Assessment of Awareness and Knowledge Regarding Human T‐Lymphotropic Virus Type 1 (HTLV‐1) Among Healthcare Workers at Imam Khomeini Hospital Complex, Tehran, in 2023–2024, A Cross‐Sectional Descriptive‐Analytical Study

ABSTRACT

Background and Aim

Human T‐Lymphotropic Virus Type 1 (HTLV‐1), is responsible for serious diseases such as Adult T‐cell leukemia/lymphoma (ATLL) and HTLV‐1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). This research aimed to explore the level of awareness and knowledge of HTLV‐1 among healthcare professionals working at Imam Khomeini hospital complex in Tehran to compare their knowledge in different aspects of this virus including basic knowledge, transmission, pathogenesis, prevention and treatment.

Methods

This cross‐sectional, descriptive‐analytical study was conducted among healthcare personnel at Imam Khomeini Hospital Complex, Tehran, during 2023–2024. Data were collected using a validated questionnaire designed to assess knowledge and attitudes about HTLV‐1. The questionnaire underwent expert review for validity and reliability testing, including a 2‐week test‐retest process with Cohen's kappa coefficient calculation. It included demographic data, binary knowledge questions about HTLV‐1 transmission, symptoms, complications, prevention, and treatment.

Results

A total of 220 healthcare workers and students (63.6% female, 36.4% male) from medical, paramedical, and service fields participated in the study. Participants' attitude and knowledge levels were assessed using correct response rates, revealing significantly higher attitude scores (64.81%) compared to knowledge scores (42.61%) based on the Wilcoxon test (p < 0.05). Gender‐based comparisons showed no statistically significant differences in attitudes (p = 0.30) or knowledge (p = 0.95). Age‐group analyses using Kruskal–Wallis tests identified significant differences in knowledge performance (p = 0.00015), with the 26–35 age group outperforming others. Job position comparisons showed no significant differences in attitude or knowledge scores (p > 0.05).

Conclusion

The study highlights a notable gap in knowledge about HTLV‐1 among healthcare professionals at Imam Khomeini Hospital Complex, despite relatively positive attitudes. Significant differences in knowledge were observed across age groups, with the 26–35 age group demonstrating better awareness. These findings underscore the need for targeted educational programs to improve HTLV‐1 knowledge, particularly among younger and less experienced staff, to enhance preventive and diagnostic capabilities.

1. Introduction

Human T‐cell lymphotropic virus type 1 (HTLV‐1), was identified in 1980 as the first retrovirus in humans with the potential to cause cancer [1]. Around 10 to 20 million individuals globally are estimated to be infected with this oncogenic retrovirus. Despite this high prevalence, the virus's epidemiology remains largely unclear, and limited initiatives have focused on controlling its spread [2]. The primary regions with high HTLV burden include southwestern Japan, southern India, the Caribbean and its neighboring regions, specific foci in South America, particularly in parts of Colombia, Brazil, and French Guiana, select intertropical West African locations like southern Gabon, parts of the Middle East, including the Mashhad region in Iran, and a few isolated clusters in the Australo‐Melanesian zone, particularly among Indigenous Aboriginal populations in Australia, who are among those with the highest rates worldwide, and in Europe, Romania is an endemic area of HTLV‐1 [3, 4]. While approximately 95% of individuals infected with HTLV‐1 remain asymptomatic carriers throughout their lives, HTLV‐1 is a persistent, untreatable infection that has the potential to lead to severe diseases, such as adult T‐cell leukemia/lymphoma (ATLL) and HTLV‐1‐associated myelopathy/tropical spastic paraparesis (HAM/TSP) [5]. Although HTLV‐1 infection may not lead to disease in most infected individuals, approximately 2.5–5% of those infected may develop ATLL, and 0.3% to 2% may progress to HAM/TSP [6]. Various inflammatory conditions such as uveitis, pulmonary complications, arthritis, myositis, and Sjögren's syndrome may occur in some individuals infected with HTLV‐1, including those with HAM/TSP [7]. Although all the clinical manifestations of HTLV‐1 infection are not yet understood, early excess mortality observed among infected individuals cannot be explained solely by the development of HAM/TSP or ATLL and may be associated with increased incidence of non‐cancerous complication [8].

