ISPH, Grad Sch Publ Hlth & Hlth Policy, New York, NY USA.
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