KNOWLEDGE, ATTITUDES, AND FACTORS ASSOCIATED WITH HIV PRE AND POST
EXPOSURE PROPHYLAXIS AMONG HEALTH SCIENCE STUDENTS AT DEBARK
UNIVERSITY AND FEDEL COLLEGE, NORTHWEST ETHIOPIA 2026
A RESEARCH PROPOSAL SUBMITTED TO DEPARTMENT OF NURSING, COLLEGE OF
HEALTH SCIENCE, DEBARK UNIVERSITY IN PARTIAL FULFILMENT OF THE
REQUIREMENT FOR BACHELOR OF SCIENCE DEGREE IN NURSING
ACKNOWLEDGEMENTS
First and foremost, I would like to express my deepest gratitude to the Almighty God for
granting me strength, health, and guidance throughout this research work.
My sincere appreciation goes to my advisor, [Insert Advisor’s Name], for their continuous
support, constructive feedback, and valuable guidance in preparing this research proposal.
I am also thankful to the Department of Public Health, College of Health and Medical Sciences,
Haramaya University, for giving me the opportunity and support to conduct this study.
Special thanks are extended to the management and staff of Hiwot Fana Comprehensive
Specialized University Hospital and Jugol Hospital for their cooperation and assistance during
ACRONYMS
Abstract
Background:
Human Immunodeficiency Virus (HIV) continues to pose a global health challenge, with young
people and healthcare workers particularly vulnerable. Evidence from Brazil, Ethiopia, China,
Kenya, and Australia consistently shows gaps in awareness, knowledge, and utilization of HIV
pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). For example, only 27.8%
of Brazilian university students demonstrated adequate knowledge of prophylaxis (Lima et al.,
2024; Matos et al., 2021), while Ethiopian health professionals reported inadequate knowledge
and attitudes toward PEP and PrEP (Shamil et al., 2021; Zimamu et al., 2024).
Studies in China found high knowledge but limited service provision (Hu et al., 2024), and
international evidence confirmed barriers such as stigma, poor training, and systemic constraints
(Sousa et al., 2021; Schluck et al., 2025; Warzywoda et al., 2024; Spence et al., 2025). These
findings highlight the urgent need to assess knowledge, attitudes, and associated factors among
health science students in Ethiopia.
Objectives:
to assess knowledge, attitudes, and factors associated with HIV pre- and post-exposure
prophylaxis among health science students at Debark University and Fedel College, Northwest
Ethiopia.
Methods and Materials:
A cross-sectional study design will be employed. Structured questionnaires adapted from
validated instruments in prior studies (Lima et al., 2024; Shamil et al., 2021; Hu et al., 2024) will
be used to collect data. Descriptive statistics will summarize knowledge and attitudes, while
regression models will identify sociodemographic, educational, and behavioral predictors.
Work Plan:
Budget Plan
Keywords:
Knowledge, Attitudes, and Factors Associated with HIV Pre and Post Exposure Prophylaxis
Among Health Science Students at Debark University and Fedel College, Northwest Ethiopia.
Abstract
Background: Human Immunodeficiency Virus (HIV) continues to pose a global health
challenge, with young people and healthcare workers particularly vulnerable. Evidence from
Brazil, Ethiopia, China, Kenya, and Australia consistently shows gaps in awareness, knowledge,
and utilization of HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
For example, only 27.8% of Brazilian university students demonstrated adequate knowledge of
prophylaxis (Lima et al., 2024; Matos et al., 2021), while Ethiopian health professionals reported
inadequate knowledge and attitudes toward PEP and PrEP (Shamil et al., 2021; Zimamu et al.,
2024). Studies in China found high knowledge but limited service provision (Hu et al., 2024),
and international evidence confirmed barriers such as stigma, poor training, and systemic
constraints (Sousa et al., 2021; Schluck et al., 2025; Warzywoda et al., 2024; Spence et al.,
2025). These findings highlight the urgent need to assess knowledge, attitudes, and associated
factors among health science students in Ethiopia.
Objectives: This study aims to assess knowledge, attitudes, and factors associated with HIV pre-
and post-exposure prophylaxis among health science students at Debark University and Fedel
College, Northwest Ethiopia.
