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Background A novel strategy to combat malaria was tested using a methodology adapted to a complex setting in the Amazon region and a hard-to-reach, mobile community. The intervention strategy tested was the distribution, after training, of malaria self-management kits to gold miners who cross the Surinamese and Brazilian borders with French Guiana to work illegally in the remote mining sites in the forest of this French overseas entity. Main text This article aims at presenting all process and implementation outcomes following the Conceptual Framework of Implementation Fidelity i.e. adherence, including content and exposure, and moderators, comprising participant responsiveness, quality of delivery, facilitation strategies, and context. The information sources are the post-intervention survey, data collected longitudinally during the intervention, a qualitative study, data collected during an outreach mission to a remote gold mining site, supervisory visit reports, in-depth feedback from the project implementers, and videos self-recorded by facilitators based on opened ended questions. As expected, being part of or close to the study community was an essential condition to enable deliverers, referred to as “facilitators”, to overcome the usual wariness of this gold mining population. Overall, the content of the intervention was in line with what was planned. With an estimated one third of the population reached, exposure was satisfactory considering the challenging context, but improvable by increasing ad hoc off-site distribution according to needs. Participant responsiveness was the main strength of the intervention, but could be enhanced by reducing the duration of the process to get a kit, which could be disincentive in some places. Regarding the quality of delivery, the main issue was the excess of information provided to participants rather than a lack of information, but this was corrected over time. The expected decrease in malaria incidence became a source of reduced interest in the kit. Expanding the scope of facilitators’ responsibilities could be a suitable response. Better articulation with existing malaria management services is recommended to ensure sustainability. Conclusions These findings supplement the evaluation outcomes for assessing the relevance of the strategy and provide useful information to perpetuate and transfer it in comparable contexts. Trial registration ClinicalTrials.gov. NCT03695770. 10/02/2018 “Retrospectively registered”.

Malaria is endemic in French Guiana, especially within the gold mining community working illegally. Gold miners travel to remote camps in the forest to carry out their activities, exposing themselves to the presumed contamination area. This paper presents the results of a qualitative case study of the Malakit project, a free distribution of self-diagnosis and self-treatment kits, along with appropriate training/information from health facilitators, at resting sites in Brazil and Suriname on the borders with French Guiana. This study documents how Malakit is part of the care trajectory of gold miners. The data was collected using three methods: 1) on-site observation; 2) semi-structured individual interviews (n=26); 3) semi-structured group interviews (n=2). The results inform us that Malakit responds to the need for treatment and facilitates access to care. Gold miners say they trust the facilitators and receive accurate explanations. The majority of participants find the kit easy to use and to carry and explanations given were sufficient, although some people needed to be reminded how to use it once in the forest. Results remind us that malaria among illegal gold miners in French Guiana is a question of social inequalities in health, where the interaction of the health, social, economic and political contexts of Brazil and French Guiana influence exposure to numerous risk factors. Thus, malaria intervention practices such as Malakit cannot be carried out without considering the complexity generated by social inequalities in health.

BACKGROUND An interventional study named Malakit was implemented between April 2018 and March 2020 to address malaria in gold mining areas in French Guiana, in collaboration with Suriname and Brazil. This innovative intervention relied on the distribution of kits for self-diagnosis and self-treatment to gold miners after training by health mediators, referred to in the project as facilitators. OBJECTIVE This paper aims to describe the process by which the information system was designed, developed, and implemented to achieve the monitoring and evaluation of the Malakit intervention. METHODS The intervention was implemented in challenging conditions at five cross-border distribution sites, which imposed strong logistical constraints for the design of the information system: isolation in the Amazon rainforest, tropical climate, and lack of reliable electricity supply and internet connection. Additional constraints originated from the interaction of the multicultural players involved in the study. The Malakit information system was developed as a patchwork of existing open-source software, commercial services, and tools developed in-house. Facilitators collected data from participants using Android tablets with ODK (Open Data Kit) Collect. A custom R package and a dashboard web app were developed to retrieve, decrypt, aggregate, monitor, and clean data according to feedback from facilitators and supervision visits on the field. RESULTS Between April 2018 and March 2020, nine facilitators generated a total of 4863 form records, corresponding to an average of 202 records per month. Facilitators’ feedback was essential for adapting and improving mobile data collection and monitoring. Few technical issues were reported. The median duration of data capture was 5 (IQR 3-7) minutes, suggesting that electronic data capture was not taking more time from participants, and it decreased over the course of the study as facilitators become more experienced. The quality of data collected by facilitators was satisfactory, with only 3.03% (147/4849) of form records requiring correction. CONCLUSIONS The development of the information system for the Malakit project was a source of innovation that mirrored the inventiveness of the intervention itself. Our experience confirms that even in a challenging environment, it is possible to produce good-quality data and evaluate a complex health intervention by carefully adapting tools to field constraints and health mediators’ experience. CLINICALTRIAL ClinicalTrials.gov NCT03695770; https://clinicaltrials.gov/ct2/show/NCT03695770

Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana. Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana. Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil. Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana. Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana. The Ink Link. Paris, France. Malaria Program, Ministry of Health of Suriname, Paramaribo, Suriname. Malaria Program, Ministry of Health of Suriname, Paramaribo, Suriname. Desenvolvimento, Prevenção, Acompanhamento e Cooperação de Fronteiras, Oiapoque, Brasil. Desenvolvimento, Prevenção, Acompanhamento e Cooperação de Fronteiras, Oiapoque, Brasil. Ministério da Saúde. Grupo Técnico da Malária. Coordenação de Doenças Transmissíveis e Zoonóticas Vetoriais. Brasília, DF, Brasil. Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana. Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana. Foundation for Scientific Research Suriname, Paramaribo, Suriname. Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana. Background: An interventional study named Malakit was implemented between April 2018 and March 2020 to address malaria in gold mining areas in French Guiana, in collaboration with Suriname and Brazil. This innovative intervention relied on the distribution of kits for self-diagnosis and self-treatment to gold miners after training by health mediators, referred to in the project as facilitators. Objective: This paper aims to describe the process by which the information system was designed, developed, and implemented to achieve the monitoring and evaluation of the Malakit intervention. Methods: The intervention was implemented in challenging conditions at five cross-border distribution sites, which imposed strong logistical constraints for the design of the information system: isolation in the Amazon rainforest, tropical climate, and lack of reliable electricity supply and internet connection. Additional constraints originated from the interaction of the multicultural players involved in the study. The Malakit information system was developed as a patchwork of existing open-source software, commercial services, and tools developed in-house. Facilitators collected data from participants using Android tablets with ODK (Open Data Kit) Collect. A custom R package and a dashboard web app were developed to retrieve, decrypt, aggregate, monitor, and clean data according to feedback from facilitators and supervision visits on the field. Results: Between April 2018 and March 2020, nine facilitators generated a total of 4863 form records, corresponding to an average of 202 records per month. Facilitators’ feedback was essential for adapting and improving mobile data collection and monitoring. Few technical issues were reported. The median duration of data capture was 5 (IQR 3-7) minutes, suggesting that electronic data capture was not taking more time from participants, and it decreased over the course of the study as facilitators become more experienced. The quality of data collected by facilitators was satisfactory, with only 3.03% (147/4849) of form records requiring correction. Conclusions: The development of the information system for the Malakit project was a source of innovation that mirrored the inventiveness of the intervention itself. Our experience confirms that even in a challenging environment, it is possible to produce good-quality data and evaluate a complex health intervention by carefully adapting tools to field constraints and health mediators’ experience.

