Knowledge gaps in HIV prevention strategies among young adults attending university-based rapid testing events: a public health cross-sectional study

OBJECTIVES: Despite advances in antiretroviral therapy and biomedical HIV prevention, awareness of modern prevention strategies remains limited. Rapid HIV testing initiatives can support early diagnosis while providing an opportunity to assess prevention awareness and facilitate engagement with services. STUDY DESIGN: We conducted a cross-sectional study of five free university-based rapid HIV testing events in Rome (Italy) between August and December 2025. METHODS: Adults aged 18 years or older were offered rapid HIV testing and invited to complete an anonymous self-administered questionnaire on sociodemographic characteristics, sexual behaviors, HIV testing history, and awareness of prevention strategies. Multivariable logistic regression models were used to identify factors independently associated with awareness of pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), treatment as prevention (TasP), and the Undetectable = Untransmittable (U=U) message. RESULTS: Overall, 518 rapid HIV tests were performed, and 389 questionnaires were included in the analysis; all tests were nonreactive. Although most participants reported basic HIV knowledge, awareness of biomedical prevention strategies was substantially lower: 39.6% were aware of PrEP, 28.8% were aware of PEP, and 17.0% recognized the meaning of U=U. Awareness of PrEP, PEP, and U=U clustered within the same participants and was associated with prior HIV testing, whereas no meaningful association emerged with general HIV knowledge. The younger age was inversely associated with PrEP awareness. Post-event contacts with the clinic were numerically higher, but the difference was not statistically significant. CONCLUSIONS: Integrating context-sensitive education into rapid testing initiatives may help broaden prevention literacy and encourage earlier engagement with testing and care.