Methods and Materials: A cross-sectional study design will be employed. Structured
questionnaires adapted from validated instruments in prior studies (Lima et al., 2024; Shamil et
al., 2021; Hu et al., 2024) will be used to collect data. Descriptive statistics will summarize
knowledge and attitudes, while regression models will identify sociodemographic, educational,
and behavioral predictors.
Work Plan: The work plan includes instrument development, pilot testing, training of data
collectors, data collection, statistical analysis, and dissemination of findings. Results will be
shared with academic institutions, local health offices, and stakeholders to inform targeted
interventions.
Budget Plan: The budget will cover training sessions, printing of questionnaires, data collection
logistics, statistical software, and dissemination workshops. Resources will be allocated
efficiently to ensure validity and reliability of findings while maintaining cost-effectiveness.
Keywords: Knowledge, Attitudes, and Factors Associated with HIV Pre and Post Exposure
Prophylaxis Among Health Science Students at Debark University and Fedel College, Northwest
Ethiopia.
1. INTRODUCTION
1.1 Background
Human Immunodeficiency Virus (HIV) remains a pressing global health challenge,
disproportionately affecting young people and healthcare workers due to occupational and
behavioral exposures. The theoretical paradigm underpinning HIV prevention emphasizes
biomedical interventions such as pre-exposure prophylaxis (PrEP) and post-exposure
prophylaxis (PEP), which are proven to reduce transmission risk when used appropriately.
Empirical evidence demonstrates persistent gaps in awareness and utilization. In Brazil, only
27.8% of university students showed adequate knowledge of prophylaxis, with age, health-
related fields of study, and prior HIV testing influencing knowledge levels (Lima et al., 2024;
Matos et al., 2021). Among people living with HIV in Brazil, awareness of PrEP and PEP was
low, undermining secondary prevention (Sousa et al., 2021). Ethiopian studies revealed
inadequate knowledge and attitudes among health professionals in Harari andDebretabor, linked
to poor training and limited practice (Shamil et al., 2021; Zimamu et al., 2024). In China,
healthcare workers demonstrated high knowledge and supportive attitudes but limited service
provision, reflecting systemic barriers (Hu et al., 2024). International findings from Kenya and
Australia further confirmed limited awareness and access, with stigma and healthcare system
constraints as major determinants (Schluck et al., 2025; Warzywoda et al., 2024; Spence et al.,
2025).
Problem Statement
Despite global and national efforts, knowledge and attitudes toward HIV prophylaxis remain
insufficient among key populations. The magnitude of the problem is evident less less than one-
third of Brazilian students demonstrated adequate knowledge (Lima et al., 2024), Ethiopian
health professionals reported poor preparedness (Shamil et al., 2021; Zimamu et al., 2024), and
systemic barriers limited service provision in China (Hu et al., 2024). The distribution of these
gaps spans botheveloped and developing contexts, highlighting severity and universal
consequences. Insufficient knowledge and negative attitudes compromise HIV prevention,
increase occupational risk, and hinder progress toward Sustainable Development Goals. Current
evidence is inadequate to fully address the problem among Ethiopian health science students,
necessitating localized research.
Justification of the Study
Previous attempts to address HIV prevention through awareness campaigns and training have
achieved limited success. While some studies reported improved knowledge in health-related
fields (Matos et al., 2021), others highlighted persistent gaps due to poor training, stigma, and
systemic challenges (Sousa et al., 2021; Schluck et al., 2025). The originality of this study lies
in its focus on health science students at Debark University and Fedel College, a population that
will become frontline healthcare providers. By integrating theoretical knowledge, empirical
evidence, and robust methodological constructs, this research will generate context-specific
insights. It is justified by the need to strengthen HIV prevention strategies, improve
preparednessIt is justified by the need to strengthen HIV prevention strategies, improve
preparedness of future professionals, and contribute to national and global evidence.
Significance of the Study
the primary purpose of this study is to present evidence on knowledge, attitudes, and factors
associated with HIV prophylaxis among Ethiopian health science students. Practically, the
findings will inform targeted educational interventions, improve training curricula, and enhance
service delivery. For study subjects, results will increase awareness and preparedness; for service
providers and managers, they will guide resource allocation and training priorities;
forolicymakers, they will support evidence-based strategies to reduce HIV incidence.
Academically, the study will enrich empirical literature, validate methodological approaches, and
contribute to comparative global evidence. Ultimately, the results will strengthen HIV prevention
efforts and support Ethiopia’s progress toward achieving health-related Sustainable Development
Goals.
