Multilevel Determinants of HIV Prevention Among Urban Refugee Youth in Uganda: Baseline Findings from the Tushirikiane-4-Uthabiti Trial.

While urban refugee youth face HIV vulnerabilities spanning socio-ecological levels, knowledge gaps persist in HIV prevention outcomes. We conducted a baseline analysis of a cohort enrolled in Tushirikiane-4-Uthabiti, an intervention focused on HIV testing practices among urban refugee youth aged 16-24 in Kampala, Uganda (N = 330). Using regression models, we examined the societal, community, and interpersonal factors associated with condom use self-efficacy [CUSE], consistent condom use, HIV self-testing [HIVST] kit access, and recent HIV testing. Most participants were women (53.3%), with a mean age of 21.3 years (SD = 2.9). One-fifth reported consistent condom use (19.1%), over half accessed HIVST kits (56.4%), and recent HIV testing (50.6%). Statistically significant results showed that higher education (β = 0.18, p < 0.001) and financial resilience (β = 0.18, p < 0.001) were positively associated with CUSE, whereas food insecurity (β =  - 0.21, p < 0.05) was negatively associated with CUSE. Being in a casual relationship (adjusted odds ratio [aOR] 3.33, p < 0.05) and CUSE (aOR 1.12, p < 0.010) were associated with increased odds of consistent condom use. Higher education (aOR 2.45, p < 0.001), adolescent sexual and reproductive health stigma (aOR 1.16, p < 0.010), and perceived HIV stigma (aOR 1.05, p < 0.05) were associated with increased odds of recent HIVST kit access. Financial resilience (aOR 1.05, p < 0.010) and young parenthood (aOR = 2.32, p < 0.010) were associated with increased odds of recent last year HIV testing. The findings demonstrate suboptimal HIV prevention outcomes and highlight the need for tailored multilevel interventions to improve the sexual health of urban refugee youth.