Strengthening HIV Prevention Through Risk Communication and Community Engagement in Cameroonian Schools: A Multiregional Study.

IntroductionHIV prevalence in Cameroon has declined over the past decade in the general population, though incidence remains worrying among adolescents and young people, largely comprised of students attending primary and higher schools, necessitating innovative community-based interventions to improve prevention in these target-populations.MethodsA mixed-methods cross-sectional study was conducted between 2019-2023 among primary and secondary school pupils and teachers in Cameroon, with the Risk Communication and Community Engagement (RCCE) framework used to provide education on HIV/AIDS, and consenting individuals tested according to national guidelines.ResultsNine out of ten national regions were included, comprising 45 localities. Overall, 1,203 participants were enrolled for HIV-screening, with a balanced female-to-male ratio (1:1). The median age was 18 years [IQR: 16-28], and adolescents (10-19 years) constituted the majority (60.1%). HIV-screening acceptance rate was high at 98%, though significantly lower in natives of the Far North region (88.9%, p<0.0001). Overall HIV-seropositivity was 1.4% (95%CI: 0.9%-2.3%), with a higher prevalence observed in rural (2.6%) compared to urban settings (0.9%) (aOR = 3.0, p = 0.032). Highest HIV-seropositivity was recorded in the 30-39 age group (6.7%, p = 0.0004), a trend that remained significant after multivariate analysis (p = 0.003). The RCCE approach fostered strong community engagement and facilitated the effective use of multimedia centers to disseminate accurate, evidence-based information on HIV prevention and care. In conclusion, HIV seroprevalence in this population remains relatively low (under 5%), although elevated prevalence rates are observed in rural-areas and among adults, particularly those aged 30-39 years.ConclusionThese findings highlight the need for integrated strategies that combine surveillance with targeted community-based interventions, addressing both students and teaching personnel especially in underserved rural regions. The RCCE approach functioning as a form of 'social vaccine,' plays a pivotal role in strengthening HIV-prevention efforts in low- and middle-income settings such as Cameroon.