Literature Review
Overview
lobally, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are
recognized as evidence-based biomedical components of combined HIV prevention strategies.
Their cost-effectiveness is context-dependent, shaped by local HIV incidence, drug and program
costs, and anticipated effectiveness. Modeling studies suggest that offering PrEP where HIV
incidence exceeds approximately 3 per 100 person-years is often cost-saving, though its
prevention value extends beyond direct monetary calculations, contributing to reduced
transmission and broader public health gains (Libsuye et al., 2024, p. 3).
At the regional level, Brazil provides an instructive example. Despite PrEP and PEP being
formally integrated into the country’s combined prevention strategy and offered through the
public health system (SUS), uptake remains limited due to low knowledge among young
populations. A university-based study of 503 students revealed that only 27.83% demonstrated
“adequate” knowledge (≥13/16 correct responses). Predictors of better knowledge included
older age, enrollment in health-related courses, prior HIV rapid testing, and prior awareness of
prophylaxis. These findings highlight that even in settings where biomedical prevention tools are
accessible, sociodemographic and behavioral factors strongly influence awareness and uptake
(Lima et al., 2024, pp. 1, 4).
Moving to the local Ethiopian context, several cross-sectional studies among healthcare
workers and students reveal variable but generally suboptimal knowledge, attitudes, and
practices toward PrEP and PEP. At Debre Markos University, 36.1% of respondents had
inadequate knowledge and 30.2% displayed unfavorable attitudes; among those exposed to HIV
risk, only 43.3% initiated PEP, often after delays (Aschale et al., 2017, pp. 1, 5). In Debre
Tabor, awareness of PrEP was relatively high (84.8%), but detailed knowledge and training
were limited (only 53.1% had prior training). Attitudes were measured at ~68% favorable,
though authors judged this level insufficient for effective prevention (Libsuye et al., 2024, p. 8).
Similarly, in the East Gojjam zone, 55.7% of respondents demonstrated good knowledge and
60.2% expressed favorable attitudes. Training, guideline reading, and prior experience were
significantly associated with better knowledge and attitudes (Mekonnen et al., 2024, p. 1).
Integrated Knowledge–Attitude–Practice (KAP) findings (presented
together)
Across the reviewed literature, knowledge, attitudes, and practices (KAP) related to HIV
prophylaxis are measured with consistent though slightly varied operational definitions.
Knowledge is typically assessed by the proportion of correct responses on domain-specific
questions, with thresholds such as ≥70% correct or scoring above 12 out of 16 items used to
classify “adequate” knowledge (Aschale et al., 2017, p. 3; Lima et al., 2024, p. 1; Mekonnen et
al., 2024, pp. 4–5). Attitudes are measured using Likert-scale items, often dichotomized at the
mean or a predetermined cutoff to distinguish favorable from unfavorable orientations (Aschale
et al., 2017, p. 3; Mekonnen et al., 2024, pp. 4–5). Practice is assessed through self-reported
behaviors, including uptake of PEP, timing of initiation, regimen completion, and provider
behaviors such as PrEP counseling or prescription. Thresholds such as >70% “Yes” responses or
frequency scales are commonly applied to classify adequate practice (Aschale et al., 2017, p. 3;
Mekonnen et al., 2024, pp. 4–5).
When these measures are examined together, several integrated patterns emerge. First,
awareness of PrEP and PEP is consistently higher than actionable clinical knowledge. For
example, in Debre Tabor, 84.8% of healthcare workers reported awareness of PrEP, yet only
53.1% had received training, and many lacked regimen-specific knowledge such as correct
identification of TDF+3TC (Libsuye et al., 2024, p. 8). This distinction between general
awareness and detailed, actionable knowledge underscores the importance of structured training
and guideline dissemination.
Second, knowledge and attitudes are tightly linked. Across multiple studies, higher knowledge
scores predict more favorable attitudes, and conversely, favorable attitudes are associated with
better knowledge. In Debre Markos, knowledge was significantly associated with attitude
(p=0.001), while in East Gojjam, respondents with good knowledge were more likely to report
favorable attitudes (Aschale et al., 2017, p. 5; Mekonnen et al., 2024, p. 1). This reciprocal
relationship suggests that interventions targeting knowledge improvement may simultaneously
enhance attitudes, and vice versa.
