TY - JOUR
T1 - COVID-19 knowledge, attitudes, and practices among people vulnerable to HIV in Uganda
T2 - A cross-sectional cohort analysis
AU - for the Multinational Observational Cohort of HIV and other Infections (MOCHI) Study Group
AU - Kasule, Job
AU - Tonzel, Julius L.
AU - Burns, Natalie
AU - Hamby, Tyler
AU - Ying, Roger
AU - Mirembe, Grace
AU - Nakabuye, Immaculate
AU - Kibuuka, Hannah
AU - Yacovone, Margaret
AU - Mwesigwa, Betty
AU - Crowell, Trevor A.
AU - Tonzel, Julius
AU - Charles, Curtisha
AU - Scheibler, Linsey
AU - Mebrahtu, Tsedal
AU - Liles, Brian
AU - Boron, Bryce
AU - Fan, Ying
AU - Li, Qun
AU - Reynolds, Alexus
AU - Schluck, Glenna
AU - Eller, Leigh Anne
AU - Imbach, Michelle
AU - Peterson, Jacob
AU - Walling, Addison
AU - Qian, Haoyu
AU - Crowell, Trevor
AU - Ake, Julie
AU - Adjei, Paul
AU - Cebula, Brennan
AU - Tonzel, Julius
AU - Naluyima, Prossy
AU - Wasswa, Ronald Ephraim
AU - Nalunga, Justine
AU - Wasswa, Emmanuel
N1 - Publisher Copyright:
© 2026 Public Library of Science. All rights reserved.
PY - 2026/3
Y1 - 2026/3
N2 - Background People with behavioral vulnerability to HIV face barriers to healthcare engagement that may impede uptake of non-pharmaceutical and other interventions to prevent COVID-19. Understanding COVID-19 knowledge, attitudes, and practices in this population can inform disease prevention efforts during future pandemics. Materials and methods From October 2022 to September 2024, we enrolled participants aged 14–55 years without HIV who endorsed recent sexually transmitted infection, injection drug use, transactional sex, condomless sex, and/or anal sex with male partners. At enrollment, we collected socio-behavioral data, including assessments of COVID-19 knowledge, attitudes, and practices. Robust Poisson regression with purposeful variable selection was used to estimate prevalence ratios with 95% confidence intervals for factors associated with COVID-19 preventive practices. Results Among 418 participants, 228 (56.9%) were female, the median age was 21 years (interquartile range 19−24), and 362 (84.9%) reported sex work. Knowledge about SARS-CoV-2 transmission routes was high (95.4%) but lower for the consequences of genetic variants (48.5%−69.7%) and possibility for asymptomatic infection or transmission (66.7%−80.8%). Handwashing was practiced by 90.8% of participants in the preceding month, whereas mask-wearing (76.5%), avoiding symptomatic people (73.7%), and any history of COVID-19 vaccination (46.9%) were less prevalent. Males were more likely to report avoiding symptomatic people (adjusted prevalence ratio 1.16 [95% confidence interval 1.03–1.31]) and COVID-19 vaccination (1.30 [1.05–1.60]). Enrollment during the BQ.1/BQ.1.1 Omicron wave was associated with less mask-wearing (0.81 [0.67–0.99]) but more vaccination (1.59 [1.29–1.95]). Discussion We observed variable COVID-19 knowledge and attitudes among Ugandan adolescents and adults with little impact on COVID-19 preventive practices. Efforts to address suboptimal uptake of disease preventive practices during this and future disease outbreaks will require more than just improving knowledge.
AB - Background People with behavioral vulnerability to HIV face barriers to healthcare engagement that may impede uptake of non-pharmaceutical and other interventions to prevent COVID-19. Understanding COVID-19 knowledge, attitudes, and practices in this population can inform disease prevention efforts during future pandemics. Materials and methods From October 2022 to September 2024, we enrolled participants aged 14–55 years without HIV who endorsed recent sexually transmitted infection, injection drug use, transactional sex, condomless sex, and/or anal sex with male partners. At enrollment, we collected socio-behavioral data, including assessments of COVID-19 knowledge, attitudes, and practices. Robust Poisson regression with purposeful variable selection was used to estimate prevalence ratios with 95% confidence intervals for factors associated with COVID-19 preventive practices. Results Among 418 participants, 228 (56.9%) were female, the median age was 21 years (interquartile range 19−24), and 362 (84.9%) reported sex work. Knowledge about SARS-CoV-2 transmission routes was high (95.4%) but lower for the consequences of genetic variants (48.5%−69.7%) and possibility for asymptomatic infection or transmission (66.7%−80.8%). Handwashing was practiced by 90.8% of participants in the preceding month, whereas mask-wearing (76.5%), avoiding symptomatic people (73.7%), and any history of COVID-19 vaccination (46.9%) were less prevalent. Males were more likely to report avoiding symptomatic people (adjusted prevalence ratio 1.16 [95% confidence interval 1.03–1.31]) and COVID-19 vaccination (1.30 [1.05–1.60]). Enrollment during the BQ.1/BQ.1.1 Omicron wave was associated with less mask-wearing (0.81 [0.67–0.99]) but more vaccination (1.59 [1.29–1.95]). Discussion We observed variable COVID-19 knowledge and attitudes among Ugandan adolescents and adults with little impact on COVID-19 preventive practices. Efforts to address suboptimal uptake of disease preventive practices during this and future disease outbreaks will require more than just improving knowledge.
UR - https://www.scopus.com/pages/publications/105031641060
U2 - 10.1371/journal.pone.0343507
DO - 10.1371/journal.pone.0343507
M3 - Article
C2 - 41774742
AN - SCOPUS:105031641060
SN - 1932-6203
VL - 21
JO - PLoS ONE
JF - PLoS ONE
IS - 3 March
M1 - e0343507
ER -