Effect of a sexually transmitted infection prevention program on voluntary counseling and testing services utilization among university students: a quasi-experimental study

Background Low utilization of Voluntary Counseling and Testing (VCT) services increases the burden of sexually transmitted infections (STIs) and HIV, rates of late diagnosis, and delayed initiation of treatment and care. Low VCT utilization is particularly high among adolescents and young adults (AYA), including university students. This behavior is predicted by personal determinants, including low risk perception of STIs, attitude toward VCT, self-efficacy in using VCT services, and subjective norms. To positively influence these determinants among university students, a behavior change program was conducted at Universidade Católica de Moçambique (UCM). This study aimed to gain insight into the effect of the program on (determinants of) VCT service utilization among first-year students. Methods We used a quasi-experimental non-equivalent comparison group design. The study took place at UCM and Universidade Licungo (UniLicungo) intervention and control setting respectively. We included 481 and 338 participants from UCM and UniLicungo respectively. We collected data on VCT service utilization, risk perception, attitude, self-efficacy, and subjective norms at enrolment, three-month, and six-month follow-up using a self-administered structured questionnaire with closed-ended questions. We analysed data using analysis of variance (ANOVA) and logistic regression analysis. Results The analysis showed increases in perceived risk of acquiring STIs, including HIV (p < .001, 95% CI [.213, .439]) and in self-efficacy to seek and use VCT services (p < .001, 95% CI [.078, .285]) from enrolment to six-month follow-up. A positive effect on subjective norms was found from enrollment to three-month follow-up (p < .001, 95% CI [.072, .370]). No significant effect was observed on attitude toward VCT. VCT utilization at the intervention university increased from 46.90% at enrolment to 54.8% at three-month follow-up and to 57.80% at six-month follow-up. This apparent increase did not significantly differ from VCT utilization patterns at the control university. Conclusion Our study results suggest that the program may have positively influenced students' perceived risk of acquiring STIs, including HIV, and their confidence in seeking and using VCT services. These effects did not translate into increased VCT services utilization. Future research is recommended to identify other determinants and evaluate alternative strategies to improve VCT utilization among university students.