Knowledge, attitudes and practices related to SARS-CoV-2 prevention in Kenya

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.

To examine COVID-19 KAPs among Kenyan adolescents and adults with behavioural vulnerability to HIV.

This study was conducted in Kericho and Homa Bay, Kenya.

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.

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]).

Belief in personal NPIs (mask-wearing and handwashing) was associated with decreased practice of social NPIs (meeting outdoors, reducing shopping, and avoiding crowds).

Future public health strategies for pandemic response should anticipate risk compensation.