HIV risk and factors associated with use of novel prevention interventions among female students at Makerere University

Abstract

Introduction: Adolescent girls and young women (AGYW), aged 15-24 years, account for 1 in 4 new HIV infections in sub-Saharan Africa. Female university students are members of this key population. Female university students engage in transactional sex, have multiple sexual partners, and sexually transmitted infections, factors which increase their HIV vulnerability. Unlike traditional HIV prevention methods, novel interventions such as HIV self-testing, and pre- and post-exposure prophylaxis are user-controlled. However, usage of these novel HIV prevention interventions among Makerere University female students was unknown. General Objective: To determine the HIV risk profile and factors associated with the use of novel prevention interventions among female undergraduate students at Makerere University. Methods: A cross-sectional study; data was collected using an online self-administered questionnaire shared via email and social media (WhatsApp). Participants were selected from the 10 colleges of Makerere University using quota sampling. Data on socio-demographic characteristics, sexual behaviours, and use of HIV self-testing, pre-or post-exposure prophylaxis were collected, and collated in Google spreadsheets, cleaned in Microsoft Excel, and analysed using STATA 14. Descriptive statistics were used to characterize HIV risk profile and logistic regression to evaluate factors associated with the use of novel prevention interventions and to estimate odds ratios and 95% confidence intervals. Results: We collected 534 responses and considered 483 for analysis. The participants’ mean (SD) age was 22.2 (1.2) years. Among the 483 participants, 57 (11.8%) had multiple sexual partners, 100 (20.9%) had never tested for HIV, 47 (9.7%) self-perceived to be at high risk for HIV, and 97 (21.0%) had partners ten or more years older. Overall, 99/473 (20.5%) female students were deemed high risk of HIV, because they had least one PrEP indication (Uganda PrEP eligibility criteria) and 184/473 (38.1%) were deemed high risk by the Balkus criteria (had an HIV risk score ≥5). Both methods of HIV risk assessment agreed that 67/483 (13.9%) were at high risk for HIV (agreement= 69.5%, 𝜿=0.2822, p<0.01). Also, 93/479 (19.4%) had ever used HIVST and older age was significantly associated with HIVST use (aOR 1.31, 95% CI: 1.07-1.60, p=0.01) in multivariable analysis. For PEP, 16/483 (3.3%) students overall (14/155 [9.0%] among PEP eligible students) reported a history of PEP use. High self-perceived risk (aOR 9.53, 95% CI: 2.56-35.55, p<0.01) and being married or living with a partner (aOR 11.75, 95% CI: 2.47-55.85, p<0.01) were significantly associated with PEP use. Six female students (1.2%, 6/482) overall (2/99 [9.0%] among PrEP eligible students) had ever used PrEP. No variable was significantly associated with PrEP use (p>0.05 for all comparisons). Conclusion: We estimate that 14% of young women and would need protection from acquiring HIV. HIVST use was low and associated with increasing (older) age. PEP use was even among eligible students and was associated with marital status and self-perceived risk for HIV. PrEP use was low even among eligible young women at high-risk for HIV. Policy makers and university administration need to increase access and awareness of HIVST, PEP, and PrEP.