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

Brennan R. Cebula, Roger Ying, Tyler Hamby, Julius Tonzel, Josphat Kosgei, Deborah Langat, Rael Bor, Britt Gayle, Matthew L. Romo, Glenna Schluck, Christine Akoth, Fred Sawe, Margaret Yacovone, Julie A. Ake, Trevor A. Crowell

Journal of Public Health in Africa | Vol 16, No 1 | a1401 | DOI: https://doi.org/10.4102/jphia.v16i1.1401 | © 2025 Brennan R. Cebula, Roger Ying, Tyler Hamby, Julius Tonzel, Josphat Kosgei, Deborah Langat, Rael Bor, Britt Gayle, Matthew L. Romo, Glenna Schluck, Christine Akoth, Fred Sawe, Margaret Yacovone, Julie A. Ake, Trevor A. Crowell | This work is licensed under CC Attribution 4.0
Submitted: 09 April 2025 | Published: 23 October 2025

About the author(s) Brennan R. Cebula, US Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, United States
Roger Ying, US Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, United States of America; and Department of Global Infectious Diseases, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States
Tyler Hamby, US Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, United States of America; and Department of Global Infectious Diseases, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States
Julius Tonzel, US Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, United States of America; and Department of Global Infectious Diseases, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States
Josphat Kosgei, HJF Medical Research International, Kericho, Kenya; and US Army Medical Research Directorate – Africa, Kericho, Kenya
Deborah Langat, HJF Medical Research International, Kericho, Kenya; and US Army Medical Research Directorate – Africa, Kericho, Kenya
Rael Bor, HJF Medical Research International, Kericho, Kenya; and US Army Medical Research Directorate – Africa, Kericho, Kenya
Britt Gayle, US Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, United States of America; and Department of Global Infectious Diseases, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States
Matthew L. Romo, US Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, United States of America; and Department of Global Infectious Diseases, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States
Glenna Schluck, US Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, United States of America; and Department of Global Infectious Diseases, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States
Christine Akoth, HJF Medical Research International, Kericho, Kenya; and US Army Medical Research Directorate – Africa, Kericho, Kenya
Fred Sawe, HJF Medical Research International, Kericho, Kenya; and US Army Medical Research Directorate – Africa, Kericho, Kenya
Margaret Yacovone, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, United States
Julie A. Ake, US Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, United States
Trevor A. Crowell, US Military HIV Research Program, Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, United States of America; and Department of Global Infectious Diseases, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States

Abstract

Background: 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.
Aim: To examine COVID-19 KAPs among Kenyan adolescents and adults with behavioural vulnerability to HIV.
Setting: This study was conducted in Kericho and Homa Bay, Kenya.
Methods: 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.
Results: 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]).
Conclusion: Belief in personal NPIs (mask-wearing and handwashing) was associated with decreased practice of social NPIs (meeting outdoors, reducing shopping, and avoiding crowds).
Contribution: Future public health strategies for pandemic response should anticipate risk compensation.

Keywords

HIV; SARS-CoV-2; COVID-19; non-pharmaceutical intervention; knowledge, attitudes and practices

Sustainable Development Goal

Goal 3: Good health and well-being

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