Evaluating the level of knowledge of HIV prevention methods and associated socio-demographic factors among adolescents before and after participating in health education in Nimule town of South Sudan.

Introduction: Adolescents in conflict-affected settings often face limited access to health information and other prevention resources, making them more vulnerable to HIV and other sexually transmitted infections. This study assessed adolescents' level of knowledge of at least three HIV prevention methods and sociodemographic characteristics among adolescents and associated with this knwoledge before and after participating in health education in the town of Nimule, South Sudan.

Materials And Methods: We collected and analysed baseline and endline data from 557 adolescents aged 10-17 aged recruited from HIV-affected households in Nimule town. The surveys were conducted between December 2020 and December 2022. Assent to participate for all participants was obtained from their caregivers while additional informed consent was obtained from adolescents aged 15-17 who were considered empowered minors by the South Sudan Ministry of Health. Adolescents were then recruited into 40 peer-led health clubs and completed a three-month comprehensive sexuality education curriculum developed by the South Sudan Ministry of Health. These participants were then followed up for 24 months, and an endline survey was conducted to collect comparabel data. Binay logistic regression analysis was used to assess the level of knowledge of at least three mIV prevention methods in line with UNAIDS conceptualisation of knowledge and associated sociodemographic factors. Associations were reported using adjusted odds ratios.

Results: Of the 768 adolescents enrolled, 557 were surveyed at baseline and endline with 301 (54.0%) being females and 276 (46.0%) males. The median age was 14 years (IQR: 11-16) at baseline and 15 years (IQR: 12-17) at the endline survey. The proportion of adolescents who knew at least three methods of HIV prevention increased from 465 (83.5%) at baseline to 556 (99.8%) at the endline survey. Unemployed adolescents had a 99% reduced chance of knowing at least three HIV prevention methods (aOR 0.01, 95% CI: 0.002-0.025, p < 0.001), whereas adolescents who self-rated their health as excellent had a 46% lower chance (aOR 0.56, 95% CI: 0.27-1.14, p < 0.025).

Conclusions: The increase in knowledge of at least three methods of HIV prevention at the endline survey highlights the important role peer-led health education programs plays in closing gaps in HIV prevention among adolescents in conflict-affected settings like South Sudan.