Using the health belief model to examine adolescent participation in HIV prevention research in Kampala, Uganda: A qualitative study

Adolescents' participation in HIV prevention research is essential for developing effective, youth-centered interventions. However, ethical, social, and practical challenges often constrain their involvement. This study explored facilitators and barriers to participation in biomedical HIV prevention research among adolescents aged 14-19 years at risk of acquiring HIV in Kampala, Uganda. As part of the FERDAR study (Feasibility of Enrolling and Retaining Adolescents at Risk of HIV), we conducted a qualitative investigation from June 2019 to June 2020. Participants were purposively selected from among those enrolled in FERDAR. We conducted in-depth interviews with 50 adolescents (30 females, 20 males) and held six focus group discussions with 52 others (27 females, 25 males). Data were analyzed using the framework analysis method, guided by constructs from the Health Belief Model. Key facilitators of participation included increased awareness of HIV risk due to study information, tangible benefits such as transportation reimbursement and access to health services (e.g., cervical cancer screening), and positive interactions with healthcare providers. Conversely, barriers included aversion to study products (e.g., pre-exposure prophylaxis), fear of HIV-positive test results, stigma, and logistical challenges like lack of time or transport funds. At the community level, mistrust and misconceptions about the research and its products further hindered participation. To enhance adolescent involvement in biomedical HIV prevention research, it is vital to address both individual and structural barriers. Promoting access to prevention services and fostering supportive, youth-friendly research environments can improve engagement and ultimately strengthen HIV prevention efforts for this vulnerable population.