Abstract
BACKGROUND: Knowledge, attitudes, and practices (KAPs) regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) non-pharmaceutical interventions (NPIs) may differ among populations with health vulnerabilities. AIM: To examine COVID-19 KAPs among Kenyan adolescents and adults with behavioural vulnerability to HIV. SETTING: This study was conducted in Kericho and Homa Bay, Kenya. METHODS: From December 2021 to April 2023, we enrolled participants without HIV aged 14-55 years who reported recent sexually transmitted infection, injection drug use, transactional sex, condomless sex, and/or anal sex with males. A self-administered questionnaire captured sociodemographic data and KAPs. Multivariable robust Poisson regression with purposeful variable selection was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors associated with NPI practices. RESULTS: Among 399 participants (median age 22 years [interquartile range 19-24]), 317 (79.4%) were female. Participants during the Omicron-variant wave were less likely to meet outdoors (PR = 0.85 [95% CI: 0.73-0.98]), reduce shopping (PR = 0.83 [95% CI: 0.73-0.96], and avoid crowds (PR = 0.81 [95% CI: 0.71-0.93]). Believing that mask-wearing prevents SARS-CoV-2 was associated with less meeting outdoors (PR = 0.44 [95% CI: 0.27-0.73]) and reducing shopping (PR = 0.48 [95% CI: 0.31-0.76]), while believing that handwashing prevents SARS-CoV-2 was associated with less crowd avoidance (PR = 0.73 [95% CI: 0.60-0.89]). Perceiving widespread community face mask use was associated with reduced shopping (PR = 1.12 [95% CI: 1.02-1.23]). CONCLUSION: Belief in personal NPIs (mask-wearing and handwashing) was associated with decreased practice of social NPIs (meeting outdoors, reducing shopping, and avoiding crowds). CONTRIBUTION: Future public health strategies for pandemic response should anticipate risk compensation.