JMIR Publications

ABSTRACT

Background:

HIV incidence among adolescent girls and young women (AGYW) aged 15–24 years in Eastern and Southern Africa remains unacceptably high. Unprotected sex not only increases the risk of HIV and other sexually transmitted infections but also contributes to the high rate of unintended pregnancies, reflecting the persistent unmet need for effective contraception among AGYW. Promising biomedical advances such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP) and long-acting reversible contraception (LARC) offer effective, durable protection against HIV and unintended pregnancy. However, uptake and persistence remain suboptimal due to barriers such as low awareness, fear of side effects, stigma, limited decision-making autonomy, and the lack of integrated reproductive health and HIV prevention services. Evidence on how community-driven and behaviorally informed strategies can effectively support the integrated rollout and uptake of LAI-PrEP and LARC among AGYW in Uganda remains limited.

Objective:

The study aims to determine the preferences and willingness of AGYW in Uganda to use LARC and LAI-PrEP; and to characterize stakeholder perceptions, practices, and social norms that may influence the adoption of integrated LARC and LAI-PrEP services. It applies the Capability, Opportunity, Motivation–Behavior (COM-B) model to identify key facilitators and barriers to uptake and adherence.

Methods:

This mixed-methods implementation science study, guided by the COM-B model and the Behavior Change Wheel will be conducted in three Kampala Capital City Authority clinics to generate evidence and co-design community-driven strategies supporting integrated LARC and LAI-PrEP uptake among AGYW. The study will proceed in three stages (1) structured surveys with 220 AGYW to assess determinants of uptake and willingness to use integrated services, (2) focus group discussions with a subsample of 30 AGYW and in-depth interviews with 20 key informants, including healthcare providers, peers, social media influencers, community leaders, and representatives from reproductive health and HIV prevention organizations, to explore perceptions, preferences, and barriers and (3) participatory co-design of behavior change strategies. Survey data will be analyzed using descriptive and regression methods, while qualitative data will be thematically analyzed. Findings will be triangulated across study phases to identify factors influencing LARC and LAI-PrEP uptake.

Results:

The study has obtained lnstitutional Review Board approval. All participants will give written informed consent. Recruitment and data collection will begin once preparatory activities are complete.

Conclusions:

Findings will provide evidence-based recommendations to inform the design of targeted interventions and policy guidelines for scaling up integrated LARC and LAI-PrEP services. Clinical Trial: Not applicable; this is not a randomized controlled trial.