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1. HIV pre-exposure prophylaxis for men who have sex with men in west Africa: a multicountry demonstration study

Author

Christian Laurent, Bintou Dembélé Keita, Issifou Yaya, Gwenvael Le Guicher, Luis Sagaon-Teyssier, Mawuényégan K Agboyibor, Alou Coulibaly, Issa Traoré, Jean-Baptiste Malan, Irith De Baetselier, August Eubanks, Lucas Riegel, Daniela Rojas Castro, Hortense Fayé-Ketté, Amadou Koné, Souba Diandé, Claver A Dagnra, Laetitia Serrano, Fodié Diallo, Ephrem Mensah, Ter Tiero E Dah, Camille Anoma, Bea Vuylsteke, Bruno Spire, Sayouba Ouedraogo, Bruno Granouillac, Martine Peeters, Clotilde Couderc, Marion Mora, Gwenaëlle Maradan, Michel Bourrelly, Mohamed Mimi, Cyril Berenger, Sylvie Boyer, Paméla Palvadeau, Thijs Reyniers, Alassane Kader Maïga, Drissa Camara, Mahamadou Diarra, Aly Ouologuem, Naboh Sangaré, Abdoul Aziz Keita, Oumar Cissé, Fodé Traoré, Bréhima Abdrahamane Ouary, Ibrahima Kanta, Rachelle Kotchi, Niamkey Thomas Aka, Kpassou Julien Lokrou, Noufo Hamed Coulibaly, Ekissi Jean Armel Koffi, Dibi Frédéric N'guessan, Stéphane-Alain Babo Yoro, Adama Cissé, Ter Tiero Elias Dah, Camille Rajaonarivelo, Fayçal Rodrique Ouedraogo, Joseph Ouedraogo, Christian Coulibaly, Mamadou Ouedraogo, Ousseni Ilboudo, Abdoulazziz Traoré, Honoré Comsiambo, Mawuényégan Kouamivi Agboyibor, Anani Attisso, Anouwarsadat Kokouba, Aléda Mawuli Badjassim, Kouakou Kokouvi Selom Agbomadji, Messan Attiogbe, Kossi Jeff Yaka, Agbégnigan Lorette Ekon, Julien Bimba, Claver Anoumou Dagnra, Kokou Dominique Tegueni, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), ARCAD Santé PLUS [Bamako, Mali], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Espoir Vie Togo [Lomé, Togo], Association African Solidarité [Ouagadougou, Burkina Faso], Espace Confiance [Abidjan, Côte d’Ivoire], Institute of Tropical Medicine [Antwerp] (ITM), Coalition PLUS [Pantin, France], Institut Pasteur de Côte d'Ivoire, Réseau International des Instituts Pasteur (RIIP), Université des sciences, des techniques et des technologies de Bamako (USTTB), Laboratoire National de Référence de la Tuberculose [Ouagadougou, Burkina Faso] (LNRT), Laboratoire National de Référence de la tuberculose [Lomé, Togo] (LNRT/CHU Lomé), CohMSM-PrEP Study Group: Christian Laurent, Issifou Yaya, Sayouba Ouedraogo, Bruno Granouillac, Gwenvael Le Guicher, Laetitia Serrano, Martine Peeters, Clotilde Couderc, Bruno Spire, Luis Sagaon-Teyssier, Marion Mora, Gwenaëlle Maradan, Michel Bourrelly, Mohamed Mimi, Cyril Berenger, Sylvie Boyer, Daniela Rojas Castro, Lucas Riegel, Paméla Palvadeau, Bea Vuylsteke, Irith De Baetselier, Thijs Reyniers, Bintou Dembélé Keita, Fodié Diallo, Alou Coulibaly, Alassane Kader Maïga, Drissa Camara, Mahamadou Diarra, Aly Ouologuem, Naboh Sangaré, Abdoul Aziz Keita, Oumar Cissé, Fodé Traoré, Bréhima Abdrahamane Ouary, Ibrahima Kanta, Camille Anoma, Jean-Baptiste Malan, Rachelle Kotchi, Niamkey Thomas Aka, Kpassou Julien Lokrou, Noufo Hamed Coulibaly, Ekissi Jean Armel Koffi, Dibi Frédéric N'guessan, Stéphane-Alain Babo Yoro, Adama Cissé, Ter Tiero Elias Dah, Issa Traoré, Camille Rajaonarivelo, Fayçal Rodrique Ouedraogo, Joseph Ouedraogo, Christian Coulibaly, Mamadou Ouedraogo, Ousseni Ilboudo, Abdoulazziz Traoré, Honoré Comsiambo, Ephrem Mensah, Mawuényégan Kouamivi Agboyibor, Anani Attisso, Anouwarsadat Kokouba, Aléda Mawuli Badjassim, Kouakou Kokouvi Selom Agbomadji, Messan Attiogbe, Kossi Jeff Yaka, Agbégnigan Lorette Ekon, Julien Bimba, Claver Anoumou Dagnra, Kokou Dominique Tegueni, Malbec, Odile, Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université des Sciences, des Techniques et des Technologies de Bamako (USTTB), and Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI)

Subjects
Adult, Male, 0301 basic medicine, Anti-HIV Agents, Epidemiology, Sexual Behavior, [SDV]Life Sciences [q-bio], Immunology, HIV Infections, Pilot Projects, Emtricitabine, Men who have sex with men, West africa, Young Adult, 03 medical and health sciences, Pre-exposure prophylaxis, 0302 clinical medicine, Virology, parasitic diseases, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Dosing, Homosexuality, Male, Tenofovir, Prospective cohort study, business.industry, 1. No poverty, 030112 virology, 3. Good health, [SDV] Life Sciences [q-bio], Africa, Western, Regimen, Infectious Diseases, Cohort, Pre-Exposure Prophylaxis, business, Demography, medicine.drug
Abstract

International audience; Background HIV pre-exposure prophylaxis (PrEP) data in men who have sex with men (MSM) in west Africa are essential to guide its large-scale implementation. We assessed the uptake of event-driven and daily PrEP, HIV incidence, and changes over time in sexual behaviours and prevalence of bacterial sexually transmitted infections (STIs) in MSM in Burkina Faso, Côte d'Ivoire, Mali, and Togo. Methods We did a prospective cohort study from Nov 20, 2017, to April 14, 2020, in four community-based clinics in Abidjan (Côte d'Ivoire), Bamako (Mali), Lomé (Togo), and Ouagadougou (Burkina Faso). Participants were MSM aged 18 years or older at substantial risk of HIV infection. Participants could choose between event-driven (2+1+1 dosing) and daily oral PrEP (tenofovir disoproxil fumarate 300 mg plus emtricitabine 200 mg), switch regimen, and discontinue or restart PrEP. We compared HIV incidence in this study with that of the same cohort before the availability of PrEP (CohMSM). Statistical analysis included the Kaplan-Meier method and mixed-effects regression models. This study is registered with ClinicalTrials.gov, NCT03459157. Findings We followed up 598 participants for a total of 743•6 person-years. At enrolment, 445 (74%) of 598 participants chose event-driven PrEP and 153 (26%) of 598 chose daily PrEP. 60 (13%) of 445 and 65 (42%) of 153 partici pants switched PrEP regimen at least once (p

Published
2021
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2. Heterogeneity in the Prevalence of High-Risk Human Papillomavirus Infection in Human Immunodeficiency Virus-Negative and Human Immunodeficiency Virus-Positive Men Who Have Sex With Men in West Africa

