Prevalence and correlates of comprehensive HIV/AIDS knowledge among adolescent girls and young women aged 15-24 years in Malawi: evidence from the 2015-16 Malawi demographic and health survey

Spatial variation and predictors of composite index of HIV/AIDS knowledge, attitude and behaviours among Ethiopian women: A spatial and multilevel analyses of the 2016 Demographic Health Survey

BACKGROUND

Although the dissemination of health information is one of the pillars of HIV prevention efforts in Ethiopia, a large segment of women in the country still lack adequate HIV/AIDS knowledge, attitude, and behaviours. Despite many studies being conducted in Ethiopia, they mostly focus on the level of women's knowledge about HIV/AIDS, failing to examine composite index of knowledge, attitude, and behaviour (KAB) domains comprehensively. In addition, the previous studies overlooked individual and community-level, and spatial predictors. Hence, this study aimed to estimate the prevalence, geographical variation (Hotspots), spatial predictors, and multilevel correlates of inadequate HIV/AIDS-Knowledge, Attitude, and Behaviour (HIV/AIDS-KAB) among Ethiopian women.

METHODS

The study conducted using the 2016 Ethiopian Demographic and Health Survey data, included 12,672 women of reproductive age group (15-49 years). A stratified, two-stage cluster sampling technique was used; a random selection of enumeration areas (clusters) followed by selecting households per cluster. Composite index of HIV/AIDS-KAB was assessed using 11 items encompassing HIV/AIDS prevention, transmission, and misconceptions. Spatial analysis was carried out using Arc-GIS version 10.7 and SaTScan version 9.6 statistical software. Spatial autocorrelation (Moran's I) was used to determine the non-randomness of the spatial variation in inadequate knowledge about HIV/AIDS. Multilevel multivariable logistic regression was performed, with the measure of association reported using adjusted odds ratio (AOR) with its corresponding 95% CI.

RESULTS

The prevalence of inadequate HIV/AIDS-KAB among Ethiopian women was 48.9% (95% CI: 48.1, 49.8), with significant spatial variations across regions (global Moran's I = 0.64, p<0.001). Ten most likely significant SaTScan clusters were identified with a high proportion of women with inadequate KAB. Somali and most parts of Afar regions were identified as hot spots for women with inadequate HIV/AIDS-KAB. Higher odds of inadequate HIV/AIDS-KAB was observed among women living in the poorest wealth quintile (AOR = 1.63; 95% CI: 1.21, 2.18), rural residents (AOR = 1.62; 95% CI: 1.18, 2.22), having no formal education (AOR = 2.66; 95% CI: 2.04, 3.48), non-autonomous (AOR = 1.71; 95% CI: (1.43, 2.28), never listen to radio (AOR = 1.56; 95% CI: (1.02, 2.39), never watched television (AOR = 1.50; 95% CI: 1.17, 1.92), not having a mobile phone (AOR = 1.45; 95% CI: 1.27, 1.88), and not visiting health facilities (AOR = 1.46; 95% CI: 1.28, 1.72).

CONCLUSION

The level of inadequate HIV/AIDS-KAB in Ethiopia was high, with significant spatial variation across regions, and Somali, and Afar regions contributed much to this high prevalence. Thus, the government should work on integrating HIV/AIDS education and prevention efforts with existing reproductive health services, regular monitoring and evaluation, and collaboration and partnership to tackle this gap. Stakeholders in the health sector should strengthen their efforts to provide tailored health education, and information campaigns with an emphasis on women who lack formal education, live in rural areas, and poorest wealth quintile should be key measures to enhancing knowledge. enhanced effort is needed to increase women's autonomy to empower women to access HIV/AIDS information. The media agencies could prioritise the dissemination of culturally sensitive HIV/AIDS information to women of reproductive age. The identified hot spots with relatively poor knowledge of HIV/AIDS should be targeted during resource allocation and interventions.

