Date of Conferral

1-22-2026

Date of Award

January 2026

Degree

Ph.D.

School

Health Sciences

Advisor

Harrison Ndetan

Abstract

Young women in Uganda face disproportionately high HIV risk compared to the general population. While pre-exposure prophylaxis (PrEP) demonstrates proven effectiveness, poor uptake and nonadherence limit its potential impact. This study examined the relationship between perceived HIV susceptibility, PrEP benefits, behavioral risk factors, service delivery models, and PrEP uptake and continuity among young women aged 15–24 in Uganda, guided by the health belief model. Data were ed from surveillance records at Mulago National Referral Hospital’s STI clinic from January 2024 to September 2025. Of N=23,765 young women screened (median age 21 years; 98.9% single or separated; 48.7% with primary education), 99.5% accessed screening through community-based services. However, only 3,958 (16.7%) initiated PrEP. Perceived HIV susceptibility was negatively associated with PrEP uptake (aOR = 0.60, 95% CI 0.55–0.65). All sociodemographic characteristics except marital status were significantly associated with PrEP uptake. HIV and STI incidence rates were 1.10 (95% CI 0.71–1.71) and 7.52 (95% CI 6.35–8.92) per 100 person-years at-risk, respectively. STI incidence was 61% (aIRR = 1.61, 95% CI 1.14-2.29) higher among participants with post-primary education than among those with primary education or less. Participants who were not married had a three-fold increase (aIRR = 3.25, 95% CI 1.32-7.99) in HIV incidence compared to those who were married. Only 117 (25%) were active on PrEP after 12 months, equivalent to a continuity rate of 6.48 (95% CI, 5.41 –7.77) persons per 100 person-years. The identified gaps indicate the need to strengthen PrEP adherence support and address misconceptions about HIV risk among young women in Uganda.

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