Author

Issifou, Yaya, Véronique, Boyer, Phyllis Amivi, Ehlan, Alou, Coulibaly, Mawuényégan Kouamivi, Agboyibor, Issa, Traoré, Malan Jean-Baptiste, Kouamé, Alassane Kader, Maiga, Ochoh Rachelle, Kotchi, Yawo Tufa, Nyasenu, Gwenaëlle, Maradan, Daniela, Rojas-Castro, Fodié, Diallo, Camille, Anoma, Ter Tiero Elias, Dah, Ephrem, Mensah, Bintou, Dembélé Keita, Bruno, Spire, Claver Anoumou, Dagnra, Christian, Laurent, Kokou Dominique, Tegueni, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Lomé [Togo], ARCAD Santé PLUS [Bamako, Mali], Espoir Vie Togo [Lomé, Togo], Association African Solidarité [Ouagadougou, Burkina Faso], Espace Confiance [Abidjan, Côte d’Ivoire], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Coalition PLUS [Pantin, France], CohMSM Study Group: Christian Laurent, Issifou Yaya, Sayouba Ouedraogo, Bruno Granouillac, Gwenvael Le Guicher, Laetitia Serrano, Martine Peeters, Clotilde Couderc, Bruno Spire, Luis Sagaon-Teyssier, Marion Mora, Gwenaëlle Maradan, Michel Bourrelly, Mohamed Mimi, Cyril Berenger, Sylvie Boyer, Daniela Rojas Castro, Lucas Riegel, Paméla Palvadeau, Bintou Dembélé Keita, Fodié Diallo, Alou Coulibaly, Alassane Kader Maïga, Drissa Camara, Mahamadou Diarra, Aly Ouologuem, Naboh Sangaré, Abdoul Aziz Keita, Oumar Cissé, Fodé Traoré, Bréhima Abdrahamane Ouary, Ibrahima Kanta, Camille Anoma, Malan Jean-Baptiste Kouamé, Ochoh Rachelle Kotchi, Niamkey Thomas Aka, Kpassou Julien Lokrou, Noufo Hamed Coulibaly, Jean Armel Ekessi Koffi, Frédéric Dibi N'guessan, Stéphane-Alain Babo Yoro, Adama Cissé, Ter Tiero Elias Dah, Issa Traoré, Camille Rajaonarivelo, Fayçal Rodrique Ouedraogo, Joseph Ouedraogo, Christian Coulibaly, Mamadou Ouedraogo, Ousseni Ilboudo, Abdoulazziz Traoré, Honoré Comsiambo, Ephrem Mensah, Richard Mawuényégan Kouamivi Agboyibor, Anani Attisso, Anouwarsadat Kokouba, Aléda Mawuli Badjassim, Kouakou Kokouvi Selom Agbomadji, Messan Attiogbe, Kossi Jeff Yaka, Agbégnigan Lorette Ekon, Julien Bimba, Claver Anoumou Yaotsè Dagnra, Phyllis Amivi Ehlan, Xavier Yawo Tufa Nyasenu, Kokou Dominique Tegueni., Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), and Dupuis, Christine

Subjects
Male, Microbiology (medical), HPV, Multivariate analysis, Adolescent, [SDV]Life Sciences [q-bio], MSM, Human immunodeficiency virus (HIV), Anal Canal, HIV Infections, Logistic regression, medicine.disease_cause, Men who have sex with men, Sexual and Gender Minorities, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Burkina Faso, Prevalence, medicine, Humans, 030212 general & internal medicine, Homosexuality, Male, Papillomaviridae, business.industry, Papillomavirus Infections, HPV infection, HIV, virus diseases, Odds ratio, medicine.disease, Confidence interval, [SDV] Life Sciences [q-bio], Vaccination, Cross-Sectional Studies, Infectious Diseases, 030220 oncology & carcinogenesis, Africa, Female, business, Demography
Abstract

Background Men who have sex with men (MSM) are at high risk of human papillomavirus (HPV) infection. We assessed (i) the prevalence of high-risk HPV (HR-HPV) infection and associated factors, and (ii) the prevalence of vaccine-preventable HPV infections in MSM in Burkina Faso, Côte d’Ivoire, Mali, and Togo. Methods A cross-sectional study was conducted in 2017–2018 among MSM ≥18 years old followed in community-based clinics. HPV infection was investigated in oral and anal samples using the e-BRID system. Factors associated with HR-HPV infection were identified using multivariate logistic regressions. Results Among 631 participants, 425 were HIV-negative and 206 HIV-positive. HR-HPV prevalence ranged from 9.2% to 34.8% in the former, and 33.3% to 71.0% in the latter, according to the study country. In multivariate analysis, HIV infection (adjusted odds ratio (aOR) 3.61, 95% confidence interval (CI) 2.48–5.27) and study country (4.73, 2.66–8.43 for Mali; 3.12, 1.68–5.80 for Burkina Faso; 3.51, 1.92–6.42 for Togo) were associated with HR-HPV infection. Other associated factors were low educational level, self-defined homosexual identity, and condomless anal sex. The prevalence of infections which can be prevented with bivalent, quadrivalent, and nonavalent vaccines was 5.9, 27.1, and 34.6% in HIV-negative participants, and 18.9, 43.7, and 54.9% in HIV-positive participants, respectively. Conclusions HR-HPV prevalence was very heterogeneous between the study countries in both HIV-negative and HIV-positive MSM. Vaccine-preventable HPV infections predominated. Vaccination should be proposed to young MSM to reduce the burden of HPV infection in this vulnerable population and their female partners in West Africa.

Published
2021
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3. Decrease in incidence of sexually transmitted infections symptoms in men who have sex with men enrolled in a quarterly HIV prevention and care programme in West Africa (CohMSM ANRS 12324—Expertise France)

Author

Ephrem Mensah, Marion Mora, Bruno Spire, Issa Traoré, Malan Jean-Baptiste Kouamé, Issifou Yaya, Camille Anoma, Alou Coulibaly, Bintou Dembélé Keita, Paméla Palvadeau, Christian Laurent, Mawuényégan Kouamivi Agboyibor, Elias Ter Tiero Dah, Fodié Diallo, Kader Maiga, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), ARCAD Santé PLUS [Bamako, Mali], Espace Confiance [Abidjan, Côte d’Ivoire], Espoir Vie Togo [Lomé, Togo], Association African Solidarité [Ouagadougou, Burkina Faso], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Muraz [Bobo-Dioulasso, Burkina Faso], Malbec, Odile, and Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI)

Subjects
Adult, [SDV]Life Sciences [q-bio], Population, Sexually Transmitted Diseases, sexual health, HIV Infections, Dermatology, Mali, Rate ratio, Men who have sex with men, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, male, Burkina Faso, Health care, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, Poisson regression, Homosexuality, Male, Prospective cohort study, education, Reproductive health, education.field_of_study, 030505 public health, business.industry, Incidence, Incidence (epidemiology), virus diseases, homosexuality, [SDV] Life Sciences [q-bio], preventive health services, Cote d'Ivoire, Infectious Diseases, Togo, Africa, symbols, Pre-Exposure Prophylaxis, 0305 other medical science, business, Demography
Abstract

ObjectiveAlthough men who have sex with men (MSM) are at high risk of STI, their access to tailored healthcare services remains limited in West Africa. We assessed the change in STI symptoms incidence over time among MSM enrolled in a quarterly HIV prevention and care programme in four cities in Burkina Faso, Côte d’Ivoire, Mali and Togo.MethodsWe performed a prospective cohort study in MSM followed up between 2015 and 2019. Men aged over 18 who reported anal sex with another man within the previous 3 months were offered quarterly syndromic diagnosis and treatment for STI, as well as HIV testing, peer-led counselling and support. Condoms and lubricants were also provided. The change in STI symptoms incidence during follow-up was investigated using a non-parametric trend test and mixed-effect Poisson regression models.Results816 participants were followed for a total duration of 1479 person-years. 198 participants (24.3%) had at least one STI symptom during follow-up. Overall, STI symptoms incidence was 20.4 per 100 person-years (95% CI 18.4 to 22.6), ranging from 15.3 in Abidjan to 33.1 in Ouagadougou (adjusted incidence rate ratio (aIRR) 2.39, 95% CI 1.55 to 3.69, pConclusionSTI symptoms incidence decreased over time but the overall burden of STI appeared to be very high in MSM followed up in West Africa. STI services including counselling, diagnosis and treatment should be reinforced. Laboratory tests that allow accurate diagnosis of STI are required. Strengthening STI services will be critical for controlling the HIV and STI epidemics in this vulnerable population and in the general population.Trial registration numberNCT02626286.