The primary ways HTLV‐1 spreads include mother‐to‐child transmission, sexual contact, and through blood or tissues containing infected cells [5]. Breastfed babies of infected mothers have a higher risk of infection than bottle‐fed babies, especially with prolonged breastfeeding. However, maternal antibodies may provide some early protection for newborns, this depends on the viral load in breast milk and the duration of breastfeeding [9]. Some studies have shown that infants breastfed for 6 months or less by an infected mother have no significant difference in transmission risk compared to infants who were fed formula. However, the transmission risk increases by approximately 3.5 times for infants breastfed for more than 6 months compared to those who were bottle‐fed [10]. The study suggests various interventions as potential strategies, including exclusive formula feeding, brief breastfeeding periods, freeze‐thawing milk, pasteurizing milk, administering antiretroviral drugs to both mother and infant, opting for cesarean delivery, clamping the umbilical cord early, screening milk donors, and avoiding cross‐breastfeeding; however, the primary intervention to reduce HTLV‐1 transmission in at‐risk population is screening [11]. Sexual transmission is more common from men to women, and infection risk increases with certain factors like an early first sexual encounter or having multiple partners. HTLV‐1 is also transmitted through contaminated blood, though screening in countries like the US, Canada, and the UK has lowered this risk. Organ donors in the US and UK are also screened for HTLV‐1 [9, 12]. Since 1995, laboratory screening for HTLV‐1 has been conducted in northeastern Iran, particularly in Razavi Khorasan Province, as an endemic area. Currently, HTLV‐1 screening for blood donors is regularly performed in seven Province; however, a national screening program has not yet been approved [13]. Regrettably, no universally standardized first‐line treatment for HTLV‐1 infection and its associated diseases exists at present [14]. Additionally, an approved vaccine for HTLV‐1 has yet to be developed. Nonetheless, research has explored various vaccine platforms, including viral vector vaccines, DNA‐based vaccines, protein and peptide formulations, dendritic cell vaccines, mRNA vaccines, and several other approaches [15].

Several studies have been conducted to evaluate the prevalence of HTLV in Iran. Mashhad, the capital of Razavi Khorasan province, along with the nearby city of Neyshabur in northeastern Iran, was previously identified as an area with a high prevalence of HTLV‐1 infection in the country [16]. It was reported that 7.2% (35 out of 483) of individuals who visited a referral laboratory in Neyshabour tested positive for HTLV‐1 infection [17]. In a separate study, findings indicated that, among a sample of 1678 individuals from the general population in Mashhad, the prevalence of HTLV‐1 infection was 2.12%, while HTLV‐II seropositivity was observed at a rate of 0.12% [18]. The general population in Birjand, the capital of South Khorasan province, showed a lower prevalence of HTLV‐1 infection at 0.35% (12 out of 3441). Additionally, a co‐infection rate of 1.17% for HBV and HTLV‐1 was identified [19]. Similarly, in Golestan province, the infection rate was reported to be 0.29% (6 out of 2,034) [20]. Although HTLV‐1 infection is predominantly found in northeastern Iran, especially in Razavi Khorasan province, it has also extended to other regions, including Alborz in central Iran, Ardabil in the northwest, Gilan in the north, and West Azerbaijan [21].

