Knowledge, attitude, and correlates of HIV post-exposure prophylaxis among medical students at three medical schools in China: a multi-center cross-sectional study

Abstract

Background HIV post-exposure prophylaxis (PEP) is effective when initiated promptly and used correctly, but uptake remains limited partly because potential users and future providers may not recognize when or how PEP should be used. Medical students are relevant for assessment because they represent future clinicians and may also encounter occupational exposure during training. Evidence on PEP-specific knowledge and attitudes among Chinese medical students remains limited. Methods We conducted a multi-center cross-sectional survey between March and August 2025 among 1,382 medical students at three medical schools in China. A structured 54-item online questionnaire assessed PEP knowledge, PEP attitudes, and HIV-related stigma. Knowledge and attitude scores were analyzed as continuous outcomes. Multivariable linear regression models were used to examine factors associated with knowledge and attitudes. Results The mean PEP knowledge score was 12.1 (SD = 4.3) on a 0–20 scale, and the mean attitude score was 52.8 (SD = 8.6) on a 15–75 scale. Knowledge was highest for basic PEP definition, the 72-h initiation window, and the 28-day regimen, but lower for delaying PEP until a baseline HIV test result is available, the HIV testing window period, and cost-related access. In adjusted analyses, higher knowledge was associated with academic year (beta = 0.26), prior PEP training (beta = 0.22), formal HIV curriculum exposure (beta = 0.12), and attendance at Site 1 relative to Site 3 (all p < = 0.004). More favorable attitudes were associated with higher knowledge (beta = 0.28), prior PEP training (beta = 0.15), clinical rotation completion (beta = 0.09), female sex (beta = 0.07), and attendance at Site 1 relative to Site 3 (all p < = 0.022). Knowledge and attitude scores were positively correlated (r = 0.29, p < 0.001). Conclusion In this large multi-site convenience sample, PEP knowledge was uneven and was weaker for applied clinical details than for general facts, whereas attitudes toward PEP were broadly favorable. Prior PEP-specific training was consistently associated with stronger scores. Because recruitment relied on institutional WeChat distribution rather than probability sampling, the findings should be interpreted as evidence from participating schools and should not be generalized directly to all medical students in China.