Published
2021
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4. Combined Sexual Behavioral Profiles in HIV-Seronegative Men Who have Sex with Men in West Africa (CohMSM ANRS 12324-Expertise France)

Author

Pierre-Julien, Coulaud, Luis, Sagaon-Teyssier, Mohamed, Mimi, Bakridine, M'madi Mrenda, Gwenaëlle, Maradan, Marion, Mora, Michel, Bourrelly, Bintou Dembélé, Keita, Abdoul Aziz, Keita, Camille, Anoma, Stéphane-Alain, Babo Yoro, Ter Tiero Elias, Dah, Christian, Coulibaly, Ephrem, Mensah, Selom, Agbomadji, Adeline, Bernier, Clotilde, Couderc, Christian, Laurent, Bruno, Spire, Claver Anoumou Yaotsè, Dagnra, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), ARCAD-SIDA [Bamako, Mali], Espace Confiance [Abidjan, Côte d’Ivoire], Association African Solidarité [Ouagadougou, Burkina Faso], Centre Muraz [Bobo-Dioulasso, Burkina Faso], Espoir Vie Togo [Lomé, Togo], Coalition PLUS [Pantin, France], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), CohMSM Study Group: Clotilde Couderc, Bruno Granouillac, Suzanne Izard, Christian Laurent, Laura March, Martine Peeters, Laetitia Serrano, Cyril Berenger, Michel Bourrelly, Pierre-Julien Coulaud, Gwenaëlle Maradan, Bakri M'madi Mrenda, Marion Mora, Enzo Parisi, Luis Sagaon-Teyssier, Bruno Spire, Adeline Bernier, Paméla Palvadeau, Daniela Rojas Castro, Drissa Camara, Oumar Cisse, Alou Coulibaly, Bintou Dembele Keita, Fodié Diallo, Mahamadou Diarra, Mady Gadjigo, Abdoul Aziz Keita, Kader Maiga, Aly Ouologuem, Fodé Traore, Niamkey Thomas Aka, Camille Anoma, Stéphane-Alain Babo Yoro, Noufo Hamed Coulibaly, Rachelle Kotchi, Patrick Kouabenan, Malan Jean-Baptiste Kouame, Kpassou Julien Lokrou, Frédéric Dibi N'Guessan, Xavier Anglaret, Jean-Marie Masumbuko, Maxime Oga, Christian Coulibaly, Ter Tiero Elias Dah, Ousseni Ilboudo, Joseph Ouedraogo, Mamadou Ouedraogo, Elisabeth Thio, Juste Rodrigue Toure, Abdoulazziz Traore, Issa Traore, Fiffou Yougbare, Nicolas Meda, Kouakou Kokouvi Selom Agbomadji, Richard Mawuényégan Kouamivi Agboyibor, Messan Attiogbe, Aléda Mawuli Badjassim, Agbégnigan Lorette Ekon, Anouwarsadat Kokouba, Ephrem Mensah, Diimiln Joseph Strauss Tablissi, Kossi Jeff Yaka, Claver Anoumou Yaotsè Dagnra, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), and Dupuis, Christine

Subjects
Male, Sexual behavior, [SDV]Life Sciences [q-bio], HIV risk, Human immunodeficiency virus (HIV), HIV Infections, Human sexuality, medicine.disease_cause, West africa, Men who have sex with men, Cohort Studies, Sexual and Gender Minorities, 0302 clinical medicine, MESH: Sexual Partners, 030212 general & internal medicine, 10. No inequality, MESH: Cohort Studies, General Psychology, virus diseases, MESH: HIV Infections, 3. Good health, [SDV] Life Sciences [q-bio], MESH: Sexual and Gender Minorities, Africa, Western, Sexual Partners, MESH: Risk-Taking, MESH: Young Adult, Cohort, Sexual orientation, 0305 other medical science, Psychology, Adult, medicine.medical_specialty, MESH: Homosexuality, Male, Young Adult, 03 medical and health sciences, Risk-Taking, Arts and Humanities (miscellaneous), Identity, MESH: Africa, Western, West Africa, medicine, Humans, MSM, Homosexuality, Male, MESH: Humans, 030505 public health, Public health, MESH: Adult, MESH: Male, Demography
Abstract

International audience; Understanding the dynamics of HIV infection in men who have sex with men (MSM) can help improve efficiency in existing prevention strategies. We aimed to identify and describe the sexual behaviors of MSM most at risk of HIV infection in West Africa. HIV-negative MSM were provided a quarterly preventive follow-up package in the community-based cohort CohMSM. They completed face-to-face sociobehavioral questionnaires every 6 months. This sub-study on 520 participants used a baseline, 6-, 12- and 18-month data cluster analysis to categorize two profiles (high risk [HRE] and moderate risk [MRE] of exposure to HIV) based on three risky sexual practices over the previous 6 months. HRE-MSM (61%) were more engaged in receptive practices, had a higher proportion of inconsistent condom use during anal sex, and reported more sexual partners than MRE-MSM (39%). The proportion of HIV seroconversions observed during the first 18 months of follow-up using sexual behavioral profiles (92% are HRE-MSM) was higher than using the three risky sexual practices separately. Factors associated with the HRE-MSM profile were being younger (18-21 years), reporting stigma, and having had no female partner while being attracted only to men. Our findings suggest that in order to identify MSM most at risk of HIV infection, several risky sexual practices need to be evaluated in a combined approach. Prevention programs should pay particular attention to younger MSM, and implement activities addressing questions of MSM identity and stigma in order to reduce the dynamic of HIV infection in Western African MSM.

Published
2019
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5. Homonegativity, sexual violence and condom use with women in men who have sex with men and women in West Africa (CohMSM)

Author

Bintou Dembélé Keita, Lucas Riegel, Michel Bourrelly, Luis Sagaon-Teyssier, Clotilde Couderc, August Eubanks, Issifou Yaya, Pierre-Julien Coulaud, Marion Fiorentino, Ephrem Mensah, Christian Laurent, Gwenaëlle Maradan, Elias Ter Tiero Dah, Bruno Spire, Daniela Rojas-Castro, Camille Anoma, Dupuis, Christine, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), ARCAD-SIDA [Bamako, Mali], Espace Confiance [Abidjan, Côte d’Ivoire], Association African Solidarité [Ouagadougou, Burkina Faso], Centre Muraz [Bobo-Dioulasso, Burkina Faso], Espoir Vie Togo [Lomé, Togo], Coalition PLUS [Pantin, France] (Community Research Laboratory Pantin), CohMSM Study Group, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), and Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1)