Given the high prevalence of HTLV‐1 in certain regions of Iran, along with its the absence of a cure or preventive vaccine, it is essential to focus on educating the public and healthcare professionals as the primary strategy for preventing transmission of HTLV‐1. This approach is particularly vital for reducing new HTLV‐1 infections in areas where the virus is endemic. However, achieving this requires that all healthcare professionals possess accurate knowledge about HTLV‐1 and maintain a professional outlook on the disease, helping to ease patients' fears and dispel misunderstandings. It is crucial for healthcare professionals to be well‐informed and to adopt a positive attitude toward managing the disease [22]. Assessing healthcare professionals' current knowledge and attitudes toward HTLV‐1 will be instrumental in designing improved educational programs that address misconceptions and foster empathy for patients. Most prior studies have focused on examining healthcare professionals' knowledge and attitudes regarding the HIV/AIDS virus [23, 24, 25]. While relatively few have investigated their understanding of the HTLV‐1 virus [26]. Therefore, this research was carried out to assess the awareness and knowledge of HTLV‐1 among healthcare professionals working at Imam Khomeini hospital complex in Tehran.

2. Material and Method

The present study is a cross‐sectional, descriptive‐analytical study conducted among 220 participants including healthcare personnel such as residents, interns, MD specialists, pharmacists, nurses, paramedics, officer staff and students from medical, paramedical, and nursing fields at Imam Khomeini Hospital Complex in Tehran during 2023–2024. Data collection methods include both library research and fieldwork.

In this study, an awareness and attitude questionnaire about HTLV‐1, modeled after existing surveys for HIV, Hepatitis B, and Hepatitis C, was designed to assess knowledge and perceptions regarding HTLV‐1.

The questionnaire, developed in two sections covering knowledge and awareness, was validated and reviewed to identify any weaknesses. Its validity and reliability were evaluated by experts in various fields of medical science, including infectious disease, obstetrics and gynecology, internal medicine, and virology. After approval, the questionnaire was administered to participants, who provided informed consent. Responses were evaluated at the Clinical Virology Research Center at Tehran University of Medical Sciences (Ethics code: IR. TUMS. SPH. REC.1402.344).

The questionnaire was paper‐based. The first section gathered demographic data, including gender, education level, field of study, and job position in the hospital. The second and third sections covered participants' knowledge and attitudes regarding HTLV‐1. For content validity, the questionnaire was presented to ten experts, including two individuals with PhDs in medical virology, two infectious disease specialists, two statisticians, one epidemiologist, one neurologist, and two general practitioners, who rated each question. Necessary adjustments were made based on their feedback. For reliability, the questionnaire was administered to 20 respondents, who completed it twice over a 2‐week interval; results from both instances were compared, and the Cohen's kappa coefficient was calculated to confirm reliability.

In the knowledge section, participants were asked about transmission routes, symptoms, complications post‐infection, the likelihood of chronic infection or cancer development post‐infection, preventive and protective measures, and treatment options. These questions are binary (Yes/No); for the purpose of scoring, “Yes” responses were considered +1 and “No” responses were considered −1. In the attitude section, participants were responded to questions about their views on patients with HTLV‐1 infection. Regarding scoring, responses were rated as follows: Strongly Disagree = −2, Disagree = −1, No opinion = 0, Agree = +1, Strongly Agree = +2. For negatively worded items, reverse scoring was applied to ensure consistency in the overall direction of the scores throughout the questionnaire. In this questionnaire, attitude was defined as participants' beliefs, feelings, perceptions, and predispositions toward HTLV‐1; awareness reflected a general recognition or consciousness that HTLV‐1 exists and may pose a risk, and knowledge refers to the factual and objective information people have about HTLV‐1 from scientific books and articles.

2.1. Statistical Analysis

Statistical analyses were performed using RStudio (version 2025.01.0). All statistical tests were two‐sided, and a p‐value < 0.05 was considered significant. Initially, the Shapiro–Wilk test was used to assess the normality of the data. Data with a p‐value greater than 0.05 were considered normally distributed, while those with a p‐value less than 0.05 were considered non‐normally distributed. If the data were normally distributed, statistical tests like ANOVA were applied to compare means across multiple groups. However, if the data did not meet the normality assumption, non‐parametric tests such as the Kruskal–Wallis, Wilcoxon, and Mann–Whitney U test were used. The Kruskal–Wallis test is a non‐parametric method to compare the rank distributions of multiple independent groups. When significant differences revealed by the Kruskal–Wallis test, post‐hoc tests were used to identify which specific groups differed. Additionally, the Mann–Whitney U test was applied for two independent groups, and Wilcoxon test was used for two related groups.