Background: Illegal gold miners are currently a key reservoir for malaria in French Guiana (FG), with a risk of emergence of resistance linked to improper use of artemisinin-based combination therapy (ACT). The remoteness of the mines and regulatory issues hinder their access to health care. Methods: An intervention researched project (Malakit) implemented in FG borders with Brazil and Suriname aimed at determining the effectiveness of distributed kits for self-diagnosis and self-treatment to illegal gold miners, after training, at strategic border staging areas. Evaluation relied on questionnaires at inclusion and follow-up visits, and pre/post intervention surveys. The primary outcome was the proportion of persons reporting a use of certified ACT after a positive malaria diagnosis. The secondary outcomes assessed antimalarial adherence, kit use and impact on malaria epidemiology. Findings: The proportion of patients reporting a use of certified ACT after a positive diagnosis increased after the intervention (OR 1.8, 95%CI [1.1-3.0]). From April 2018 to March 2020, 3,733 persons participated in the intervention. The kit was used correctly by 71.7% [65.8-77.7] of the 223 persons reporting having used a malakit during the follow-up visits. The intervention could have accelerated the decline in malaria incidence in the region by 42.9%. InterpretationThis innovative international project showed that people with low education can correctly self-manage their malaria symptoms. This strategy could be integrated in the malaria control programs of the countries involved and considered in other regions with residual malaria in remote areas. Funding: This project was funded by the European Union, the Global Fund, PAHO, Brazil MoH, Cayenne Hospital and FG Health Regional Agency. Declaration of Interest: Any authors declare to have no conflict of interest. Ethical Approval: Each participant gave a written consent after clear and appropriate information. Ethics approvals were obtained from countries where the project was implemented (Table 1). The project was the subject of a Normal CNIL Declaration on 24 May 2018 (Declaration Number 2188949 v 0) for data analysis according to the General Data Protection Regulation (European Union Regulation 2016/679).

A prospective study was conducted among different intra and extra-hospital populations of French Guiana to evaluate the performance of saliva testing compared to nasopharyngeal swabs. Persons aged 3 years and older with mild symptoms suggestive of COVID-19 and asymptomatic persons with a testing indication were prospectively enrolled. Nasopharyngeal and salivary samples were stored at 4°C before analysis. Both samples were analyzed with the same Real-time PCR amplification of E gene, N gene, and RdRp gene. Between July 22th and October 28th, 1159 persons were included, of which 1028 were analyzed. When only considering as positives those with 2 target genes with Ct values

Background In French Guiana, gold miners working illegally represents a major reservoir of malaria. This mobile population, mainly of Brazilian descent, enters the French Guianese forest from neighbouring countries, Suriname and Brazil. A complex and innovative intervention was piloted as a cooperation with the three involved countries involved to control malaria in this specific population. The principle was that health workers called “facilitators” provide the participants with a self-diagnosis and self-treatment kit along with adequate training and material to rapidly manage an episode of malaria symptoms on their own, when they find themselves isolated from health care services. Methods This paper describes the design, development, content of the intervention and players’ organization of this multi-country project, the opportunities and constraints encountered, and the lessons learnt at this stage. Results The choice not to implement the usual “Test and Treat” approach within the community is mainly driven by regulatory reasons. The content of medical messages tends to balance the tension between thoroughness, accuracy and efficacy. The wide range of tools developed through a participatory approach was intended to cope with the challenges of the literacy level of the target population. Despite the difficulties encountered due to language, regulation differences and distance between partners, cooperation was fruitful, due to the complementary of stakeholders, their involvement at all important stages and regular face-to-face meetings. Discussion and conclusion This experience shows the feasibility of an ambitious project of action-research in a border malaria context, involving several countries and with a mobile and undocumented population. It reveals some factors of success which may be transferable in analogous settings.