Subjects
Male, 0301 basic medicine, MESH: Sexual Behavior, [SDV]Life Sciences [q-bio], HIV Infections, West africa, law.invention, Men who have sex with men, Condoms, Sexual and Gender Minorities, 0302 clinical medicine, 5. Gender equality, law, Immunology and Allergy, Medicine, MESH: Sexual Partners, 030212 general & internal medicine, Sexual violence, MESH: HIV Infections, 3. Good health, [SDV] Life Sciences [q-bio], MESH: Sexual and Gender Minorities, Sexual Partners, Infectious Diseases, Sexual behavior, Togo, Cohort, Female, France, Design support, Psychosocial, MESH: Sex Offenses, MESH: Cote d'Ivoire, Sexual Behavior, Immunology, MESH: Homosexuality, Male, 03 medical and health sciences, MESH: Condoms, Condom, Burkina Faso, Humans, MESH: Burkina Faso, Homosexuality, Male, MESH: Humans, business.industry, Sex Offenses, MESH: Male, MESH: France, Cote d'Ivoire, 030104 developmental biology, MESH: Togo, business, MESH: Female, Demography
Abstract

International audience; Objective: The study aimed to explore longitudinal interactions between homonegativity and sexual behaviors with female partners among HIV-negative West African men who have sex with men and women (MSMW).Design and method: The community-based cohort CohMSM ANRS 12324 - Expertise France enrolled MSM in Togo, Burkina Faso, Côte d'Ivoire and Mali. Sociobehavioral data were collected every 6 months. Using 30-month follow-up data, a multiprobit analysis was performed to investigate the relationship between psychosocial and behavioral variables ex-ante (t - 1) and ex-post (t).Results: MSMW (n = 326) accounted for half of all participants in CohMSM. They reported inconsistent condom use with women in 39% of visits. Perceived and internalized homonegativity at t - 1 tended to lead to sexual violence toward women at t (P < 0.1), which was associated with inconsistent condom use with them at t (P < 0.05).Conclusion: Given the high HIV prevalence in West African MSM, widespread condom-less sex with women in MSMW, and the aggravating effect of social and internalized homonegativity, more research in the MSMW subpopulation is needed to assess the risk of HIV bridging to women and to design support activities.

Published
2021
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6. To Pool or Not to Pool Samples for Sexually Transmitted Infections Detection in Men Who Have Sex With Men? An Evaluation of a New Pooling Method Using the GeneXpert Instrument in West Africa

Author

Bea Vuylsteke, Alain Yeo, Amadou Koné, Camille Anoma, Tania Crucitti, Anoumou Dagnra, Elias Ter Tiero Dah, Bintou Dembélé Keita, Irith De Baetselier, Hortense Faye-Kette, Issifou Yaya, Christian Laurent, Ephrem Mensah, and Souba Diandé

Subjects
Microbiology (medical), Male, medicine.medical_specialty, Gonorrhea, Pooling, Sexually Transmitted Diseases, Chlamydia trachomatis, Dermatology, urologic and male genital diseases, medicine.disease_cause, Asymptomatic, Men who have sex with men, 03 medical and health sciences, Sexual and Gender Minorities, 0302 clinical medicine, medicine, Prevalence, Humans, 030212 general & internal medicine, Homosexuality, Male, 030505 public health, GeneXpert MTB/RIF, Chlamydia, business.industry, Obstetrics, Public Health, Environmental and Occupational Health, Chlamydia Infections, medicine.disease, Neisseria gonorrhoeae, Africa, Western, Infectious Diseases, Africa, medicine.symptom, 0305 other medical science, business
Abstract

Background Men who have sex with men (MSM) using preexposure prophylaxis (PrEP) are at risk for sexually transmitted infections (STIs). Therefore, PrEP services should include regular screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at urethra, anorectum, and pharynx. However, financial and logistic challenges arise in low-resource settings. We assessed a new STI sample pooling method using the GeneXpert instrument among MSM initiating PrEP in West Africa. Methods Urine, anorectal, and pharyngeal samples were pooled per individual for analysis. In case of an invalid result only (strategy 1) or a positive result of the pool (strategy 2), samples were analyzed individually to identify the infection's biological location. The results of 2 different pooling strategies were compared against the individual results obtained by a criterion standard. Results We found a prevalence of 14.5% for chlamydia and 11.5% for gonorrhea, with a predominance of infections being extragenital (77.6%). The majority of infections were asymptomatic (88.2%). The pooling strategy 1, had a sensitivity, specificity and agreement for CT of 95.4%, 98.7%, and 0.93, respectively; and 92.3%, 99.2%, and 0.93 for pooling strategy 2. For NG, these figures were 88.9%, 97.7%, and 0.85 for strategy 1, and 88.9%, 96.7%, and 0.81 for strategy 2. Conclusions West African MSM have a high prevalence of extragenital and asymptomatic STIs. The GeneXpert method provides an opportunity to move from syndromic toward etiological STI diagnosis in low-income countries, as the platform is available in African countries for tuberculosis testing. Pooling will reduce costs of triple site testing.

Published
2020

7. Sexual health needs of female sex workers in Côte d’Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention

Author

Valentine, Becquet, Marcellin, Nouaman, Mélanie, Plazy, Jean-Marie, Masumbuko, Camille, Anoma, Soh, Kouame, Christine, Danel, Serge Paul, Eholie, Joseph, Larmarange, Yeo, Roselyne, Institut national d'études démographiques (INED), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Programme PAC-CI, ANRS France Recherche Nord & sud Sida-hiv hépatites, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Espace Confiance [Abidjan, Côte d’Ivoire], Aprosam, Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)-Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), ANRS 12361 PrEP-CI, and Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)

Subjects
Male, Safe Sex, demography, [SDV]Life Sciences [q-bio], Human sexuality, law.invention, [SHS]Humanities and Social Sciences, Pre-exposure prophylaxis, 0302 clinical medicine, law, HEALTH_SERVICES, 030212 general & internal medicine, Reproductive health, education.field_of_study, public health, virus diseases, General Medicine, 3. Good health, AIDS, Sexual Partners, SEXUALLY_TRANSMITTED_DISEASES, Community health, Female, epidemiology, Sexual Health, 0305 other medical science, Ivory Coast, HIV infections, Adult, medicine.medical_specialty, REPRODUCTIVE_HEALTH, IVORY_COAST, sexually transmitted diseases, Sexual Behavior, Sex workers, Population, HIV & AIDS, IDLIC, 03 medical and health sciences, Young Adult, Condom, Acquired immunodeficiency syndrome (AIDS), medicine, Humans, reproductive health, education, health services, PROSTITUTION, Retrospective Studies, 030505 public health, business.industry, HIV, medicine.disease, Sexual intercourse, Cote d'Ivoire, Cross-Sectional Studies, Family medicine, Pre-Exposure Prophylaxis, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, SUB-SAHARAN_AFRICA, business, qualitative research, Follow-Up Studies
Abstract

ObjectiveTo describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population.Design and settingThe ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d’Ivoire.ParticipantsA convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs’ risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services.ResultsAlthough 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner’s HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication.ConclusionsDespite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d’Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.