3. Results

3.1. Demographic Data

A total of 220 healthcare workers and students from various medical, paramedical participated in this study, of whom 63.6% were female and 36.4% were male. The age distribution chart and the percentage of participants by job position are presented in Figures 1 and 2. Due to the critical role of nurses in maintaining patient care, we separated them from other paramedical staff for analysis. The medical group also includes newly arrived medical students, interns/general practitioners, residents, and specialists. In the Iranian context: Medical students are those who have not yet passed the basic sciences exam. Interns refer to general medical practitioners who have graduated from medical school and are completing their mandatory internship year before full licensure. Residents are licensed M.D undergoing specialized postgraduate training. Paramedicine refers to allied health professions such as medical laboratory science, radiology, anesthesiology, and other related fields.

Figure 1.

Age distribution of the study samples. This bar chart illustrates the number of participants across the age range 18–55 years.

Figure 2.

Frequency distribution of participants by positions.

3.2. Comparison of Attitude and Knowledge Groups Based on Correct Responses

A comparison between attitude and knowledge responses among participants showed that, on average, 64.81% of answers to attitude‐related questions were correct, while 42.61% of answers to knowledge‐related questions were correct. This suggests that participants have a significantly better attitude than knowledge regarding the topic. To examine the statistical significance of this difference, both groups were tested for the Shapiro–Wilk test. The test produced W‐values of 0.95883 (p = 5.702e‐06) for attitude questions and 0.98428 (p = 0.01529) for knowledge questions, both indicating non‐normal distributions as the p‐values were below 0.05. As a result, the Wilcoxon non‐parametric test was conducted for further comparison.

The Wilcoxon test yielded a W‐value of 39848 with a p‐value of < 2.2e‐16, a statistically significant result (p < 0.05), confirming a meaningful difference between attitude and knowledge scores. Specifically, the average percentage of correct responses for attitude questions (64.81%) is significantly higher than that for knowledge questions (42.61%), suggesting that individuals in this sample hold a more positive attitude than actual knowledge on the topic, such as HTLV‐1.

3.3. Gender‐Based Comparison in Attitude and Knowledge Questions

An additional gender‐based analysis revealed that the average percentage of correct responses to attitude questions was 63.45% for men and 65.58% for women, indicating that, on average, women performed slightly better. However, the Mann–Whitney U test result (W = 5136, p = 0.3045) shows that this difference is not statistically significant, suggesting that the observed gap could be attributed to chance rather than any intrinsic difference between men and women regarding attitude.

When analyzing knowledge‐based responses by gender, men scored 42.54% and women 42.65% correct responses, showing only a minimal difference. The Mann–Whitney U test result (W = 5571, p = 0.9499) further indicates that this difference is not statistically significant. Therefore, it appears that the performance difference between men and women on knowledge questions may be due to random variation rather than a meaningful distinction.

3.4. Age Group Differences in Attitude Questions

The graph of average correct responses for attitude questions across different age groups shows that participants aged 46–55 demonstrated a stronger attitude than other age groups (Figure 3). This observation suggests that this age group may hold a more positive attitude toward the subject in question. Results from the Shapiro–Wilk normality test are as follows: for the 18–25 age group, the p‐value was 0.00877, indicating non‐normality; for the 26–35 age group, the p‐value was 0.0000260, also indicating non‐normality; the 36–45 age group had a p‐value of 0.456, suggesting normality; and the 46–55 age group had a p‐value of 0.463, also suggesting normality. The results of the Kruskal–Wallis test for comparing correct response rates in attitude‐related questions among age groups yielded a chi‐squared value of 3.7263 with 3 degrees of freedom and a p‐value of 0.2926. There was no statistically significant difference in performance on attitude‐related questions among the different age groups.

