Determinants of HIV testing and oral PrEP uptake among youth at Malawi University of Business and Applied Sciences: A cross-sectional study employing the Health Belief Model

In Malawi, approximately 9000 new HIV infections occur annually among youth. As of 2017, only 50.2% of young men and 68.2% of young women aged 15-24 years had been tested for HIV infection. Oral pre-exposure prophylaxis is recommended for HIV-seronegative at-risk individuals and has been available to youth since 2022. This study assessed the determinants of HIV testing and oral PrEP uptake among youth at the Malawi University of Business and Applied Sciences, guided by the Health Belief Model. A cross-sectional study was conducted using a stratified random sampling method to select 377 youth aged 18-24 years. Data were collected using a self-administered questionnaire and analyzed using STATA software version 14.1, with statistical significance set at p < 0.05. Descriptive statistics and multivariable logistic regression analyses were performed. One factor was associated with HIV testing: being aged 21-24 years (AOR = 2.5; 95%CI = 1.34,4.59). Seven factors were significantly associated with oral PrEP uptake; being male (AOR = 2.8; 95%CI = 1.23,6.72), perceiving a threat of HIV infection (AOR = 5.7; 95%CI = 1.80,18.18), testing for HIV at a three-month interval (AOR = 5.5; 95%CI = 1.92,15.52), knowing the partner's HIV status (AOR = 2.5; 95%CI = 1.04,5.86), knowing someone taking oral PrEP (AOR = 4.8; 95%CI = 2.17,10.71), having awareness about PrEP (AOR = 11.4; 95%CI = 1.08,119.90), and being willing to take a daily pill (AOR = 1.9; 95%CI = 0.84,4.09). External cues showed that youth primarily obtained information about HIV testing and oral PrEP from social media and peers. In conclusion, associations highlighted the importance of involving partners and peers in promoting PrEP uptake. Digital media served as an important source of information among youth, and targeted health communication strategies could leverage these channels as effective cues to increase HIV testing and oral PrEP uptake.