Published
2020
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8. Reaching a Different Population of MSM in West Africa With the Integration of PrEP Into a Comprehensive Prevention Package (CohMSM-PrEP ANRS 12369—Expertise France)

Author

Camille Anoma, Daniela Rojas Castro, Luis Sagaon-Teyssier, Gwenaëlle Maradan, Bintou Dembélé Keita, Michel Bourrelly, August Eubanks, Marion Mora, Ephrem Mensah, Issifou Yaya, Ter Tiero Elias Dah, Bruno Spire, Christian Laurent, Lucas Riegel, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), ARCAD-SIDA [Bamako, Mali], Espace Confiance [Abidjan, Côte d’Ivoire], Association African Solidarité [Ouagadougou, Burkina Faso], Centre Muraz [Bobo-Dioulasso, Burkina Faso], Espoir Vie Togo [Lomé, Togo], Coalition PLUS [Pantin, France] (Community Research Laboratory Pantin), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), CohMSM-PrEP Study Group, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), and Dupuis, Christine

Subjects
Male, medicine.medical_specialty, Anti-HIV Agents, media_common.quotation_subject, [SDV]Life Sciences [q-bio], Population, Psychological intervention, HIV Infections, 030312 virology, Men who have sex with men, 03 medical and health sciences, Pre-exposure prophylaxis, Risk Factors, Odds Ratio, Medicine, Humans, Pharmacology (medical), Homosexuality, Homosexuality, Male, 10. No inequality, education, media_common, 0303 health sciences, education.field_of_study, Unsafe Sex, business.industry, 1. No poverty, virus diseases, 16. Peace & justice, 3. Good health, [SDV] Life Sciences [q-bio], Outreach, Africa, Western, Infectious Diseases, Family medicine, Cohort, Pre-Exposure Prophylaxis, business, Peer education
Abstract

International audience; Background: In West Africa, few HIV services target men who have sex with men (MSM). In 2015, the interventional cohort CohMSM started offering a community-based prevention package for MSM. Participants expressed interest in pre-exposure prophylaxis (PrEP) and their eligibility was demonstrated. In 2017, PrEP was added to services already offered as part of a new program, CohMSM-PrEP, which recruited CohMSM participants and new participants. We aimed to determine whether the introduction of PrEP as an additional prevention tool influenced the type of participant signing up for CohMSM-PrEP.Methods: CohMSM-PrEP recruited HIV-negative MSM in community-based clinics in Mali, Cote d'Ivoire, Burkina Faso, and Togo. Quarterly follow-up included free clinical examinations, PrEP, HIV/sexually transmitted infection screening, peer education, condoms, and lubricants. Sociobehavioral data were collected every 3 months using face-to-face questionnaires. Our outcome was participant type: new participants vs CohMSM participants. Logistic regression was performed to identify the factors associated with being a new participant.Results: Of the 524 MSM included in CohMSM-PrEP, 41% were new participants. After adjustment, multivariate analysis showed they were more socioeconomically disadvantaged with financial insecurity, social isolation-including isolation within the MSM community-and riskier sexual practices.Conclusion: The introduction of PrEP as an additional prevention tool and the use of peer-based outreach services over time influenced the type of participant signing up for a community-based HIV prevention cohort in West Africa. Adding these elements to existing interventions in Sub-Saharan Africa could be the key to reaching MSM marginalized from HIV prevention and care programs.

Published
2020
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9. Changes in risky sexual behaviours among West African MSM enrolled in a quarterly HIV testing and counselling prevention programme (CohMSM ANRS 12324 - Expertise France)

Author

Camille Anoma, Marion Mora, Abdoul Aziz Keita, Bintou Dembélé Keita, Mohamed Mimi, Stéphane-Alain Babo Yoro, Daniela Rojas Castro, Pierre-Julien Coulaud, Michel Bourrelly, Paméla Palvadeau, Adeline Bernier, Ephrem Mensah, Bruno Spire, Selom Agbomadji, Christian Coulibaly, Clotilde Couderc, Elias Ter Tiero Dah, Christian Laurent, Gwenaëlle Maradan, Luis Sagaon-Teyssier, Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Muraz [Bobo-Dioulasso, Burkina Faso], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD), Espace Confiance [Abidjan, Côte d’Ivoire], Association African Solidarité [Ouagadougou, Burkina Faso], Espoir Vie Togo [Lomé, Togo], Coalition PLUS, Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Université de Montpellier (UM), Institut de Recherche pour le Développement (IRD [France-Sud]), Université de Montpellier (UM), and Aiello, Mélisande

Subjects
Counseling, Male, [SDV]Life Sciences [q-bio], Social Stigma, Intimate Partner Violence, HIV Infections, hiv, 030312 virology, Mali, Men who have sex with men, law.invention, Cohort Studies, Condoms, Health Risk Behaviors, Sexual and Gender Minorities, 0302 clinical medicine, prevention, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Medicine, 030212 general & internal medicine, Depression (differential diagnoses), 0303 health sciences, Depression, Risk of infection, Age Factors, sexual behaviour, Gender Identity, virus diseases, 3. Good health, Infectious Diseases, Togo, Cohort, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Bisexuality, Adult, Sexual Behavior, Sexually Transmitted Diseases, Dermatology, Hiv testing, Young Adult, 03 medical and health sciences, Condom, Burkina Faso, West Africa, Humans, MSM, Unsafe Sex, business.industry, Sex Work, Mental health, Self Concept, Cote d'Ivoire, Logistic Models, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Harassment, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Risk Reduction Behavior, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Demography
Abstract

ObjectivesWhether regular HIV testing and counselling reduce risky sexual behaviours in African men who have sex with men (MSM) is still a matter for debate. We aimed to identify behavioural trajectories based on HIV risk exposure (HRE) and factors affecting their evolution.MethodsData were collected from 621 HIV-negative West African MSM (Mali, Cote d'Ivoire, Burkina Faso and Togo) included in a community-based cohort providing quarterly HIV testing and counselling. Sociobehavioural data were collected every 6 months. HRE was defined as reporting inconsistent condom use during receptive anal sex with male partners of unknown HIV status in the previous 6 months. Using 18-month follow-up data, group-based trajectory modelling helped identify behavioural trajectories and determine the factors associated with their evolution. HIV seroconversions (n=67) were specified in each group trajectory.ResultsTwo distinct group trajectories were identified: medium-risk exposure MSM (ME-MSM) (61%, 6.4% of whom having seroconverted) and high-risk exposure MSM (HE-MSM) (39%, 17.5% of whom having seroconverted). A significant declining trend in the probability of reporting HRE over time ((95% CI)) was observed for HE-MSM (from 0.59 (0.48 to 0.70) at M0 to 0.31 (0.22 to 0.41) at M18), while it remained constant for ME-MSM (0.034 (0.0 to 0.079)). This can be explained by a progressive use of risk reduction strategies (less receptive anal sex, better knowledge of their partners’ status and increasing condom use). Being younger, living in Burkina Faso, self-considering both a man and a woman and reporting a higher level of depression were all associated with HE membership. Among HE-MSM, HRE was higher in those practising transactional or group sex and those experiencing psychological harassment.ConclusionsQuarterly HIV testing and counselling seem to reduce risky sexual behaviours in HIV-negative MSM at greatest risk of infection. Specific support for young MSM, focusing on identity and mental health, is needed to strengthen HIV prevention in West African MSM.

Published
2020
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10. Estimating the number of female sex workers in Côte d'Ivoire: results and lessons learned

Author

Camille Anoma, Marie Laga, Bea Vuylsteke, Lazare Sika, Elise Kacou, and Gisèle Semdé

Subjects
Population, Sex workers, Developing country, Mark and recapture, 03 medical and health sciences, 0302 clinical medicine, Humans, 030212 general & internal medicine, Cities, education, Socioeconomics, Developing Countries, Poverty, education.field_of_study, Sex Workers, 030505 public health, Population statistics, Population size, Public Health, Environmental and Occupational Health, Female sex, Census, Cote d'Ivoire, Infectious Diseases, Geography, Female, Parasitology, 0305 other medical science
Abstract

Objective To report on the results of three size estimations of the populations of female sex workers (FSW) in five cities in Cote d'Ivoire and on operational lessons learned, which may be relevant for key populations programs in other parts of the world. Methods We applied three methods: mapping and census, capture-recapture and service multiplier. All were applied between 2008 and 2009 in Abidjan, San Pedro, Bouake, Yamoussoukro and Abengourou. Results Abidjan was the city with the highest number of FSW by far, with estimations between 7880 (census) and 13714 (service multiplier). The estimations in San Pedro, Bouake and Yamoussoukro were very similar, with figures ranging from 1160 (Yamoussoukro, census) to 1916 (San Pedro, capture-recapture). Important operational lessons were learned, including strategies for mapping, the importance of involving peer sex workers for implementing the capture-recapture and the identification of the right question for the multiplier method. Conclusions Successful application of three methods to estimate the population size of FSW in five cities in Cote d'Ivoire enabled us to make recommendations for size estimations of key population in low income countries. This article is protected by copyright. All rights reserved.