Third, attitudes and practice are connected but mediated by systemic barriers. Favorable
attitudes increase the likelihood of appropriate practice, such as counseling, prescribing, or
prompt PEP initiation. However, positive attitudes alone do not guarantee correct practice. In
Debre Markos, despite some knowledge and favorable attitudes, timely PEP initiation and
completion were poor, reflecting institutional and access constraints (Aschale et al., 2017, p. 1).
Finally, there are persistent practice gaps despite knowledge and attitude gains. In Debre
Markos, only 43.3% of exposed healthcare workers used PEP, and 53.2% initiated PEP after
more han one hour. Even where knowledge existed about timing and duration, adherence and
prompt initiation were inadequate (Aschale et al., 2017, pp. 1, 5). This demonstrates that
knowledge and attitude are necessary but insufficient; systemic factors such as drug
availability, institutional protocols, and access pathways are critical determinants of
effective practice.s tudent population behaviors mirror knowledge deficits: In Brazil, students
who had undergone rapid HIV testing or who reported prior familiarity with PrEP/PEP had
higher knowledge scores, suggesting testing and counseling services act as knowledge gateways
that may shape attitudes/practices later(Lima et al., 2024, p. 1,4).
Accessibility factors
A consistent theme across the literature is that training and guideline access are modifiable
factors strongly associated with improved knowledge, attitudes, and practices (KAP). Evidence
from East Gojjam shows that training more than doubled the odds of favorable attitudes and was
significantly associated with better knowledge, while studies in Debre Tabor and Debre Markos
similarly recommend structured training to strengthen both knowledge and practice (Aschale et
al., 2017, p. 1; Libsuye et al., 2024, p. 8; Mekonnen et al., 2024, p. 1). Beyond training, the
availability of clear clinical guidelines at points of care is essential. In East Gojjam, reading
guidelines was directly associated with better attitudes and knowledge, underscoring the
importance of accessible, standardized guidance for translating conceptual awareness into correct
practice (Mekonnen et al., 2024, p. 1).
However, drug and service availability, alongside supply chain reliability, remain critical
determinants of practice. Provider perceptions of availability influence willingness to counsel or
prescribe prophylaxis. Even when conceptual awareness exists, limited knowledge about local
availability or regimen specifics reduces practical prescribing. For example, in Debre Tabor,
although many respondents knew PrEP was available, some could not correctly identify the
regimen, revealing how gaps in supply chain communication and clarity undermine effective use
(Libsuye et al., 2024, p. 8).
The functioning of health system processes and occupational pathways also shapes outcomes.
PEP effectiveness depends on rapid workplace reporting and immediate drug access. Delays in
initiation observed in Debre Markos highlight failures in workplace systems—such as reporting
mechanisms, drug availability at hand, and timely counseling—that prevent knowledge and
favorable attitudes from translating into correct practice (Aschale et al., 2017, p. 1).
At the policy level, cost and programmatic prioritization influence decisions about offering PrEP.
While cost-effectiveness analyses suggest PrEP is most efficient in higher-incidence settings, the
Debre Tabor study cautions that monetary considerations should not be the sole determinant. The
non-monetary value of HIV prevention—including reduced transmission, improved quality of
life, and broader public health benefits—must be factored into programmatic choices (Libsuye et
al., 2024, p. 3).
Finally, stigma and service acceptability remain pervasive barriers. Stigma within healthcare
settings reduces access and engagement with prevention services, undermining both testing and
prophylaxis uptake. Background literature cited in student and healthcare worker studies
emphasizes that stigma discourages individuals from seeking prophylaxis even when knowledge
and attitudes are favorable, thereby weakening the overall effectiveness of prevention strategies
(Costa et al., 2021, p. 16; Lima et al., 2024, pp. 2–3).
Prevention factors
evidence across multiple studies confirms that PrEP and PEP are clinically effective when used
according to established guidelines. PrEP regimens most commonly include tenofovir disoproxil
fumarate (TDF) plus lamivudine (3TC), as noted in provider questionnaires, while PEP is
effective only if initiated promptly after exposure and completed for the recommended duration
(Aschale et al., 2017, p. 3; Mekonnen et al., 2024, pp. 4–5). These findings underscore the
importance of both regimen accuracy and adherence to timing protocols in ensuring prophylactic
effectiveness.
