Didactic-Pedagogical Modeling of the Acquisition of Preventive Skills Related to Combined HIV Prevention among Key Populations in Kinshasa

Background: Combined HIV prevention is recognized as an effective approach for reducing new HIV infections among key populations. However, the sustainable acquisition of preventive skills depends not only on access to information, but also on the quality and relevance of the didactic and pedagogical strategies used during health education interventions. Objective: This study aimed to develop a didactic-pedagogical model of the determinants associated with the acquisition of preventive skills related to combined HIV prevention among key populations in Kinshasa. Methods: A longitudinal analytical study was conducted from 2022 to 2024 among 844 participants belonging to key populations in Kinshasa. Data were collected using a structured 64-item questionnaire assessing knowledge related to combined HIV prevention, perceived didactic-pedagogical strategies, motivation, self-efficacy, and environmental factors. Generalized estimating equations (GEE) were used to identify factors associated with the acquisition of preventive skills. Generalized additive models (GAM) and linear mixed models (LMM) were also explored to assess predictive performance. Results: Among the 844 participants, 618 (73.2%) demonstrated satisfactory acquisition of preventive skills, while 226 (26.8%) demonstrated insufficient acquisition. Participatory discussions, practical demonstrations, audiovisual materials, individualized feedback, intrinsic motivation, and self-efficacy were significantly associated with the acquisition of preventive skills (p < 0.05). Sociodemographic factors independently associated with the outcome included marital status, residential district, and occupation. Among the predictive models examined, the GAM showed the best reported discriminative performance (AUC = 0.87), followed by the GEE (AUC = 0.81) and the LMM (AUC = 0.79). Conclusion: The results suggest that the acquisition of preventive skills among key populations is influenced by the interaction between knowledge, active pedagogical strategies, motivation, self-efficacy, and the social and health environment. The proposed MIDCAP-HIV model provides a contextualized framework for strengthening competency-based health education and combined HIV prevention programs in the Democratic Republic of the Congo.