PREVALENCE AND DETERMINANTS OF HIV PRE EXPOSURE AND POST EXPOSURE PROPHYLAXIS USE AMONG YOUNG ADULTS IN KHWISERO SUBCOUNTY, KENYA

Abstract

HIV/AIDS remains a major global public health threat despite the emergence of biomedical prevention strategies such as HIV Pre Exposure Prophylaxis and Post Exposure Prophylaxis. Despite their efficacy, utilization rates are low among youths aged 15-24, who account for approximately 27% of new infections globally and 33% in Kenya. While the determinants of HIV Pre Exposure Prophylaxis and Post Exposure Prophylaxis usage have been documented among men who have sex with men, female sex workers, adolescent girls, and women, there are limited studies focusing on young adults, a high-risk population for HIV infection. This study aimed to address this gap by focusing specifically on young adults aged 18-24 in Khwisero sub-county, Kenya. The study investigated the prevalence and determinants of HIV Pre Exposure Prophylaxis and Post Exposure Prophylaxis use among young adults, with specific objectives including the determination of uptake prevalence and the exploration of demographic, health system, and socio-cultural determinants. Guided by the Health Belief Model, a cross-sectional design was adopted. The target population comprised young adults aged 18-24, with a sample size of 426 respondents determined using the Yamane formula. Two wards in Khwisero Sub-County were selected using simple random sampling, and systematic sampling was employed to select young adults from community units within these wards. Quantitative data were collected via a semi-structured questionnaire, while qualitative data were obtained through Key Informant Interviews. The Statistical Package for Social Sciences version 26 was used to analyze quantitative data through descriptive and inferential statistics, including chi-square and logistic regression at a significance level of 0.05. Thematic analysis was employed for qualitative data, and findings were presented in tables, figures, narratives, and direct quotes. The study revealed low prevalence of Pre Exposure Prophylaxis (23.4%) and Post Exposure Prophylaxis (22.6%) utilization. Significant determinants of Pre Exposure Prophylaxis use included education level (χ2=8.1, OR=0.21, P=0.04), religion (χ2=5.0, OR=0.40, P=0.03), affordability (χ2=9.74, AOR=1.89, P=0.002), provider-initiated counseling (χ2=17.09, AOR=2.69, P<0.001), and stigma (AOR=0.37, P=0.002). Factors affecting Post Exposure Prophylaxis utilization encompassed education level (χ2=17.76, OR=0.43, P<0.001), marital status (χ2=6.47, OR=0.33, P=0.04), living arrangement (χ2=9.91, OR=1.95, P<0.001), and provider-initiated counseling (χ2=5.71, AOR=1.49, P=0.02). Qualitative data highlighted additional factors such as adherence support and cultural beliefs. These results highlight the urgent need for targeted interventions to enhance Pre Exposure Prophylaxis and Post Exposure Prophylaxis utilization among young adults. By addressing the identified barriers and leveraging facilitators, policymakers can formulate strategies and interventions to strengthen uptake, ultimately reducing new HIV infections among young adults.