Knowledge, perceptions, and utilization of Pre-exposure prophylaxis among youth at ntšekhe government hospital, lesotho

Background: Pre-Exposure Prophylaxis (PrEP) is an effective biomedical intervention for preventing HIV transmission among high-risk populations. However, despite its proven efficacy, the uptake of PrEP remains low among youth in Lesotho, particularly those accessing services at Ntšekhe Government Hospital. This study aims to assess the knowledge, perceptions, and utilisation of PrEP amongst the youth aged 18–24 years at the hospital. Methods: A cross-sectional survey was conducted from June to July 2024, involving 152 youth who completed structured questionnaires. Descriptive statistics were used to examine socio-demographic data, knowledge levels, and perceptions, while inferential analyses explored the relationships between education, gender, and PrEP utilisation. Findings: The study reveals that 71 % of participants were aware of PrEP, yet only 12.5 % had ever used it. Interestingly, a counterintuitive finding emerged: individuals with higher education, despite demonstrating significantly better knowledge of PrEP (p < 0.001), were less likely to use it, suggesting internal or structural barriers to uptake. This unexpected trend signals a need for further qualitative investigation. Gender disparities were also evident, with males significantly less likely to report PrEP use compared to females (p < 0.001). A moderate positive correlation (r = 0.431, p < 0.001) was found between perceptions of PrEP's effectiveness and its utilisation. Interpretations: The findings highlight the need for targeted public health interventions to address knowledge gaps, dispel misconceptions, and reduce barriers to PrEP access, particularly among young people in Lesotho. Expanding PrEP education and addressing gender-specific factors are crucial steps in improving PrEP uptake and preventing HIV transmission in this high-risk population. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.