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Impact of Post-Exposure Prophylaxis Awareness on HIV Post-Exposure Prophylaxis Uptake among University Students in Nigeria

Abstract

Human immunodeficiency virus (HIV) infection remains an important public health concern, and timely access to effective post-exposure prevention is essential following potential exposure to HIV. Post-exposure prophylaxis (PEP) is an emergency HIV prevention intervention involving the use of antiretroviral medicines after a potential exposure to HIV to reduce the likelihood of infection. The effectiveness of PEP is strongly associated with prompt initiation and appropriate completion of the recommended regimen. Post-exposure prophylaxis awareness provides university students with information about circumstances that may constitute potential HIV exposure, the purpose and effectiveness of PEP, the importance of seeking care promptly, eligibility for PEP, where PEP can be obtained, appropriate testing and follow-up procedures, and the need to complete the prescribed regimen. HIV PEP uptake refers to the utilization of PEP services by eligible students following a potential exposure to HIV. Among university students in Nigeria, inadequate PEP uptake may be associated with limited awareness, misconceptions about HIV transmission, lack of knowledge about where PEP services are available, stigma, fear of disclosure, concerns about medication, perceived low risk of HIV exposure, and delays in seeking healthcare. Effective PEP awareness may improve students' understanding of the intervention and encourage timely utilization of available PEP services following potential exposure. Against this background, this study investigates the impact of post-exposure prophylaxis awareness on HIV post-exposure prophylaxis uptake among university students in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and the Theory of Planned Behavior. The Health Belief Model provides a framework for understanding students' decisions to seek PEP through perceived susceptibility to HIV infection, perceived severity of HIV, perceived benefits of PEP, perceived barriers to accessing PEP, and cues to action. Social Cognitive Theory emphasizes the influence of knowledge, self-efficacy, social influences, observational learning, and environmental conditions on health-seeking behaviour. The Theory of Planned Behavior explains how attitudes toward PEP, perceived social expectations, and perceived behavioural control may influence students' intentions and decisions to utilize PEP following potential HIV exposure. Collectively, these theoretical perspectives provide a suitable framework for explaining how PEP awareness may influence HIV PEP uptake among university students in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from undergraduate students in selected Nigerian universities using a structured self-administered questionnaire, PEP awareness assessment, and PEP utilization assessment tool. A multistage sampling technique will be employed to select universities, faculties or departments, academic levels, and eligible students. Where feasible, selected student groups or university settings will be assigned to intervention and comparison groups. Students in the intervention group will receive structured PEP awareness education covering HIV transmission, circumstances associated with potential HIV exposure, the purpose and importance of PEP, eligibility, the need for prompt initiation following a potential exposure, duration and adherence requirements, HIV testing and follow-up, confidentiality, possible barriers to access, and locations of available PEP services. HIV PEP uptake will be assessed using indicators such as knowledge of available PEP services, willingness to seek PEP following potential exposure, actual presentation for PEP when an eligible exposure occurs, timely initiation of PEP where indicated, completion of prescribed PEP, and attendance for recommended follow-up services. Where feasible, actual PEP utilization will be verified through appropriate university health-centre or healthcare records while maintaining confidentiality. Descriptive statistics will be used to summarize participants' sociodemographic characteristics, previous HIV education, PEP awareness, knowledge of PEP access points, and PEP utilization patterns. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the impact of PEP awareness on PEP uptake. Where appropriate, awareness and uptake indicators before and after the intervention will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that PEP awareness has a significant positive impact on HIV PEP uptake among university students in Nigeria. Students exposed to structured PEP awareness education are expected to demonstrate improved knowledge of HIV exposure risks, the purpose of PEP, the importance of prompt healthcare presentation, available PEP services, and appropriate follow-up procedures. Increased awareness is expected to reduce delays in seeking care following potential exposure and encourage timely utilization of PEP among eligible students. Education may also correct misconceptions about PEP, reduce fear and stigma, and improve knowledge of where confidential PEP services can be obtained. However, awareness alone may not guarantee PEP uptake because students may continue to experience barriers such as limited availability of PEP services, lack of awareness of service locations, fear of stigma or disclosure, concerns about medication, transportation difficulties, financial barriers, and delays in recognizing the need for emergency prevention. Consequently, PEP awareness may be most effective when supported by accessible and confidential university-based PEP services, clear referral pathways, trained healthcare personnel, 24-hour or extended-hour access where feasible, HIV counselling and testing services, and sustained student-focused HIV prevention education. The study is expected to contribute to the literature on PEP awareness, HIV post-exposure prophylaxis, HIV prevention, university health, sexual health education, health-seeking behaviour, and public health in Nigeria by providing empirical evidence on the impact of PEP awareness on PEP uptake among university students. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Agency for the Control of AIDS, university health centres, healthcare facilities, university administrators, student health programmes, public health practitioners, health educators, development partners, and policymakers regarding strategies for improving timely access to HIV post-exposure prevention. The study will also provide evidence-based recommendations for integrating PEP education into university health programmes, strengthening confidential and accessible PEP services, improving awareness of PEP access points, establishing effective emergency referral systems, reducing HIV-related stigma and misinformation, strengthening HIV testing and counselling, and promoting timely utilization of PEP among university students following potential HIV exposure.

Keywords: Post-exposure prophylaxis awareness, HIV PEP uptake, university students, Nigeria, HIV prevention, post-exposure prophylaxis, HIV testing, sexual health education, HIV awareness, emergency HIV prevention, health-seeking behaviour, university health, health education, public health.