Comprehensive HIV knowledge and associated factors among reproductive-age women: analysis of the Gambia Demographic and Health Survey 2019/2020

INTRODUCTION

Globally, there are 37.7 million people living with human immunodeficiency virus (HIV). So far, there is no study done in Gambia which assessed comprehensive HIV knowledge and its associated factors. Therefore, this study aims to assess comprehensive HIV knowledge and its associated factors among reproductive-age women in Gambia.

OBJECTIVE

To assess the prevalence of comprehensive HIV knowledge and its associated factors among reproductive-age women in Gambia.

METHODS

The study used the Gambian Demographic and Health Survey, which was conducted from 21 November 2019 to 30 March 2020 in Gambia. The survey employed a stratified two-stage cluster sampling technique to recruit study participants. Logistic regression analysis was used to identify factors associated with HIV comprehensive knowledge. Statistical significance was declared at a P value of less than 0.05 with a 95% confidence interval (CI).

RESULTS

The overall prevalence of comprehensive HIV knowledge was 27.1% (25.1-36.2%). Older age [adjusted odds ratio (AOR) of 1.20 (95% CI 1.16-1.26)], using contraceptive [AOR of 1.15 (95% CI 1.01-1.31)], higher education [AOR of 4.73 (95% CI 3.86-5.81)], rich wealth quintile [AOR of 1.61 (95% CI 1.37-1.87)], media exposure [AOR of 1.76 (95% CI 1.39-2.23)], ever tested for HIV [AOR of 1.55 (95% CI 1.42-1.74)], visited health facility within the last 12 months [AOR of 1.26 (95% CI 1.12-1.41)] and decision-making autonomy [AOR of 1.42 (95% CI 1.27-1.60)] were positively associated with comprehensive HIV knowledge. However, being married [AOR of 0.72 (95% CI 0.62-0.82)] was negatively associated with comprehensive HIV knowledge.

CONCLUSIONS

The prevalence of comprehensive HIV knowledge was low in Gambia. Educational interventions that focused mainly on awareness creation about HIV/AIDS should be designed especially for married women and lower socio-economic status. An effort has to be made to address those disparities at the national level.

Prevalence and determinants of not testing for HIV among young adult women in Papua New Guinea: findings from the Demographic and Health Survey, 2016-2018

OBJECTIVE

The aim of this study was to assess the prevalence of not testing for HIV and its determinants among young adult women aged 15-29 years in Papua New Guinea (PNG).

DESIGN AND SETTING

The study used secondary data from the 2016 to 2018 PNG Demographic and Health Survey (PNGDHS), a nationally representative cross-sectional survey that used a two-stage stratified sampling.

PARTICIPANTS

A total weighed sample of 5164 young adult women aged 15-29 years were included in the analysis.

PRIMARY OUTCOME MEASURE

Ever been tested for HIV was the primary outcome of the study. All analyses were adjusted using survey weights to account for unequal sampling probabilities.

RESULTS

The prevalence of not testing for HIV was 58.8% (95% CI: 57.4% to 60.1%). The mean age was 21.65 years (SD = 4.23). Of the women who were not tested for HIV, the majority were never married (79.4%), without formal education (63%), not working (60.2%), and from rural areas (62.9%). In the multivariable analysis, those who were never married (adjusted OR (AOR) 4.9, 95% CI 3.6 to 6.6), had poor wealth index (AOR 1.8, 95% CI 1.3 to 2.5), were from rural areas (AOR 2.0, 95% CI 1.5 to 2.6), were from the Momase region (AOR 1.3, 95% CI 1.0 to 1.7), did not read newspapers or magazines (AOR 1.7, 95% CI 1.3 to 2.1), did not listen to the radio (AOR 1.5, 95% CI 1.1 to 2.0), experienced early sexual debut (AOR 1.5, 95% CI 1.1 to 1.9), had one sexual partner (AOR 1.5, 95% CI 1.2 to 2.0) and reported no sexually transmitted infection (STI) in the past 12 months (AOR 1.8, 95% CI 1.1 to 3.1) had higher odds of not testing for HIV.