Figure 3.

Comparison of participants' attitude across age groups: 18–25, 26–35, 36–45, 46–55 years.

Based on these findings, it appears that age groups do not significantly differ in their attitude‐related responses. Therefore, no specific age group can be identified as having better or worse attitudes in this context.

3.5. Age Group Differences in Knowledge Questions

Additionally, we analyzed performance on knowledge‐related questions by age group. A preliminary observation from the data suggests that the 46–55 age group, followed by the 26–35 age group, demonstrated relatively better knowledge compared to other age groups, as indicated by their higher percentages of correct responses (Figure 4).

Figure 4.

Comparison of participants' knowledge across age groups: 18–25, 26–35, 36–45, 46–55 years.

The Shapiro–Wilk test was performed, and the results are as follows: for the 18–25 age group, the p‐value was 0.312, indicating a non‐normal distribution; for the 26–35 age group, the p‐value was 0.406, also indicating a non‐normal distribution; for the 36–45 age group, the p‐value was 0.530, indicating normality; and for the 46–55 age group, the p‐value was 0.0, indicating a non‐normal distribution. The results of the Kruskal–Wallis test showed a chi‐squared value of 20.197 and a p‐value of 0.000154. The small p‐value (less than 0.05) indicated significant differences in the percentage of correct answers across the different age groups.

The Dunn test, a post‐hoc test, was applied, and the results showed significant differences in the percentage of correct answers across age groups. A detailed analysis revealed the following: when comparing the 18–25 age group with the 26–35 age group, the 18–25 age group had a lower percentage of correct answers, indicating that the 26–35 age group performed better. In the comparison between the 26–35 and 36–45 age groups, the 26–35 group had a higher percentage of correct answers, again showing better performance in the 26–35 group. There was no significant difference between the 18–25 and 46–55 age groups, suggesting that their performance was similar. Similarly, there were no significant differences between the 26–35 and 46–55 age groups or between the 36–45 and 46–55 age groups, indicating that the performance of these groups was similar.

In conclusion, the best performance in terms of correct answers to knowledge‐related questions was observed in the 26–35 age group, while the lowest performance was found in the 18–25 age group. The 26–35 age group performed better than the other groups, and the 18–25 age group had the lowest percentage of correct answers. The other age groups (36–45 and 46–55) did not show significant differences in performance, as their results were at a similar level.

3.6. Differences in Job Position Performance on Attitude Questions

The following chart displays the average correct answers for each job position group regarding attitude‐related questions. It appears that the personnel group has a more accurate attitude compared to the two other job position groups.

Based on the results of the Shapiro–Wilk test, the data on the percentage of correct answers for the different job position groups are not normally distributed, with a p‐value for all groups being less than 0.05. Therefore, the Kruskal–Wallis test was used. The results of the test are as follows: Test statistic value: 5.38, Degrees of freedom: 2, p‐value: 0.06784. Based on the results of the Kruskal–Wallis test, there are no significant differences between the job position groups on attitude‐related questions (Figure 5).

Figure 5.

Comparison of participants' attitude by positions.

3.7. Differences in Job Position Performance on Knowledge Questions

To compare the performance of different job positions on knowledge‐related questions, we observe the average correct answers for each job position group in the chart below. It appears that the Medical Science group has a more accurate knowledge compared to the other two job position groups.

According to the results of the Shapiro–Wilk test, the percentage of correct answers for the various job position groups is not normally distributed, with a P‐Value less than 0.05 for all groups. Therefore, the Kruskal‐Wallis test was used. The results of the Kruskal–Wallis test are as follows: the test statistic is 4.6792, with 2 degrees of freedom and a p‐value of 0.09637. Since the p‐value is greater than the common significance level of 0.05, we cannot claim a significant difference between the Medical Sciences, Staff, and Para‐medicine groups regarding the knowledge‐related questions (Figure 6). Correct answers per knowledge and attitude questions have been presented in Supplemental file.

