Health Behavior

BackgroundPatient engagement is a critical component of high-quality research. When implemented intentionally, partnerships with patient partners and other knowledge users ensure that research findings are relevant and meaningful to intended users. Integrated knowledge translation (iKT) is a collaborative approach that supports a bidirectional partnership between researchers and knowledge users throughout the research process.ObjectiveThis study aimed to examine the experiences and identify the facilitators and barriers to participating in an iKT panel for a consensus-building study.MethodsA qualitative descriptive study using semi-structured interviews was conducted with members of the iKT panel, including youth, caregivers, healthcare providers, and health system leaders. The Patient Engagement in Research Scale (PEIRS-22) was used to assess the degree of meaningful engagement. Data were analysed using a descriptive thematic approach.ResultsEleven panel members (3 youth, 2 caregivers, 2 healthcare providers, and 4 health system leaders) participated. Among the 10 participants who completed PEIRS-22, the mean total score was 88.3 (SD = 10.5), with most reporting very or extremely meaningful (70%) level of engagement. Five overarching themes capturing the facilitators and barriers influencing panel members' engagement were identified. Facilitators included clear and consistent communication, strong trust in and support from the research team, an inclusive and empowering environment, accessible and flexible participation options, and meaningful involvement that promoted a sense of value and connection. Key barriers included communication burden, power dynamics among panel members, competing commitments, technology challenges, and mismatched expectations.ConclusionEngagement through an iKT approach is a complex, relational process that requires strong communication, intentional structures, and a supportive environment. Findings highlight the importance of fostering interpersonal relationships among diverse knowledge users to enhance collaboration and strengthen engagement.Patient and public contributionMembers of an iKT panel for a larger consensus-building research study were participants in this evaluation. Findings will be shared with panel members to inform and refine engagement strategies for future research activities.

BackgroundAdolescents in low- and middle-income countries face high rates of unintended pregnancy, sexually transmitted infections (STIs), and unmet sexual and reproductive health (SRH) needs. In Uganda, 24% of girls aged 15-19 years have begun childbearing, yet modern contraceptive prevalence among adolescents remains low (15%). These challenges are particularly severe in the Busoga region, where sociocultural norms, poverty, and limited health system capacity hinder access to adolescent-friendly SRH services. Despite national guidelines, utilization remains low. Few studies have triangulated perspectives from adolescents, health providers, and community/religious leaders. We explored stakeholder views to provide an integrated understanding of factors influencing adolescent SRH service utilization in Busoga, Uganda.MethodsAn exploratory qualitative study was conducted in Iganga and Bugweri districts. Four focus group discussions with 38 adolescents (13-19 years), stratified by sex, age group, and residence, and 12 key informant interviews with health providers and community leaders were conducted. Adolescents were recruited through peer networks, while key informants were purposively selected. Data were collected (November-December 2024), transcribed verbatim, and analyzed inductively using thematic analysis with NVivo 14. Ethical approval and informed consent/assent were obtained.ResultsAdolescents, health providers, and community stakeholders described SRH service utilization as shaped by adolescent motivation alongside persistent barriers. Adolescents showed strong preventive intent, but uptake was limited by misconceptions about contraception, fears of infertility, long distances, lack of privacy, negative provider attitudes, and commodity stock-outs. Providers and community leaders echoed concerns around misinformation, limited parental guidance, moral norms, and structural constraints. All stakeholders converged on the need for confidential, accessible, and peer- and community-based adolescent SRH services.ConclusionAdolescents in Busoga are motivated to use SRH services, but intersecting sociostructural and system barriers limit utilization. Strengthening adolescent-friendly services, improving provider responsiveness, addressing misinformation, and expanding community-based delivery are essential to enhance equitable access.

IntroductionDaily oral pre-exposure prophylaxis (PrEP) use remains low among adolescent girls and young women (AGYW). We evaluated whether a peer support intervention improved daily oral PrEP uptake and adherence among AGYW at high risk of HIV acquisition in Kampala, Uganda.MethodsWe conducted an open-label randomized controlled trial (January 2023-June 2024) among 14- to 24-year-olds engaged in sex work. Eligible participants were randomized 1:1 to receive either health worker counselling only (control) or supplemented with peer support (intervention). Peer leaders delivered co-created peer education sessions starting 1 month after enrolment. Participants were followed for 12 months. Co-primary outcomes were PrEP uptake (yes/no) and adherence, evaluated using two separate measures; optimal if: ≥85% pill-counts (primary measure); positive point-of-care urine tenofovir test. Both arms received adherence counselling based on urine results.Secondary outcomesPrEP persistence (time to discontinuation) and cost-effectiveness (cost per disability adjusted life year/DALY averted). Analysis used logistic regression (uptake); generalized estimating equations (adherence), Cox regression (persistence) and incremental cost-effectiveness ratio (ICER) below US$537 per DALY averted was considered cost-effective.ResultsWe enrolled 394 participants (197 per arm) with a mean age of 19.4 (SD ±2.3) years. The intervention did not impact PrEP uptake (OR 1.15; 95% CI 0.77-1.71) but improved adherence, pill count (OR 2.20; 95% CI 1.23-3.95) and urine assay (OR 2.18; 95% CI 1.22-3.91). Optimal adherence was low but significantly higher in the intervention by both measures: pill count (intervention = 54.8%, control = 39.6%, p = 0.008), urine assay (intervention = 54.8%, control = 40.8%, p = 0.001). Median duration before PrEP discontinuation was 38 days (IQR 0-319 days); intervention (56 days), control (29 days). The intervention had no effect on persistence (HR 0.86; 95% CI 0.64-1.14). It was cost-effective with the urine tenofovir assay (ICER = $459) but not with pill counts (ICER = $581).ConclusionsThis peer-led intervention improved PrEP adherence among AGYW in Kampala and is recommended in high-incidence settings. Urine tenofovir testing can be used to assess adherence if affordable. Enhanced peer support strategies are needed until long-acting PrEP becomes accessible and acceptable. Future research should optimize timing, intensity and delivery models of peer support interventions and integrate them with long-acting PrEP to improve sustainability.