Published
2017
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11. Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa

Author

Michel Bourrelly, Bintou Dembélé Keita, Ephrem Mensah, Camille Anoma, Abdoul Aziz Keita, Pierre-Julien Coulaud, Elias Ter Tiero Dah, Bruno Spire, Cheick Haïballa Kounta, Stéphane-Alain Babo Yoro, Gwenaëlle Maradan, Luis Sagaon-Teyssier, Selom Agbomadji, Clotilde Couderc, Marion Mora, Christian Laurent, Christian Coulibaly, Adeline Bernier, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Centre Muraz [Bobo-Dioulasso, Burkina Faso], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut de Recherche pour le Développement (IRD [France-Sud]), Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Montpellier (UM), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), and Aiello, Mélisande

Subjects
RNA viruses, Male, Safe Sex, Epidemiology, Economics, Physiology, [SDV]Life Sciences [q-bio], Social Sciences, HIV Infections, Human sexuality, Pathology and Laboratory Medicine, Men who have sex with men, West africa, Geographical Locations, Cohort Studies, 0302 clinical medicine, Immunodeficiency Viruses, Reproductive Physiology, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Copulation, Medicine and Health Sciences, Medicine, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Generalized estimating equation, Alcohol Consumption, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, 3. Good health, [SDV] Life Sciences [q-bio], Africa, Western, Sexual Partners, Medical Microbiology, HIV epidemiology, Viral Pathogens, Sex life, Viruses, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Pathogens, 0305 other medical science, Research Article, Adult, Sexual Behavior, HIV prevention, Men WHO Have Sex with Men, Transactional sex, Microbiology, Young Adult, 03 medical and health sciences, Retroviruses, Humans, Homosexuality, Male, Microbial Pathogens, Socioeconomic status, Nutrition, Preventive medicine, Sex Workers, 030505 public health, business.industry, Lentivirus, Organisms, Biology and Life Sciences, HIV, Diet, Public and occupational health, People and Places, Africa, Population Groupings, business, Finance, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Sexuality Groupings, Demography
Abstract

International audience; Although the HIV epidemic is generalized in West Africa, some population groups such as men who have sex with men (MSM), especially those engaged in transactional sex (TS), are thought to be particularly more vulnerable to HIV than others. However, few data are available to help identify their health-related needs with a view to implementing targeted prevention interventions. To fill this knowledge gap, we aimed to characterize MSM reporting TS (MSM-TS) and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM, which was conducted in Burkina Faso, Côte d'Ivoire, Mali and Togo. Three stigmatization sub-scores were constructed (experienced, perceived and internalized). The generalized estimating equation method was used for data analysis. Of the total 630 HIV-negative MSM recruited in CohMSM, 463, 410 and 244 had a follow-up visit at 6, 12 and 18 months, respectively. In a total of 1747 follow-up visits, 478 TS encounters were reported by 289 MSM-TS (45.9%). Of the latter, 91 regularly reported TS (31.5%), 55 (19.0%) stopped reporting TS after baseline, and 53 (18.3%) reported TS after baseline and 90 (31.1%) occasionally reported TS. The following variables, regarding the previous 6 months, were positively associated with TS: being younger (aOR[95%CI]:1.86[1.39-2.50]), less educated (aOR[95%CI]:1.49[1.09-2.03]), unmarried status (aOR[95%CI]:1.79[1.10-2.93]), satisfaction with current sex life (aOR[95%CI]:1.41[1.06-1.88]), group sex with men (aOR[95%CI]:2.07[1.46-2.94]), multiple male sexual partners (aOR[95%CI]:1.85[1.40-2.44]), receptive or versatile anal sex with male partners (aOR [95%CI]:1.48[1.12-1.96]), giving benefits in exchange for sex with a man (aOR[95%CI]:2.80[1.97-3.98]), alcohol consumption (aOR[95%CI]:1.44[1.08-1.93]) and drug use (aOR[95%CI]:1.82[1.24-2.68]) during sex, and finally experiencing stigmatization (aOR [95%CI]:1.15[1.07-1.25]). Condom use during anal sex (aOR[95%CI]:0.73[0.53-0.99]) was negatively associated with TS.

Published
2019
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12. Male clients of male sex workers in West Africa: A neglected high-risk population

Author

Cheick Haïballa Kounta, Luis Sagaon-Teyssier, Pierre-Julien Coulaud, Marion Mora, Gwenaelle Maradan, Michel Bourrelly, Abdoul Aziz Keita, Stéphane-Alain Babo Yoro, Camille Anoma, Christian Coulibaly, Elias Ter Tiero Dah, Selom Agbomadji, Ephrem Mensah, Adeline Bernier, Clotilde Couderc, Bintou Dembélé Keita, Christian Laurent, Bruno Spire, CohMSM Study Group, Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Institut de Recherche pour le Développement (IRD [France-Sud]), Université de Montpellier (UM), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), and Aiello, Mélisande

Subjects
RNA viruses, Male, Bisexuals, [SDV]Life Sciences [q-bio], Human sexuality, HIV Infections, 030312 virology, Logistic regression, Pathology and Laboratory Medicine, Mali, Men who have sex with men, Geographical Locations, Sexual and Gender Minorities, 0302 clinical medicine, Immunodeficiency Viruses, Risk Factors, Medicine and Health Sciences, Medicine, 030212 general & internal medicine, Homosexuality, Young adult, Male Sex Workers, Prospective cohort study, media_common, 0303 health sciences, education.field_of_study, Multidisciplinary, Middle Aged, [SDV] Life Sciences [q-bio], Professions, Medical Microbiology, Viral Pathogens, Viruses, Infectious diseases, Pathogens, Research Article, Adult, Science, media_common.quotation_subject, Sexual Behavior, Population, HIV prevention, Men WHO Have Sex with Men, Transactional sex, Viral diseases, Microbiology, 03 medical and health sciences, Young Adult, Retroviruses, Burkina Faso, Humans, Homosexuality, Male, education, Microbial Pathogens, Preventive medicine, Sex Workers, business.industry, Lentivirus, Organisms, Biology and Life Sciences, HIV, Public and occupational health, Logistic Models, People and Places, Africa, Population Groupings, business, Demography, Sexuality Groupings
Abstract

International audience; Research on male clients of male sex workers (MCMSW) has been neglected for a long time globally. We aimed to characterize MCMSW and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM conducted in Burkina Faso, Côte d'Ivoire, Mali and Togo. Our study focused on HIV-negative men who have sex with other men (MSM), recruited between 06/2015 and 01/2018 by a team of trained peer educators. Scheduled study visits at 6, 12 and 18 months included medical examinations, HIV screening, risk-reduction counselling and face-to-face interviews to collect information on their sociodemographic characteristics, sexual behaviours, and HIV risk-reduction strategies (HIV-RRS). Three stigmatization sub-scores were constructed (experienced, perceived and internalized). Mixed-effects logistic regression was used for data analysis. Of the 280 participants recruited at baseline, 238, 211 and 118, respectively, had a follow-up visit at 6, 12 and 18 months. Over a total of 847 visits, 47 transactional sex (TS) encounters were reported by 38 MCMSW (13.6%). Of the latter, only one participant reported systematic TS (2.6%), 18 (47.4%) stopped reporting TS after baseline, while 6 (15.8%) reported TS after baseline. Thirteen participants (34.2%) reported occasional TS. After adjusting for country of study and age, the following self-reported factors were associated with a greater likelihood of being MCMSW: protected anal sex, exclusively insertive anal sex with male sexual partners, avoidance of sex after consuming psychoactive products and experiencing stigmatization (all during the previous 6 months). The majority of MCMSW in this study practiced HIV-RRS with male sexual partners, including engaging in protected anal sex, avoidance of sex when consuming psychoactive products, and practising exclusively insertive anal sex.

