Determinants of preventive sexual behaviours among first year university students in Beira city, central Mozambique: a cross-sectional study.

BACKGROUND: Understanding determinants of preventive sexual behaviours is important for intervention efforts to support these behaviours and, thereby, reduce STIs and HIV burden. In general, there is limited insight into determinants of preventive behaviours among university students in Mozambique. Therefore, this study set out to assess both the prevalence and the determinants of condom use and voluntary counselling and testing (VCT) service use in first year university students. METHODS: We conducted a cross-sectional study in May-September 2021, at the Universidade Católica de Moçambique and the Universidade Licungo, in Beira central Mozambique. We collected data on sociodemographic characteristics, heterosexual relationship experiences and personal determinants posited to be associated with condom use and VCT service use. We included 819 participants, who were selected using a clustered and random sampling design. We used Pearson's chi-square test to compare proportion and estimate the crude odd ratio as the effect size measure at 95% confidence interval, and Confidence Interval-Based Estimation of Relevance to determine correlation coefficients of means and the behaviours of interest at 95% confidence interval. RESULTS: Condoms were used by 96.1% of male participants and 95.0% of female participants. Additionally, 55.1% of male participants and 57.5% of female participants had previously used VCT services. Condom use was associated with discussing sexuality with mother, and self-efficacy for condom use negotiation, and negatively associated with attitudes that condoms reduce pleasure. VCT service use was associated with discussing sexuality with mother, sexual debut, having a sexual partner, and being in what they consider an important heterosexual relationship. Knowledge, attitude, self-efficacy and subjective norms were weakly associated with VCT service use. CONCLUSION: In first year university students in Mozambique, reported condom use was high but VCT services were only used by about half of the participants. Interventions aiming to increase VCT service use should focus on improving communication between parents and their adolescent or young adult children, providing personalized risk information, demonstrating that VCT service use is pleasant and non-judgmental, improving users' confidence to schedule a visit, and preparing users for possible positive testing results.

INTRODUçãO: Compreender os determinantes de comportamentos sexuais preventivos é importante para guiar o desenvolvimento de intervenções que reforçam e apoiam estes comportamentos e, assim, reduzir a carga das infecções transmitida sexualmente (ITSs) e do Vírus de Imunodeficiência Humana (HIV). Em geral, informação sobre os determinantes de comportamentos preventivos entre os estudantes universitários é limitada em Moçambique. Portanto, este estudo teve como objetivo avaliar a prevalência e os determinantes do uso de preservativos e uso dos serviços de aconselhamento e testagem em saúde (ATS) em estudantes universitários do primeiro ano. MéTODOS: Realizamos um estudo transversal em Maio­Setembro de 2021, na Universidade Católica de Moçambique e na Universidade Licungo, na Beira centro de Moçambique. Coletamos dados sobre características sociodemográficas, experiências de relacionamento heterossexual e determinantes pessoais considerados associados ao uso de preservativo e ao uso dos serviços de ATS. Foram incluídos 819 participantes, estes foram selecionados usando o desenho amostral de conglomerado e aleatório. Utilizamos o teste qui-quadrado para comparar as proporções, usamos odd ratio para estimativa de tamanho do efeito a 95% de intervalo de confiança. e para identificar os determinantes relevantes usamos a abordagem da estimativa de relevância baseada no intervalos de confiança (CIBER). RESULTADOS: O uso do preservativo foi declarado por cerca de 96,1% dos participantes homens e 95,0% de participantes mulheres. Mas apenas 55,1% dos participantes homens e 57,5% das participantes mulheres referiram terem usado o serviço de ATS. O uso do preservativo foi associado à discussão da sexualidade com a mãe e positivamente associado à autoconfiança para negociação do uso do preservativo, e negativamente associado à atitude de que, o preservativo reduz o prazer. O uso dos serviços de ATS foi associado à discussão da sexualidade com a mãe, início da vida sexual, ter um parceiro sexual e estar num relacionamento heterossexual que consideram importante. Conhecimento, atitude, autoconfiança e normas subjetivas mostraram-se fracamente associados ao uso de serviços de ATS. CONCLUSãO: Em estudantes universitários do primeiro ano em Moçambique, o relatado de uso do preservativo foi elevado, mas os serviços de ATS foram usados por apenas cerca de metade dos participantes. Intervenções que visam aumentar a visita e utilização dos serviços ATS devem centrar-se na melhoria da comunicação entre os pais e os seus filhos adolescentes ou jovens adultos, fornecendo informações personalizadas sobre riscos, demonstrando que a utilização dos serviços de ATS é agradável e sem julgamentos, incentivar a autoconfiança dos utentes para agendar uma visita à ATS e preparar usuários para possíveis resultados de testes positivos.

Evaluation of a Sexual Transmitted Infection Prevention Program Among University Students in Beira City Central Mozambique: A Study Protocol.

