Uganda is among the high-burden HIV countries with an average national HIV prevalence of 5.8%[1], but with poor utilization of Pre-exposure prophylaxis (PrEP) as only 180,000 individuals have been initiated on PrEP across 65 districts by 2021 [2], with varying levels of uptake of between 30.6% and 60% among the eligible high risk population[3,4]. This is expected to be much lower among adolescents and young adults who are at the high risk to HIV acquisition [5]. Several barriers to PrEP utilization have been noted, including fear of side effects, pill burden, perceived low HIV risk, stigma,, and lifestyle-related challenges, reduced awareness about PrEP [3,4,6].

Soroti city, located in Teso sub-region, Eastern Uganda, has a higher HIV prevalence of 13.3% as compared to the national HIV prevalence of 5.8%[1,7], thus a potential HIV transmission and yet to date there is limited evidence on PrEP use especially among the sexually active young population at high risk in this region [8]. To close the gaps and devise more effective strategies to improve PrEP uptake, continuation, and effective use to achieve the PrEP policy implementation, there is a need to understand PrEP utilization and its factors among sexually active adolescents and young adults. This study, therefore, aimed to assess the prevalence of PrEP utilization and its factors among sexually active adolescents and young adults in Soroti City, Uganda.

Study setting. The study was conducted in four health facilities that were purposively selected because they provide PrEP services to all at-risk populations in the city, and these include: Princess Diana Health Center IV, Kichinjaji Health Center III, Eastern Division Health Center III, and Western Division Health Center III. These are lower-level health facilities in the city providing comprehensive HIV prevention and treatment services to adolescents and young people. The facilities have adolescent and youth friendly services and so make it easy for young people to access PrEP when they visit the sites. Soroti city is in the Teso sub-region of Northeastern Uganda, 310km from and Northeast of the Uganda’s capital Kampala. Soroti city has a population of 133,774 persons, with 33,659 households and an average size of 3.9 persons per household [9]. The Major economic activity is a business hub of the Teso sub-region, in addition to agriculture, agro-processing and trade.[10].

This study involved sexually active adolescents and young adults aged 18–24 years who attended adolescent and youth-friendly services at the selected health facilities in Soroti City at the time of study. These are young people, mostly out of school and living in a city with high HIV transmission rates.

Inclusion criteria. All sexually active adolescents and young adults aged 18 to 24 years with self-report of testing HIV negative within the previous 6 months, residents of Soroti City at the time of study who attended adolescent and youth-friendly services at the selected health facilities.

Exclusion criteria. Adolescents and young adults aged 18 to 24 years who were critically or mentally ill were excluded from the study.

Sampling procedure. Purposive sampling was done to select the 4 health facilities that provide adolescent and youth-friendly services, including PrEP, to the eligible PrEP candidates. The 421 study participants who had come to receive healthcare services from study sites were selected using a consecutive sampling approach till a predetermined sample size based on the population served was reached per site.

Data collection procedure. The data was collected through guided face to face interviews using semi-structured questionnaires in a simple private room by the trained research assistants (RAs).

The Primary outcome was PrEP utilization measured as the proportion of participants who have ever used PrEP for HIV prevention.

Independent variables included sociodemographic variables such as age, gender and education. Sociocultural factors included stigma, religious beliefs, and peer influence. Health system-related factors assessed included the accessibility and availability of PrEP services.

The data collected were entered into EpiData version 4.6, cleaned for missing data, duplicates, and unsound entries. The data was then exported to Statistical Package for the Social Sciences (SPSS) version 27 for further analysis. Numerical data were summarized using mean and standard deviations for Continuous variables and into frequencies, percentages, and proportions for categorical variables. We then conducted a bivariate analysis using a binary Logistic regression Results were reported as adjusted odds ratios with their corresponding 95% confidence intervals (CIs). A p-value < 0.05 was considered statistically significant.

The mean age of respondents was 21.60 years (SD = 2.12). Most participants were Christians (91.7%, n = 386), and 66.3% (n = 279) were out of school. The majority (67%, n = 282) of the study participants were unemployed (Table 1).

The prevalence of PrEP utilization among adolescents and young adults in Soroti City was 14.5% (95% CI: 11.4–18.2, n = 61).

At Multivariate analysis the factors found to be significantly associated with PrEP utilization included Gender, HIV risk awareness, having stigma and having no social support and peer influence (Table 2).

In this study, we aimed to assess the utilization of PrEP and associated factors among adolescents and young adults in a city with more than twice the national HIV prevalence[1,7]. We found low utilization of PrEP at only 14.5%. PrEP utilization in Sub-Saharan Africa (SSA) is generally low and similar to our findings among this population as reported at 15% in a systematic review among adults and adolescent girls, and young women in Africa [11,12].

We also found that females were 55% less likely to utilize PrEP compared to males. This is in line with findings in Eastern, Southern, and Western Africa[6]. This could be due to misinformation about PrEP among adolescent and young girls, such as the belief that PrEP leads to birth defects and infertility, and gender-related barriers, like limited autonomy [13,14].

In our study, participants who had stigma associated with PrEP were more likely to have low utilization. This finding aligns with studies conducted in Kenya, Uganda, and South Africa [15–17]. These results underscore the need for continuous health education to address the negative attitudes and to strengthen PrEP health promotion campaigns for high-risk populations.

Individuals without peer influence and social support were 88% less likely to use PrEP than those with peer and social support. This finding underpins the importance of peers in providing support such as health information among adolescents and young people as earlier on observed in Eastern Uganda[18]. It is therefore important to involve competent peers to improve the uptake of PrEP in this sub-population.

Reduced HIV risk awareness was associated with reduced PrEP utilization. This highlights the need for continuous health education for adolescents and young people to be aware of their HIV risk engaged in prevention initiatives.