An educational intervention improves HIV competence of secondary school staff in Uganda: a stepped wedge cluster randomized trial

HIV competence, encompassing knowledge, skills, attitudes, and practices to prevent, manage, and reduce HIV impact, is critical for meeting young people's HIV prevention and care needs. This study evaluated the effect of the Community of Practice on HIV (CoP-HIV) educational intervention on staff HIV competence and prevention knowledge in Ugandan schools, where HIV prevalence is rising among youth. Using a stepped-wedge cluster randomized trial, the intervention was implemented across six schools in western Uganda (March-September 2023). It included two eight-hour workshops and a handbook on HIV prevention and care, delivered over one month per school. Data were collected from 174 randomly selected staff (mean age 34.9 years, 49.9% female) at four points: baseline, T1, T2, and T3. Linear mixed-effects modeling showed significant improvements in HIV competence (20-point increase; β = 19.87, SE = 1.02, p < 0.05) and prevention knowledge (5.5-point increase; β = 5.5, SE = 0.97, p < 0.05). Competence varied by school and time, while prevention knowledge improved consistently. The CoP-HIV intervention enhanced staff capacity, demonstrating potential for broader school-based HIV control. Despite pragmatic design strengths, short follow-up and reliance on self-reported data were limitations. Longer-term studies should examine effects on students' preventive behaviors and well-being.