Community Perspectives and Behavior Change Strategies for Integrated Long-Acting Reversible Contraception and...

HIV incidence among adolescent girls and young women (AGYW) aged 15-24 years in Eastern and Southern Africa remains unacceptably high. Unprotected sex increases the risk of HIV and other sexually transmitted infections and unintended pregnancies, reflecting an unmet need for effective contraception among AGYW. Long-acting injectable preexposure prophylaxis (LAI-PrEP) and long-acting reversible contraception (LARC) offer effective, durable protection against HIV and unintended pregnancy. However, uptake and persistence remain suboptimal due to low awareness, fear of side effects, stigma, limited decision-making autonomy, and poor integrated reproductive health and HIV prevention services. Evidence on community-driven and behaviorally informed strategies to support integrated rollout and uptake of LAI-PrEP and LARC among AGYW in Uganda remains limited.

The study aims to determine the preferences and willingness of AGYW in Uganda to use LARC and LAI-PrEP, and characterize stakeholder perceptions, practices, and social norms that may influence adoption of integrated LARC and LAI-PrEP services. It applies the Capability, Opportunity, Motivation-Behavior (COM-B) model to identify facilitators and barriers to uptake and adherence.

This mixed methods implementation science study, guided by the COM-B model and the Behavior Change Wheel (BCW), will be conducted in 3 Kampala Capital City Authority clinics to generate evidence and co-design community-driven strategies supporting integrated LARC and LAI-PrEP uptake among AGYW. The study will proceed in three stages: (1) structured surveys with 220 AGYW to assess determinants of uptake and willingness to use integrated services, (2) focus group discussions with 30 AGYW and in-depth interviews with 20 key informants to explore perceptions, preferences, and barriers, and (3) participatory co-design of behavior change strategies. Survey data will be analyzed using descriptive and multivariable regression methods, while qualitative data will undergo reflexive thematic analysis guided by Braun and Clarke. Findings will be integrated using a convergent mixed methods approach through triangulation and joint displays to identify factors influencing implementation of integrated LARC and LAI-PrEP services.

The study was funded in February 2026. Ethical approval was obtained from the Joint Clinical Research Centre Research Ethics Committee (JCRC IRB/EC; JCRC-2025-143), Kampala Capital City Authority (DPHE/KCCA/1302/01), and the Uganda National Council for Science and Technology (UNCST; HS6232ES). Written informed consent was obtained from all participants. Study preparation, including staff training, development of study materials, and community sensitization, was completed before participant recruitment. Participant recruitment began in March 2026, and was completed in July 2026, with 220 AGYW and 20 key informants enrolled. Data cleaning and quality assurance are ongoing, with quantitative and qualitative analyses planned following completion of all study activities. Findings are anticipated to be reported in 2027.

Findings will provide evidence-based recommendations to inform the targeted interventions and policy guidelines for scaling up integrated LARC and LAI-PrEP services.

PRR1-10.2196/88635.