CONCLUSIONS

Our study found a very high unmet need for HIV testing among young adult women in PNG. Health promotion programmes should be designed to increase HIV knowledge and access to testing services, particularly targeting young women who are disadvantaged and from rural areas.

The knowledge mapping of HIV/AIDS in Indonesians living on six major islands using the Indonesian version of the HIV-KQ-18 instrument

Indonesia's total number of HIV/AIDS cases is still high. Inadequate knowledge about the risk of HIV infection will influence HIV prevention and therapy. This study aimed to map the level of HIV-related knowledge among Indonesians living on six major islands in Indonesia and investigate the relationship between socio-demographic characteristics and HIV/AIDS knowledge. This cross-sectional study used the Bahasa Indonesia version of the HIV Knowledge Questionnaire-18 items (HIV-KQ-18) Instrument. Data collection was done online through the Google form application. A total of 5,364 participants were recruited. The participants from Java had the highest degree of HIV/AIDS knowledge, which was 12.5% higher than participants from Sumatra, Kalimantan, Sulawesi, Papua, and Maluku. Linear regression showed that region, educational level, monthly expenditure, occupation, background in health sciences, and workshop attendance were significantly correlated with HIV knowledge. Participants typically understand that "HIV/AIDS transmission" only happens when sex partners are changed. Additionally, the government still needs improvement in HIV/AIDS education, particularly in the HIV incubation period, HIV transmission from pregnant women to the fetus, and condom use as one method of protection. There are disparities in HIV/AIDS knowledge levels among the major islands of Indonesia. Based on these findings, the government's health promotion program to increase public awareness of HIV/AIDS must be implemented vigorously. Additionally, in line with our research findings, it is essential to broaden the scope of HIV/AIDS education and promotion materials.

Comprehensive Knowledge of HIV and AIDS and Related Factors in Angolans Aged between 15 and 49 Years

A comprehensive knowledge of HIV and AIDS among men and women in Africa is reportedly low. To the best of our knowledge, no studies using any definition of comprehensive knowledge of HIV and AIDS have been conducted in Angola. To address this gap, we aimed to describe the comprehensive knowledge held by individuals aged between 15 and 49 years regarding HIV and AIDS and some associated factors, using the most recent Angolan demographic and health survey (DHS). Using an observational, cross-sectional design, we analyzed data collected from 19,785 individuals aged between 15 and 49 years for the 2016 DHS in Angola. We conducted a logistic regression analysis of descriptive and complex samples to examine the data and to unravel possible factors associated with having a comprehensive knowledge of HIV and AIDS. Almost half of the respondents (47.7%) had a general comprehensive knowledge of HIV and AIDS. Individuals who watched television (adjusted odds ratio [aOR]: 2.40; 95% CI: 2.11, 2.72) or read newspapers and magazines (aOR: 1.99; 95% CI: 1.72, 2.30) more than once a week had higher odds of having a comprehensive knowledge of HIV and AIDS compared to those who did not. Similarly, having completed primary education and above (aOR: 1.83; 95% CI: 1.67, 2.00) or living in urban areas (aOR: 1.51; 95% CI: 1.34, 1.71) increased the likelihood of individuals having a comprehensive knowledge of HIV and AIDS compared to their counterparts. These results reflect inequalities that require further attention at either a research or a political level. Nevertheless, we consider that these results can assist decision-makers in advocating for continuous investment in HIV health literacy and in adapting global solutions to local Angolan contexts.

Comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda: a nationwide cross-sectional study

BACKGROUND

Limited comprehensive knowledge of HIV/AIDS is highlighted as one of the major factors linked to the high prevalence of HIV among adolescents and young girls. Thus, it is crucial to identify factors that facilitate or hinder adolescent girls from having comprehensive knowledge of HIV/AIDS. We, therefore, assessed the prevalence of comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda.