Published
2019
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13. Taking empowerment into account: the response of community-based organisations to the HIV care needs of men who have sex with men in West Africa (CohMSM ANRS 12324 - Expertise France)

Author

Bintou Dembélé Keita, Elias Ter Tiero Dah, Elisabeth Thio, Camille Anoma, Marie Préau, Clotilde Couderc, Bruno Spire, Christian Laurent, Gwenaëlle Maradan, Pierre-Julien Coulaud, Marion Mora, Lorette Ekon, Adeline Bernier, Maxime Oga, Fodé Traoré, Ephrem Mensah, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Montpellier (UM), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), and Aiello, Mélisande

Subjects
Gerontology, Adult, Male, Health (social science), Social Psychology, [SDV]Life Sciences [q-bio], media_common.quotation_subject, Discourse analysis, Social Stigma, Stigma (botany), Identity (social science), HIV Infections, Mali, Men who have sex with men, Power (social and political), 03 medical and health sciences, Young Adult, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Burkina Faso, Medicine, Humans, MSM, 030212 general & internal medicine, Community Health Services, Homosexuality, Male, 10. No inequality, Empowerment, media_common, Sexual identity, Motivation, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, community-based organisations, 030505 public health, business.industry, Public Health, Environmental and Occupational Health, HIV, 16. Peace & justice, [SDV] Life Sciences [q-bio], Cote d'Ivoire, Togo, Africa, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Thematic analysis, 0305 other medical science, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Empowerment is an ongoing process through which individuals and communities appropriate power and acquire the capability to function autonomously. Research on empowerment in men who have sex with men (MSM) is lacking in community-based contexts. We investigated the relationship between willingness to be empowered and HIV care needs in West African MSM accessing community-based organisations’ (CBO) services. Fifty-three interviews were administered to HIV-negative MSM participating in the CohMSM study (Mali, Burkina Faso, Côte d’Ivoire, Togo). Five indicators of empowerment were identified from a discourse analysis: (i) motivation to access HIV services, (ii) willingness to improve HIV services, (iii) desire to be involved in new activities, (iv) desire to participate in such services, (v) willingness to collaborate in decision making. Based on these indicators, participants were classified into two profiles: high (19/53, 36%) and low (34/53, 64%) level of willingness to be empowered (HWE, LWE). Using a thematic analysis, HWE participants were focused on collective benefit (preventive follow-up, questions about MSM identity), while LWE participants were centred on individual benefit (medical care). CBOs should consider empowerment as a tool to advance collective health benefits for MSM. To improve empowerment in MSM, specific training on issues regarding sexual identity and stigma is needed for CBO providers.

Published
2019
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14. Hepatitis B Virus Prevalence and Vaccination in Men Who Have Sex With Men in West Africa (CohMSM ANRS 12324—Expertise France)

Author

Ter Tiero Elias, Dah, Clotilde, Couderc, Alou, Coulibaly, Malan Jean-Baptiste, Kouamé, Mawuényégan Kouamivi, Agboyibor, Issa, Traoré, Gwenaëlle, Maradan, Daniela, Rojas Castro, Ephrem, Mensah, Camille, Anoma, Bintou, Dembélé Keita, Bruno, Spire, Christian, Laurent, Claver Anoumou Yaotsé, Dagnra, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Institut de Recherche pour le Développement (IRD [France-Sud]), Centre Muraz [Bobo-Dioulasso, Burkina Faso], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Aiello, Mélisande, Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), and Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI)

Subjects
HBsAg, 030231 tropical medicine, prevalence, men who have sex with men, medicine.disease_cause, Logistic regression, Men who have sex with men, 03 medical and health sciences, 0302 clinical medicine, [SDV.IMM.VAC] Life Sciences [q-bio]/Immunology/Vaccinology, parasitic diseases, medicine, Major Article, 030212 general & internal medicine, Hepatitis B virus, business.industry, virus diseases, Odds ratio, Hepatitis B, medicine.disease, vaccination, Confidence interval, 3. Good health, Vaccination, Infectious Diseases, Oncology, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Africa, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, hepatitis B, [SDV.IMM.VAC]Life Sciences [q-bio]/Immunology/Vaccinology, business, Demography
Abstract

BackgroundAlthough men who have sex with men (MSM) are at high risk of hepatitis B virus (HBV) infection, they do not have access to vaccination in West Africa, which is a highly endemic region. We investigated HBV prevalence and associated factors, as well as acceptability and difficulties of vaccination in MSM enrolled in an operational research program in Burkina Faso, Côte d’Ivoire, Mali, and Togo.MethodsWe followed up 779 MSM in 2015–2018. Participants who were negative for both hepatitis B surface antigen (HBsAg) and antibodies (anti-HBs) at enrollment were offered HBV vaccination. Factors associated with HBV infection were identified using logistic regression models.ResultsOverall, HBV prevalence was 11.2% (95% confidence interval [CI], 9.0%–13.6%). It was lower in Togo than in Côte d’Ivoire (2.7% vs 17.3%; adjusted odds ratio [aOR], 0.12; 95% CI, 0.02–0.28) and higher in participants with 6+ recent male sexual partners (21.0% vs 9.3%; aOR, 1.48; 95% CI, 1.12–1.97). Of 528 participants eligible for vaccination, 484 (91.7%) were willing to be vaccinated and received at least 1 dose (ranging from 68.2% in Abidjan to 96.4% in Bamako; P < .001). Of the latter, 390 (80.6%) received 3 or 4 doses. The proportion of participants for whom the minimum required time between each dose was respected ranged from 10.9% in Bamako to 88.6% in Lomé (P < .001).ConclusionsMSM in West Africa should be targeted more for HBV screening and vaccination. Although vaccination is well accepted by MSM, greater training of health care workers and education of MSM are required.

Published
2019
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15. Interest in HIV pre-exposure prophylaxis in men who have sex with men in West Africa (CohMSM ANRS 12324 - Expertise France)

Author

Pierre-Julien, Coulaud, Luis, Sagaon-Teyssier, Bakridine, M'madi Mrenda, Gwenaëlle, Maradan, Marion, Mora, Michel, Bourrelly, Bintou, Dembélé Keita, Abdoul Aziz, Keita, Camille, Anoma, Stéphane-Alain, Babo Yoro, Ter Tiero Elias, Dah, Christian, Coulibaly, Ephrem, Mensah, Selom, Agbomadji, Adeline, Bernier, Clotilde, Couderc, Christian, Laurent, Bruno, Spire, Claver Anoumou Yaotsè, Dagnra, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), ARCAD-SIDA [Bamako, Mali], Espace Confiance [Abidjan, Côte d’Ivoire], Association African Solidarité [Ouagadougou, Burkina Faso], Centre Muraz [Bobo-Dioulasso, Burkina Faso], Espoir Vie Togo [Lomé, Togo], Coalition PLUS [Pantin, France], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), This study was funded by the ANRS (France Recherche Nord & Sud Sida-hiv Hépatites, ANRS 12324) and Expertise France (Initiative 5%). PJC was the recipient of a doctoral fellowship from ANRS (B7-ANRS 12324)., The CohMSM Study Group : Granouillac B, Izard S, March L, Peeters M, Serrano L, Berenger C, Parisi E, Palvadeau P, Rojas Castro D, Trenado E, Camara D, Cisse O, Coulibaly A, Diallo F, Diarra M, Gadjigo M, Maiga K, Ouologuem A, Traore F, Aka NT, Coulibaly NH, Kotchi R, Kouabenan P, Kouame MJ, Lokrou KJ, N'Guessan FD, Anglaret X, Masumbuko JM, Oga M, Ilboudo O, Ouedraogo J, Ouedraogo M, Thio E, Toure JR, Traore A, Traore I, Yougbare F, Meda N, Agboyibor RMK, Attiogbe M, Badjassim AM, Ekon AL, Kokouba A, Tablissi DJS, Yaka KJ, Dagnra CAY., Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Dupuis, Christine, and Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI)

