COVID-19 Knowledge, Attitudes, and Practices among People with and Without HIV in Four Countries in Sub-Saharan Africa

Background: Pandemic preparedness requires understanding knowledge, attitudes, and practices related to disease prevention. We characterized these factors in a vulnerable population during the COVID-19 pandemic across four sub-Saharan African countries to inform outbreak responses. Methods: The African Cohort Study (AFRICOS) enrolls people with and without HIV aged ≥15 years in Kenya, Nigeria, Tanzania, and Uganda. From May 2022 to October 2023, we collected self-reported past-month preventive practices, attitudes toward preventive measure effectiveness, perceptions of community preventive measure use, and concern for personal infection and community spread. Purposeful variable selection using Robust Poisson regression with prevalence ratios (PR) was used to test associations with each preventive practice. Results: Among 2,521 participants (57% female, median age 43.2 [interquartile range 32-51.5] years), 70% reported mask wearing, 53% social distancing, and 35% avoiding crowds. Negative attitudes toward social distancing effectiveness were associated with lower preventive measure use (mask wearing: PR=0.76, 95% CI [0.63-0.91]; social distancing: 0.42 [0.30-0.59]; avoiding crowds: 0.29 [0.18-0.35]) as was having little-no concern about personal infection and community spread (mask wearing: 0.77, [0.70-0.85]; social distancing: 0.54 [0.45-0.64]; avoiding crowds: 0.45 [0.35-0.57]). Perceptions of lower community social distancing were associated with higher preventive measure use (mask wearing: 1.12 [1.06-1.18]; social distancing: 1.41 [1.29-1.54]; avoiding crowds: 1.66 [1.41-1.97]) as were perceptions of lower community mask wearing (mask wearing: 1.21 [1.15-1.27]; social distancing: 1.21 [1.10-1.33]; avoiding crowds: 1.24 [1.04-1.47]). Conclusion: Based on these findings, future efforts to enhance uptake of preventive measures should prioritize improving perceptions of their effectiveness and understanding of infection risks.