METHODS

We used secondary data from the Rwanda Demographic and Health Survey (RDHS) 2020 comprising 3258 adolescent girls (aged 15 to 19 years). Comprehensive knowledge was considered if an adolescent girl answered correctly all the six indicators; always using condoms during sex can reduce the risk of getting HIV, having one sexual partner only who has no other partners can reduce the risk of getting HIV, a healthy-looking person can have HIV, can get HIV from mosquito bites, can get HIV by sharing food with persons who have AIDS, and can get HIV by witchcraft or supernatural means. We, then, conducted multivariable logistic regression to explore the associated factors, using SPSS (version 25).

RESULTS

Of the 3258 adolescent girls, 1746 (53.6%, 95%CI: 52.2-55.6) had comprehensive knowledge about HIV/AIDS. Adolescent girls with secondary education (AOR = 1.40, 95% CI: 1.13-3.20), health insurance (AOR = 1.39, 95% CI: 1.12-1.73), a mobile phone (AOR = 1.26, 95% CI: 1.04-1.52), exposure to television (AOR = 1.23, 95% CI: 1.05-1.44), and a history of an HIV test (AOR = 1.26, 95% CI: 1.07-1.49) had higher odds of comprehensive HIV knowledge, compared to their respective counterparts. However, girls residing in Kigali (AOR = 0.65, 95% CI: 0.49-0.87) and Northern (AOR = 0.75, 95% CI: 0.59-0.95) regions, and those of Anglican religion (AOR = 0.82, 95% CI: 0.68-0.99) had less odds of comprehensive knowledge compared to those in Southern region and of the Catholic religion.

CONCLUSIONS

To increase the comprehensive understanding of the disease at a young age, the need for expanded access to HIV preventive education through formal educational curriculum, and mass and social media via mobile phones is highlighted. In addition, the continued involvement of key decision-makers and community actors, such as religious leaders, is vital.

Promoting Well-being Among Informal Caregivers of People With HIV/AIDS in Rural Malawi: Community-Based Participatory Research Approach

BACKGROUND

People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries.

OBJECTIVE

This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera.

METHODS

We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers.

RESULTS

The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities.

CONCLUSIONS

This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers' role.

The Efficacy of a Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Controlled Trial in the Context of COVID-19

BACKGROUND

Adolescents contribute slightly less than one-third of all new HIV infections in sub-Saharan Africa. There is a need for more effective intervention approaches to help young adolescents safely navigate through adolescence and into adulthood. We are assessing the efficacy of Tumaini, a smartphone game designed to prevent HIV among young Africans. Against the background of COVID-19, meaningful alteration of the research protocol was necessary to ensure successful implementation and retention of the study participants in ongoing research.

OBJECTIVE

The objective of our protocol is to determine (1) if Tumaini delays sexual debut and increases condom use at first sex and (2) whether it influences behavioral mediators of early and unprotected sex.

METHODS

Participants were recruited from Kisumu County in Western Kenya. This study is a 2-arm, individual-randomized controlled trial that enrolled 1004 adolescents aged between 12 years and 15 years. The intervention arm participants are playing Tumaini, while the control arm is provided with Brainilis, a commercially available control game. The study period will last 45 months. At baseline, participants in both arms completed a baseline survey and biological testing for HIV and herpes simplex virus, type 2 (HSV-2); participants will have annual game play periods in years 1-3. They will also complete a total of 12 follow-up surveys. At endline, repeat biological testing will be conducted. Protocol adaptations were necessitated by the COVID-19 pandemic and implemented in accordance with local public health guidelines.

RESULTS

Participants were enrolled between October 2020 and November 2020. We plan to complete study procedures in September 2024. The enrolled participant sample was 50.1% (499/996) female and had a mean age of 14.0 (SD 0.6) years.

CONCLUSIONS

This ongoing research demonstrates that, with appropriate revisions to planned protocol activities guided by the need to maintain study integrity, protect both study participants and staff, and adhere to institutional review board and local health authority guidelines, human subject research is possible in the context of a global pandemic. If the trial demonstrates efficacy, Tumaini would provide an alternative, remote means of delivering age-appropriate education to adolescents on safer sex, HIV prevention, and effective life skills on a highly scalable, low-cost, and culturally adaptable platform.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04437667; https://clinicaltrials.gov/ct2/show/NCT04437667.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/35117.