From a policy perspective, programmatic targeting and prioritization are essential. Offering PrEP
in populations where HIV incidence exceeds 3 per 100 person-years is often cost-saving, but
implementation must be guided by local epidemiology and feasibility. The Debre Tabor study
highlights that while cost-effectiveness is a critical consideration, monetary calculations should
not overshadow the broader non-monetary value of HIV prevention, including reduced
transmission and improved quality of life (Libsuye et al., 2024, p. 3).
Effective implementation also depends on integration with existing health services. Embedding
PrEP and PEP into antiretroviral therapy (ART), voluntary counseling and testing (VCT), and
prevention of mother-to-child transmission (PMTCT) services improves provider familiarity and
uptake. Providers working in these units often demonstrate better knowledge and are key targets
for training and implementation efforts, suggesting that integration strengthens both service
delivery and professional competence (Mekonnen et al., 2024, p. 1).
Beyond biomedical and system factors, psychosocial and lifestyle determinants intersect directly
with knowledge, attitudes, and practices (KAP). Among students, older age, enrollment in health
courses, prior HIV rapid testing, and not having recent sexual activity were associated with
higher knowledge, indicating that life stage, education, and engagement with testing services
shape awareness and attitudes (Lima et al., 2024, p. 4). Similarly, providers’ personal behaviors
influence their professional KAP: in East Gojjam, those who reported “good sexual behavior”
and who practiced HIV testing themselves were more likely to have good knowledge, suggesting
that personal health practices reinforce professional engagement with prevention services
(Mekonnen et al., 2024, p. 8).
Finally, stigma, fear, and prevailing social norms remain powerful barriers. Fear of stigma
reduces willingness to seek testing and prophylaxis, even when information is available. Students
in Brazil reported stigma and taboos as obstacles to adopting prevention measures, reflecting
how social pressures undermine biomedical interventions (Lima et al., 2024, pp. 2–3). This
highlights the need for stigma reduction strategies alongside technical training and service
integration to ensure that knowledge and favorable attitudes translate into consistent practice.
Lifestyle factor
particularly sexual partnerships and testing history—play a central role in shaping exposure to
information and the uptake of HIV prophylaxis. These behavioral and experiential factors
intersect directly with knowledge, attitudes, and practices (KAP), influencing how students
perceive risk and engage with prevention services.
Evidence from Brazilian university settings shows that students’ personal behaviors, such as
sexual activity patterns and prior HIV testing, are strongly associated with their knowledge
levels. For instance, older students, those enrolled in health courses, and those with prior rapid
testing experience demonstrated significantly higher knowledge of PrEP and PEP. Conversely,
students reporting recent sexual activity without testing were less likely to have adequate
knowledge, suggesting that life stage, academic orientation, and engagement with testing
services are key determinants of awareness and preparedness (Lima et al., 2024, pp. 2–3).
These findings underscore the importance of targeting university environments as critical sites
for awareness campaigns and accessible services. Universities represent concentrated
populations of young adults who are both at risk of HIV exposure and positioned to become
future health professionals. Embedding prophylaxis education and services within campus health
systems not only increases accessibility but also normalizes engagement with HIV prevention,
reducing stigma and taboos that often deter students from seeking care.
By integrating awareness campaigns into student health services, linking prophylaxis education
with routine HIV testing, and addressing lifestyle-related risk behaviors, institutions can create a
supportive environment where knowledge translates into practice. This approach ensures that
student lifestyles are not barriers but entry points for effective HIV prevention strategies,
aligning personal experiences with professional training and public health goals.
Determinant factors
The evidence from the uploaded studies demonstrates that knowledge, attitudes, and practices
(KAP) toward HIV prophylaxis are shaped by a constellation of socio-demographic,
occupational, and structural determinants, each intersecting to influence outcomes.
Sociodemographic factors consistently predict knowledge and attitudes. Among students, older
age (>24 years), enrollment in health courses, family income, campus location, and prior HIV
testing history were associated with higher knowledge levels (Lima et al., 2024, p. 4). Among
providers, male sex, longer service years (≥10), professional role, and higher education level
were linked to better knowledge and attitudes in East Gojjam and Debre Markos (Aschale et al.,
2017, p. 5; Mekonnen et al., 2024, p. 1). These findings highlight how both life stage and
professional experience shape preparedness for prophylaxis use.
