{"doi":"10.1371/journal.pone.0343507","title":"COVID-19 knowledge, attitudes, and practices among people vulnerable to HIV in Uganda: A cross-sectional cohort analysis","abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background</jats:title>\n                    <jats:p>People with behavioral vulnerability to HIV face barriers to healthcare engagement that may impede uptake of non-pharmaceutical and other interventions to prevent COVID-19. Understanding COVID-19 knowledge, attitudes, and practices in this population can inform disease prevention efforts during future pandemics.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods</jats:title>\n                    <jats:p>From October 2022 to September 2024, we enrolled participants aged 14–55 years without HIV who endorsed recent sexually transmitted infection, injection drug use, transactional sex, condomless sex, and/or anal sex with male partners. At enrollment, we collected socio-behavioral data, including assessments of COVID-19 knowledge, attitudes, and practices. Robust Poisson regression with purposeful variable selection was used to estimate prevalence ratios with 95% confidence intervals for factors associated with COVID-19 preventive practices.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results</jats:title>\n                    <jats:p>Among 418 participants, 228 (56.9%) were female, the median age was 21 years (interquartile range 19−24), and 362 (84.9%) reported sex work. Knowledge about SARS-CoV-2 transmission routes was high (95.4%) but lower for the consequences of genetic variants (48.5%−69.7%) and possibility for asymptomatic infection or transmission (66.7%−80.8%). Handwashing was practiced by 90.8% of participants in the preceding month, whereas mask-wearing (76.5%), avoiding symptomatic people (73.7%), and any history of COVID-19 vaccination (46.9%) were less prevalent. Males were more likely to report avoiding symptomatic people (adjusted prevalence ratio 1.16 [95% confidence interval 1.03–1.31]) and COVID-19 vaccination (1.30 [1.05–1.60]). Enrollment during the BQ.1/BQ.1.1 Omicron wave was associated with less mask-wearing (0.81 [0.67–0.99]) but more vaccination (1.59 [1.29–1.95]).</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion</jats:title>\n                    <jats:p>We observed variable COVID-19 knowledge and attitudes among Ugandan adolescents and adults with little impact on COVID-19 preventive practices. Efforts to address suboptimal uptake of disease preventive practices during this and future disease outbreaks will require more than just improving knowledge.</jats:p>\n                  </jats:sec>","journal":"PLOS One","year":2026,"id":643170,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1673341,"name":"Julius L. Tonzel","orcid":null,"position":1,"is_corresponding":false},{"id":1118492,"name":"Natalie Burns","orcid":null,"position":2,"is_corresponding":false},{"id":1443517,"name":"Tyler Hamby","orcid":"0000-0002-0523-8769","position":3,"is_corresponding":false},{"id":1103092,"name":"Roger Ying","orcid":"0000-0002-0380-3197","position":4,"is_corresponding":false},{"id":997938,"name":"Grace Mirembe","orcid":null,"position":5,"is_corresponding":false},{"id":1060037,"name":"Immaculate Nakabuye","orcid":null,"position":6,"is_corresponding":false},{"id":347963,"name":"Hannah Kibuuka","orcid":"0000-0002-2293-1944","position":7,"is_corresponding":false},{"id":803859,"name":"Margaret Yacovone","orcid":"0000-0002-6983-8560","position":8,"is_corresponding":false},{"id":997387,"name":"Betty Mwesigwa","orcid":"0000-0002-0463-8998","position":9,"is_corresponding":false},{"id":288618,"name":"Trevor A. Crowell","orcid":"0000-0001-5947-265X","position":10,"is_corresponding":false},{"id":1673340,"name":"Job Kasule","orcid":null,"position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"COVID-19 knowledge, attitudes, and practices among people vulnerable to HIV in Uganda: A cross-sectional cohort analysis","abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background</jats:title>\n                    <jats:p>People with behavioral vulnerability to HIV face barriers to healthcare engagement that may impede uptake of non-pharmaceutical and other interventions to prevent COVID-19. Understanding COVID-19 knowledge, attitudes, and practices in this population can inform disease prevention efforts during future pandemics.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods</jats:title>\n                    <jats:p>From October 2022 to September 2024, we enrolled participants aged 14–55 years without HIV who endorsed recent sexually transmitted infection, injection drug use, transactional sex, condomless sex, and/or anal sex with male partners. At enrollment, we collected socio-behavioral data, including assessments of COVID-19 knowledge, attitudes, and practices. Robust Poisson regression with purposeful variable selection was used to estimate prevalence ratios with 95% confidence intervals for factors associated with COVID-19 preventive practices.</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results</jats:title>\n                    <jats:p>Among 418 participants, 228 (56.9%) were female, the median age was 21 years (interquartile range 19−24), and 362 (84.9%) reported sex work. Knowledge about SARS-CoV-2 transmission routes was high (95.4%) but lower for the consequences of genetic variants (48.5%−69.7%) and possibility for asymptomatic infection or transmission (66.7%−80.8%). Handwashing was practiced by 90.8% of participants in the preceding month, whereas mask-wearing (76.5%), avoiding symptomatic people (73.7%), and any history of COVID-19 vaccination (46.9%) were less prevalent. Males were more likely to report avoiding symptomatic people (adjusted prevalence ratio 1.16 [95% confidence interval 1.03–1.31]) and COVID-19 vaccination (1.30 [1.05–1.60]). Enrollment during the BQ.1/BQ.1.1 Omicron wave was associated with less mask-wearing (0.81 [0.67–0.99]) but more vaccination (1.59 [1.29–1.95]).</jats:p>\n                  </jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion</jats:title>\n                    <jats:p>We observed variable COVID-19 knowledge and attitudes among Ugandan adolescents and adults with little impact on COVID-19 preventive practices. Efforts to address suboptimal uptake of disease preventive practices during this and future disease outbreaks will require more than just improving knowledge.</jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":0.0,"endowment":0.0,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"41774742","pmcid":"PMC12956106","openalex_id":null,"authors":[],"funders":[{"funder_name":"U.S. Army","grant_id":"W81XWH-18-2-0040","title":null},{"funder_name":"U.S. Army","grant_id":"HT9425-24-3-0004","title":null},{"funder_name":"Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases","grant_id":"AAI20052001","title":null},{"funder_name":"National Institute of Mental Health","grant_id":"RF1 MH133442","title":null}],"total_grants":4,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0343507&type=printable","host_type":"publisher"},{"url":"https://dx.plos.org/10.1371/journal.pone.0343507","host_type":"publisher"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12956106/pdf/pone.0343507.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC12956106","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC12956106?pdf=render","host_type":"Europe_PMC"}],"fields_of_study":[],"mesh_terms":["Humans","HIV Infections","Cohort Studies","Cross-Sectional Studies","Health Knowledge, Attitudes, Practice","Sexual Behavior","Adolescent","Adult","Middle Aged","Uganda","Female","Male","Young Adult","COVID-19","SARS-CoV-2"],"keywords":[],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-08T13:35:15.187299Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}