Figure 6.

Comparison of participants' knowledge by positions.

4. Discussion

This study aims to assess the attitudes and knowledge about HTLV‐1 among future healthcare personnel in Tehran, Iran. Due to the infectious nature of HTLV‐1 and the lack of a cure or preventative vaccine, educating the public on prevention methods is crucial [27]. Additionally, in this study, education of healthcare worker is considered especially important for ensuring accurate knowledge and maintaining a professional, informed perspective on HTLV‐1, which can help to dispel fear and correct misconceptions among patients, and, importantly, encouraged them to undergo testing.

Most prior research has focused on examining healthcare providers' knowledge and attitudes toward HIV/AIDS [28, 29, 30, 31, 32]. Only a limited number of studies have explored their understanding of the HTLV‐1 virus. In a study by Bayegi et al., researchers assessed the knowledge and attitudes of medical students at Mashhad University of Medical Sciences regarding the HTLV‐1 virus [26]. The study involved a sample of 271 participants who completed a questionnaire. The questionnaire in this study consisted of four parts: demographic characteristics, the amount of information resources used, the level of awareness about HTLV‐1 and, measuring the attitude of students toward HTLV‐1 infection. The scoring system included 40 knowledge assessment questions with response options of Yes, No, and Don't know, as well as 20 attitude measurement questions. In the statistical analysis of the questions, only the correct answers were awarded the desired score. Findings revealed that the students had a moderate level of knowledge, scoring an average of 16.66 out of 40. Additionally, their attitudes towards the virus were measured at an average level, with a mean score of 68.11. Unlike our study findings, which suggest that most participants are unaware that HTLV can be transmitted via blood transfusion, this study observed that a significant portion of students (206 out of 271) recognized blood as a transmission route for the infection [26]. As well, Patriquin et al. (2020) conducted a study examining Canadian physicians' knowledge, attitudes, and beliefs regarding the HTLV infection risk in solid organ transplantation [33]. Sixty‐eight clinicians took part in this survey. The majority (94.9%) accurately recognized the link between HTLV and adult T‐cell leukemia (ATLL), and around 40% estimated the risk of developing ATLL to be either 2% or 5% (n = 37) [33]. Additionally, most participants (89.7%) identified HTLV as the cause of HTLV‐associated myelopathy (HAM) (n = 39), with over half believing the disease risk to be 2% or lower (n = 38) Just over 50% of respondents rated HTLV donor screening as important or highly important for intravenous drug users, individuals with a history of multiple blood transfusions, and those from regions such as Africa, the Caribbean, and Asia [33]. In a study by Fowler et al., researchers investigated the views of healthcare professionals and Aboriginal people from communities impacted by HTLV‐1 to identify barriers in preventing its transmission in remote areas [34]. Through a series of semi‐structured and unstructured interviews with 30 Australian Aboriginal individuals, 26 non‐Aboriginal healthcare providers, and 3 non‐Aboriginal community workers, they examined perspectives on HTLV‐1, particularly in relation to sexual and reproductive health rights [34]. Both deductive and inductive approaches were used to analyze the data, with a decolonizing perspective that highlighted marginalized narratives. In this perspective, western colonial biases against Aboriginal Australians are set aside in the interpretation of data, thereby allowing marginalized indigenous narratives to be critically explored. A key discovery was the divergence between Aboriginal participants' and healthcare providers' views on information sharing. Aboriginal participants expressed a strong belief that their communities should be fully informed about HTLV‐1 and could handle this knowledge. Other perspectives included distrust toward the healthcare system, fear of social stigma, collective responsibility, and the assertion of the right to make decisions about their future. in contrast to healthcare professionals' concerns that the complexity of the virus might overwhelm Aboriginal patients [34]. Further examination revealed a range of understandings and practices regarding HTLV‐1 among healthcare workers, with differing levels of awareness in clinical settings. Some individuals had less knowledge compared to others. Additionally, the research highlighted that the public health responses remain in early stages, with no standardized protocol in place. They also stated that HTLV‐1 continues to be an overlooked infection in Australia [34]. Zihlmann et al. conducted a qualitative study at the outpatient clinic in São Paulo, Brazil, using participant observation and life story interviews with 13 patients, both symptomatic and asymptomatic [35]. The study aimed to gain insight into how individuals living with HTLV‐1 perceive and manage their condition, as well as to identify challenges within their healthcare experience. Participants revealed that HTLV‐1 remains widely unknown among the general public and health professionals alike. While counseling is infrequent, when offered, it primarily reassures patients of the low likelihood of developing related diseases, without adequately addressing risks of transmission or reproductive choices [35]. Many patients keep their diagnosis concealed due to stigma, leading to a lack of visibility for the disease, which can hinder both personal self‐care and the detection of HTLV‐1 among family members. This perception of invisibility is seemingly shared by some healthcare providers, who may not fully grasp the importance of infection prevention efforts [35].