Occupational and educational determinants further reinforce these patterns. Providers
working in ART, VCT, and PMTCT units, those with prior training, and those who had read
guidelines consistently demonstrated stronger knowledge and more favorable attitudes.
Physicians in Debre Markos stood out, with 95.2% reporting adequate knowledge, underscoring
the role of professional specialization and exposure to HIV services in shaping competency
(Aschale et al., 2017, p. 5).
t the structural level, workplace systems and institutional policies determine whether
knowledge and attitudes translate into effective practice. The availability of PEP medications,
clear reporting pathways, and supply chain integrity are critical. Failures in these systems—such
as delays and incomplete use of PEP in Debre Markos—illustrate how structural weaknesses
undermine timely initiation and completion, even when providers possess adequate knowledge
and favorable attitudes (Aschale et al., 2017, p. 1). Despite these insights, the uploaded studies
reveal several gaps and limitations. Most are cross-sectional, limiting causal inference and the
ability to assess intervention effects over time (Aschale et al., 2017, p. 1; Lima et al., 2024, p. 1;
Mekonnen et al., 2024, p. 1). Evidence is geographically concentrated in Ethiopian health
facilities and one Brazilian university, leaving key populations such as MSM, sex workers, and
transgender individuals underrepresented (Lima et al., 2024, pp. 2–3; Mekonnen et al., 2024, p.
1). Measurement heterogeneity—different KAP instruments and cutoffs (≥70% vs. >12/16)—
complicates direct comparisons (Aschale et al., 2017, p. 3; Lima et al., 2024, p. 1; Mekonnen et
al., 2024, pp. 4–5). Moreover, there is limited evidence on real-world PrEP uptake, long-term
adherence, or post-intervention improvements in prescribing behavior, and insufficient
qualitative depth to fully capture how stigma and psychosocial dynamics obstruct uptake (Lima
et al., 2024, pp. 2–3). From this synthesis, several actionable implications emerge. Training and
guideline dissemination are repeatedly shown to be high-yield interventions, strongly
associated with better knowledge and more favorable attitudes, and necessary preconditions
for correct practice such as prescribing, counseling, and timely PEP initiation (Libsuye et al.,
2024, p. 8; Mekonnen et al., 2024, p. 1). Yet systems and access matter equally: facilities must
ensure immediate availability of PEP, clear reporting procedures, and visible guidelines at points
of care, otherwise knowledge and attitude gains will not translate into consistent practice
(Aschale et al., 2017, p. 1; Libsuye et al., 2024, p. 8). Targeted awareness for young people and
students is also required, as the Brazilian study demonstrates low knowledge among university
populations, making campuses critical settings for combined prevention education, rapid
testing, and linkage to services (Lima et al., 2024, pp. 1–3). Addressing stigma and psychosocial
barriers is equally vital; reducing discrimination in health services and embedding
stigma-reduction into awareness campaigns and HCW training will improve acceptability and
uptake (Costa et al., 2021, p. 16; Lima et al., 2024, pp. 2–3).
Recommendations for policymakers and program managers are clear: prioritize training
programs for all cadres of HCWs on PrEP/PEP regimens, eligibility, monitoring, and counseling;
ensure clinical guidelines are accessible and promoted in ART/VCT/PMTCT units (Libsuye et
al., 2024, p. 8; Mekonnen et al., 2024, p. 1); strengthen workplace systems for PEP with
immediate drug access, simple reporting, and follow-up to minimize delays (Aschale et al., 2017,
p. 1); integrate university-based HIV education and rapid testing campaigns with referral
pathways to PrEP and PEP services (Lima et al., 2024, pp. 1–3); and include stigma-reduction
interventions in training and outreach (Costa et al., 2021, p. 16). For researchers, longitudinal
and implementation studies, expansion to key populations, and mixed-methods approaches
exploring psychosocial barriers are essential next steps.
Concluding statement: The uploaded articles present consistent evidence that awareness of
PrEP and PEP exists in many settings, but detailed, actionable knowledge and appropriate
practices remain uneven. Knowledge and attitudes are interdependent and strongly influenced by
training, guideline access, professional experience, and workplace systems, while psychosocial
factors such as stigma and individual behavioral contexts further shape uptake. To translate KAP
gains into effective prevention, programs must combine provider training, accessible guidelines,
rapid PEP delivery systems, accessible PrEP services targeted to high-risk groups, and
stigma-reduction interventions—coupled with longitudinal research to measure impact.