Subjects
Adult, Male, Health Knowledge, Attitudes, Practice, Anti-HIV Agents, Human immunodeficiency virus (HIV), men who have sex with men, HIV Infections, Transactional sex, Mali, medicine.disease_cause, Logistic regression, Men who have sex with men, Sexual and Gender Minorities, Young Adult, 03 medical and health sciences, Pre-exposure prophylaxis, 0302 clinical medicine, prevention, Burkina Faso, medicine, Humans, 030212 general & internal medicine, Homosexuality, Male, pre-exposure prophylaxis, 030505 public health, Unsafe Sex, business.industry, Public Health, Environmental and Occupational Health, HIV, Odds ratio, Patient Acceptance of Health Care, Confidence interval, 3. Good health, Cote d'Ivoire, Cross-Sectional Studies, Infectious Diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Togo, Africa, Parasitology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, prophylaxis, 0305 other medical science, business, Demography, Cohort study
Abstract

International audience; OBJECTIVE:To explore the interest in taking PrEP among Western African men who have sex with men (MSM).METHODS:A cross-sectional survey was implemented at enrolment of HIV-negative MSM in a multiple centre community-based cohort study in four West African countries (Mali, Côte d'Ivoire, Burkina Faso, Togo). A standardised face-to-face questionnaire collected data on socio-demographic and behavioural characteristics over the previous 6 months. Descriptive analysis and multivariate logistic regression helped identify factors associated with the interest in taking PrEP.RESULTS:Of 564 participants, 87% were interested in taking PrEP. Interest in PrEP was associated with inconsistent condom use for anal sex (adjusted odds ratio (aOR): 2.11; 95% confidence interval (CI) 1.21-3.67), transactional sex (aOR: 2.02; 95% CI 1.11-3.71), searching for male sexual partners on the Internet in the previous month (aOR: 1.86; 95% CI 1.01-3.43), having a high level of self-esteem (aOR: 1.20; 95% CI 1.06-1.36), having at least one sexually transmitted infections at enrolment (aOR: 5.08; 95% CI 1.40-18.4) and not being aware of PrEP (aOR: 2.03; 95% CI 1.04-3.96). Participants having sex with HIV-positive male partners (aOR: 0.28; 95% CI 0.11-0.74), those being more sexually attracted to women than to men (aOR: 0.20; 95% CI 0.07-0.89) and those reporting psychological and material support from close friends (aOR: 0.33; 95% CI 0.15-0.73) were less interested in taking PreP.CONCLUSIONS:Western African HIV-negative MSM appear very interested in taking PrEP, especially those most at risk of HIV infection. PrEP implementation in a comprehensive prevention package should be considered urgently.

Published
2018
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16. Is PrEP Needed for MSM in West Africa? HIV Incidence in a Prospective Multicountry Cohort

Author

Sylvain Ehouman, Abdoulaye Sidibe Wade, Alou Coulibaly, Yves Yomb, Emilie Henry, Bruno Spire, Christian Laurent, Clotilde Couderc, Bintou Dembélé Keita, Camille Anoma, and Abdou K. Diop

Subjects
0301 basic medicine, Adult, Male, Health Knowledge, Attitudes, Practice, Anti-HIV Agents, Health knowledge, HIV Infections, Pilot Projects, West africa, 03 medical and health sciences, Pre-exposure prophylaxis, Young Adult, 0302 clinical medicine, Environmental health, Medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Prospective Studies, Homosexuality, Male, Prospective cohort study, Sex Workers, Unsafe Sex, business.industry, Incidence (epidemiology), Incidence, Hiv incidence, Patient Acceptance of Health Care, 030112 virology, Africa, Western, Infectious Diseases, Multicenter study, Cohort, Pre-Exposure Prophylaxis, business, Needs Assessment
Published
2017

17. Hepatitis B treatment eligibility in West Africa: Uncertainties and need for prospective cohort studies

Author

Judicaël Tine, Marcellin Nouaman, Camille Anoma, François Dabis, Gilles Wandeler, Alain Attia, Didier K. Ekouevi, Antoine Jaquet, André Inwoley, Aristophane Tanon, and Moussa Seydi

Subjects
Adult, Male, medicine.medical_specialty, Cirrhosis, medicine.disease_cause, Article, Men who have sex with men, 03 medical and health sciences, Sexual and Gender Minorities, 0302 clinical medicine, Hepatitis B, Chronic, Interquartile range, Internal medicine, medicine, Prevalence, Humans, 030212 general & internal medicine, Prospective cohort study, Hepatitis B virus, Sex Workers, Hepatology, business.industry, Prisoners, virus diseases, Hepatitis B, medicine.disease, digestive system diseases, 3. Good health, Africa, Western, Cross-Sectional Studies, Immunology, 030211 gastroenterology & hepatology, Female, Transient elastography, business, Viral load
Abstract

BACKGROUND & AIMS While universal screening of hepatitis B virus (HBV) is recommended in high burden countries, little is known about the proportion of HBV-infected persons in need of antiviral therapy in these settings. METHODS Prisoners in Senegal and Togo, as well as female sex workers and men who have sex with men in Cote d'Ivoire were screened for HBV infection. All HBsAg-positive participants underwent transient elastography, alanine aminotransferase (ALT) and HBV viral load quantification. Individuals with liver cirrhosis or those aged>30 years with an HBV replication ≥20 000 IU/ml and elevated ALT were considered eligible for antiviral therapy. RESULTS Of 1 256 participants, 110 (8.8%) were HBsAg-positive; their median age was 30 years [interquartile range: 25-33] and 96 (86.5%) were men. Three individuals (2.7%) had liver cirrhosis while 28 (29.5%) of 94 participants with available measurements had an HBV viral load ≥20 000 IU/ml. Overall, 11 (10.0%) subjects were considered eligible for immediate antiviral treatment; 2.1% of participants in Dakar, 7.7% in Abidjan and 21.6% in Lome (p=0.001) and 59 (53.4%) for close monitoring due to the presence of significant liver fibrosis, elevated ALT or significant HBV replication. CONCLUSIONS Among vulnerable populations in West Africa, a minority of HBV-infected individuals were eligible for immediate antiviral therapy. Prospective cohort studies are necessary to evaluate anti-HBV treatment eligibility facing the significant proportion of individuals with active chronic HBV infection. This article is protected by copyright. All rights reserved.

Published
2017

18. Is sub-Saharan Africa ready for pre-exposure prophylaxis?

Author

Aliou Sylla, Elias Ter Tiero Dah, Martine Somda, Hakima Himmich, Jorge Flores Aranda, Jeanne Gapiya, Adeline Bernier, and Camille Anoma

Subjects
medicine.medical_specialty, Sub saharan, Tenofovir, Anti-HIV Agents, Epidemiology, Immunology, Administration, Oral, Sex workers, HIV Infections, 03 medical and health sciences, Health services, Pre-exposure prophylaxis, 0302 clinical medicine, Virology, Environmental health, Emtricitabine, Humans, Medicine, 030212 general & internal medicine, Men having sex with men, Psychiatry, Africa South of the Sahara, 030505 public health, Social discrimination, business.industry, Infectious Diseases, Pre-Exposure Prophylaxis, 0305 other medical science, business, medicine.drug
Published
2016
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