The Kasaba Quartet: The Impact of Card Games on Knowledge and Self-Efficacy HIV/AIDS Prevention

BACKGROUND: The rate of HIV/AIDS infection is increasing every year. The highest rates of HIV infection are among adolescents aged 15–24 years. Therefore, appropriate action is needed to prevent HIV transmission through risky behavior in adolescents. AIM: The purpose of this study was to determine the effect of Kasaba Quartet card game on HIV/AIDS knowledge and self-efficacy in preventing HIV/AIDS-related risk behavior in adolescents. METHODS: The study used a quasi-experiment with an equivalent time-series design. The intervention in this study was a card game using the Kasaba Quartet. The card game was held 3 times with a 1-day break. Adolescents’ HIV/AIDS knowledge and self-efficacy were measured at the end of each card game. Sampling used purposive sampling with criteria including adolescents aged 12–16 years and domiciled in Bandung. A total of 30 people were involved in this study. RESULTS: After playing the Kasaba Quartet card game, the results showed that adolescents’ knowledge of HIV/AIDS in the excellent category increased significantly, with average scores from 66.04 ± 16.219 to 97.40 ± 2.776. Likewise, adolescents’ self-efficacy with the high sort was raised, from 77.83 ± 8.67 to 97.60 ± 3.45. The results of statistical tests using the Friedman test showed the significance level of 0.001 (Sig. <0.05). In other words, there was an effect of the Kasaba quartet card game on HIV knowledge and self-efficacy in preventing HIV risk behavior. CONCLUSIONS: Thus, the Kasaba Quartet card game effectively increases knowledge of HIV/AIDS and self-efficacy in preventing risky behavior in adolescents. The study results can be used as an alternative strategy to increase knowledge and confidence in adolescents to avoid the spread of HIV/AIDS cases.

Comprehensive HIV/AIDS knowledge and safer sex negotiation among adolescent girls and young women in sub-Saharan Africa

Globally, HIV/AIDS remains a public health issue, especially in sub-Saharan Africa (SSA). Despite the increased advocacy and dissemination of comprehensive HIV/AIDS information in SSA, it appears that little progress has been made to reduce the incidence of HIV/AIDS in the sub-region. This study, therefore, examined the association between comprehensive HIV/AIDS knowledge and safer sex negotiation among adolescent girls and young women in SSA. Data were taken from the Demographic and Health Surveys conducted between 2010 and 2019 in 30 countries in SSA. The study sample comprised 37,364 adolescent girls and young women aged 15-24. A multivariable binary logistic regression analysis was done to test the hypothesis that there is a positive association between comprehensive HIV/AIDS knowledge and safer sex negotiation. Adolescent girls and young women who had comprehensive knowledge on HIV/AIDS were more likely to negotiate for safer sex compared with those who had no comprehensive knowledge on HIV/AIDS (AOR=1.31, 95% CI: 1.22-1.41). At the country level, the positive association between comprehensive knowledge on HIV/AIDS and safer sex negotiation was significant in Chad, Congo DR, Gambia, Guinea, Liberia, Ethiopia and Malawi. On the other hand, in Togo, adolescent girls and young women who had comprehensive HIV/AIDS knowledge were less likely to negotiate for safer sex. These findings can inform policies and programmes on the crucial role of comprehensive HIV/AIDS education and knowledge in increasing safer sex negotiation among adolescent girls and young women in SSA. The study recommends that Togo needs to address certain practices such as intimate partner violence against adolescent girls and young women, which prevent them from negotiating for safer sex, despite their higher knowledge on comprehensive HIV/AIDS. Lessons can be learnt from Chad, Congo DR, Gambia, Guinea, Liberia, Ethiopia and Malawi about the scale-up of programmes and interventions targeted at young women.