It is essential to conduct further studies to assess healthcare workers' attitudes and knowledge about HTLV. Such research could reveal specific educational needs, allowing for targeted training programs that would better equip healthcare providers to manage and address HTLV in endemic areas effectively.

5. Conclusion

This study revealed a gap between knowledge and attitudes toward HTLV‐1, with participants having more positive attitudes than their knowledge levels. This gap highlights the importance of implementing educational programs to increase individuals' awareness, as insufficient knowledge may hinder effective prevention and control efforts. The difference in knowledge and attitude levels between males and females was minimal and not statistically significant, suggesting that educational interventions do not need to be strongly tailored by gender. Participants aged 26–35 demonstrated significantly better knowledge than younger age groups; however, there was no significant difference in attitudes based on age. This suggests that individuals in this age group may have greater knowledge due to higher education levels or more extensive life experience, while positive attitudes are not necessarily dependent on high knowledge levels. It also indicates that younger populations need more targeted education and awareness efforts. Moreover, the lack of significant differences across professional positions suggests occupation is not a major factor influencing knowledge and attitudes.

These findings underscore the importance of public health strategies that prioritize improving knowledge while building on the generally positive attitudes identified. Future efforts should focus on younger demographics and address barriers to awareness through inclusive, accessible, and targeted educational programs. Further research is needed to identify effective interventions and evaluate their impact on HTLV‐1 knowledge and prevention.

Author Contributions

Arash Letafati: conceptualization, review and editing. Yasaman Goudarzi: visualization, review and editing. Kasra Allaei Rouzbahani, Marjan Ghasemi, Mehdi Norouzi: methodology, writing original draft. Mohsen Sheikhi, Mahsa Afzali: statistical analysis. Ahmadreza Sadeghi, Sayed‐HamidrezaMozhgani: supervision, review and editing, funding acquisition.

Ethics Statement

This study was approved by the Ethics Committees of Medical Sciences Research at Tehran University of Medical Sciences, Iran. Also, Informed consent letter was provided for each participant included in the study (IR. TUMS. SPH. REC.1402.344).

Consent

Informed consent for publication of identifiable information/images journal was obtained.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The lead author Ahmadreza Sadeghi, Sayed‐Hamidreza Mozhgani affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Supporting information

Awareness Questionnaire.

Letafati A., Goudarzi Y., Sheikhi M., et al., “Assessment of Awareness and Knowledge Regarding Human T‐Lymphotropic Virus Type 1 (HTLV‐1) Among Healthcare Workers at Imam Khomeini Hospital Complex, Tehran, in 2023–2024, A Cross‐Sectional Descriptive‐Analytical Study,” Health Science Reports 9 (2026): e71860, 10.1002/hsr2.71860.

Data Availability Statement

Data will be made available on reasonable request from corresponding authors.