Background: Unhealthy sexual behaviors, such as unprotected sexual intercourse and lack of using screening services increase cyclical transmission of sexually transmitted infections including Human Immunodeficiency Virus (HIV), especially among young adults. Hence health promotion programs can contribute to reduce the consequences, by changing (determinants of) these behaviors. Such interventions need to embrace a comprehensive approach and apply theory-and evidence-based methods. This article describes the protocol for a process and effect evaluation study of a sexually transmitted infection prevention program among university students in Beira city, central Mozambique. Methods: The on-going program at Universidade Católica de Moçambique is described following the six steps of Intervention Mapping (IM), with a focus on the evaluation plan (i.e., the final step in IM). The details regarding previous steps in the protocol are briefly described as well, as they lay the foundation for the final step. The overall study will apply a hybrid type 1 approach by assessing the effectiveness of the intervention while gettering implementation. The process evaluation will apply qualitative and quantitative methods to gain insight in the context, reach, dose delivered, dose received and recruitment. Interviews with closed and open-ended questions will be conducted with program implementers and users. A quasi-experimental non-equivalent control group design is used to evaluate the effectiveness. A cohort of university students will be followed for 6 months. Self-administrated questionnaires will be used to collect data every 3 months. Discussion: A combination of process and effect evaluation is proposed. This is a useful and fruitful procedure, since concurrent process evaluation can allow researchers to better interpret findings from the effect evaluation and understand how the intervention might replicate in similar contexts. We decided to follow the IM approach since, it is a theory-and evidence-based, systematic and detailed guide regarding what to do at every steps. A quasi-experimental non-equivalent control group design was chosen to fit the context of the study and generate outcomes with high external validity. Study Registration: 004/CIBS/2020.

Determinants of preventive sexual behaviours among first year university students in Beira city, central Mozambique: a cross-sectional study

Background: Understanding determinants of preventive sexual behaviours is important for intervention efforts to support these behaviours and, thereby, reduce STIs and HIV burden. In general, there is limited insight into determinants of preventive behaviours among university students in Mozambique. Therefore, this study set out to assess both the prevalence and the determinants of condom use and voluntary counselling and testing (VCT) service use in first year university students. Methods: We conducted a cross-sectional study in May-September 2021, at the Universidade Católica de Moçambique and the Universidade Licungo, in Beira central Mozambique. We collected data on sociodemographic characteristics, heterosexual relationship experiences and personal determinants posited to be associated with condom use and VCT service use. We included 819 participants, who were selected using a clustered and random sampling design. We used Pearson's chi-square test to compare proportion and estimate the crude odd ratio as the effect size measure at 95% confidence interval, and Confidence Interval-Based Estimation of Relevance to determine correlation coefficients of means and the behaviours of interest at 95% confidence interval. Results: Condoms were used by 96.1% of male participants and 95.0% of female participants. Additionally, 55.1% of male participants and 57.5% of female participants had previously used VCT services. Condom use was associated with discussing sexuality with mother, and self-efficacy for condom use negotiation, and negatively associated with attitudes that condoms reduce pleasure. VCT service use was associated with discussing sexuality with mother, sexual debut, having a sexual partner, and being in what they consider an important heterosexual relationship. Knowledge, attitude, self-efficacy and subjective norms were weakly associated with VCT service use. Conclusion: In first year university students in Mozambique, reported condom use was high but VCT services were only used by about half of the participants. Interventions aiming to increase VCT service use should focus on improving communication between parents and their adolescent or young adult children, providing personalized risk information, demonstrating that VCT service use is pleasant and non-judgmental, improving users' confidence to schedule a visit, and preparing users for possible positive testing results

Evaluation of a Sexual Transmitted Infection Prevention Program Among University Students in Beira City Central Mozambique: A Study Protocol

Background: Unhealthy sexual behaviors, such as unprotected sexual intercourse and lack of using screening services increase cyclical transmission of sexually transmitted infections including Human Immunodeficiency Virus (HIV), especially among young adults. Hence health promotion programs can contribute to reduce the consequences, by changing (determinants of) these behaviors. Such interventions need to embrace a comprehensive approach and apply theory-and evidence-based methods. This article describes the protocol for a process and effect evaluation study of a sexually transmitted infection prevention program among university students in Beira city, central Mozambique. Methods: The on-going program at Universidade Católica de Moçambique is described following the six steps of Intervention Mapping (IM), with a focus on the evaluation plan (i.e., the final step in IM). The details regarding previous steps in the protocol are briefly described as well, as they lay the foundation for the final step. The overall study will apply a hybrid type 1 approach by assessing the effectiveness of the intervention while gettering implementation. The process evaluation will apply qualitative and quantitative methods to gain insight in the context, reach, dose delivered, dose received and recruitment. Interviews with closed and open-ended questions will be conducted with program implementers and users. A quasi-experimental non-equivalent control group design is used to evaluate the effectiveness. A cohort of university students will be followed for 6 months. Self-administrated questionnaires will be used to collect data every 3 months. Discussion: A combination of process and effect evaluation is proposed. This is a useful and fruitful procedure, since concurrent process evaluation can allow researchers to better interpret findings from the effect evaluation and understand how the intervention might replicate in similar contexts. We decided to follow the IM approach since, it is a theory-and evidence-based, systematic and detailed guide regarding what to do at every steps. A quasi-experimental non-equivalent control group design was chosen to fit the context of the study and generate outcomes with high external validity.