Introduction L’emergence de pathogenes a augmente depuis 1940, en particulier d’origine zoonotiques (60 %), issus majoritairement de la faune sauvage (72 %). L’anthropisation et le bouleversement des ecosystemes favorisent le franchissement des barrieres inter-espece, particulierement en zone de grande biodiversite comme en Amazonie. Les personnes pratiquant une activite d’orpaillage, a fortiori non regulee, seraient-elles particulierement touchees par les zoonoses ? Materiels et methodes Capitalisant sur une etude visant a evaluer l’epidemiologie du paludisme sur les sites d’orpaillage clandestins en Amazonie, un examen clinique complet et un prelevement biologique pour mise en collection ont ete effectues en 2019 aupres des personnes majeures et consentantes travaillant sur ces mines. L’examen recensait les signes dermatologiques de leishmaniose avec un ecouvillonnage pour PCR Leishmania en cas de lesion ulceree active, ceux evocateurs de lepre et les antecedents vaccinaux contre la fievre jaune. Au niveau biologique ont ete realises la recherche d’anticorps neutralisant la fievre jaune, d’IgG de phase I et II contre la fievre Q, et des tests MAT (Microscopic Agglutination Test) contre la leptospirose. Resultats Entre octobre et decembre 2019, 380 personnes ont ete inclues dans l’etude. La seroprevalence de la leptospirose etait de 25,5 % (IC95 % = 21,2-30,1). De nombreux mammiferes sauvages sud-americains sont connus pour etre porteurs de leptospires. Cette forte seroprevalence va dans le sens d’un cycle sauvage de leptospirose en Amazonie. La prevalence de la fievre Q etait de 2.9 % (IC95 % = 1,2-4,6). Ceci est plus faible que la prevalence sur le littoral, ce qui affaiblit l’hypothese d’un reservoir de Coxiella burnettii en foret profonde ou tellurique, reservoir toujours inconnu a ce jour dans la region. La majorite des participants declaraient etre vaccines contre la fievre jaune (91.8 %) et 97.9 % avaient des Ac seroneutralisants. Le risque d’epidemie de fievre jaune, comme dans le cas au Bresil en 2016-2019, semble donc peu probable. Dix pourcent (0,7-1,3) des participants avaient des lesions de leishmaniose cutanee, dont trois avaient une lesion active en cette saison seche. Une seule PCR a donne un diagnostic d’espece : L. guyanensis. Concernant la lepre, cinq personnes avaient des lesions typiques, dont trois etaient connues et en cours de traitement, soit une prevalence minimale estimee a 78,9/10 000 pa. Tous venaient de l’Etat bresilien du Maranhao, ou la prevalence en population generale en 2019 etait 17 fois moindre a 4,5/10 000 pa. Cela pose de nombreuses questions, dont celle du role du reservoir animal potentiel qu’est le tatou, sur lequel des travaux sont en cours en Guyane. Conclusion Ces donnees uniques eclairent d’un jour nouveau des cycles de transmission de zoonoses encore mal connus dans la region. A l’heure des problematiques de One Health, une surveillance particuliere doit etre accordee a ces populations vulnerables en contact direct avec l’ecosysteme tropical.

Current testing for COVID-19 relies on reverse-transcriptase polymerase chain reaction from a nasopharyngeal swab specimen. Saliva samples have advantages regarding ease and painlessness of collection, which does not require trained staff and may allow self-sampling. We enrolled 776 persons at various field-testing sites and collected nasopharyngeal and pooled saliva samples. One hundred sixty two had a positive COVID-19 RT-PCR, 61% were mildly symptomatic and 39% asymptomatic. The sensitivity of RT-PCR on saliva samples vs. nasopharygeal swabs varied depending on the patient groups considered or on Ct thresholds. There were 10 (6.2%) patients with a positive saliva sample and a negative nasopharyngeal swab, all of whom had Ct values

BackgroundIllegal gold miners are currently key hosts for malaria in French Guiana (FG), with a risk of emergence of resistance linked to improper use of artemisinin-based combination therapy (ACT). The remoteness of the mines and regulatory issues hinder their access to health care.MethodsA quasi-experimental researched project (Malakit) implemented in FG borders with Brazil and Suriname aimed at determining the effectiveness of distributed kits for self-diagnosis and self-treatment to illegal gold miners, after training, at strategic border staging areas. Evaluation relied on questionnaires at inclusion and follow-up visits, and pre/post intervention surveys. The primary outcome was the proportion of persons reporting a use of certified ACT after a positive malaria diagnosis. The secondary outcomes assessed antimalarial adherence, kit use and impact on malaria epidemiology.FindingsThe proportion of patients reporting a use of certified ACT after a positive diagnosis increased after the intervention (OR 1.8, 95%CI [1.1-3.0]). From April 2018 to March 2020, 3,733 persons participated in the intervention. The kit was used correctly by 71.7% [65.8-77.7] of the 223 persons reporting having used a malakit during the follow-up visits. No serious adverse events related to the misuse of malakit have been reported. The intervention appears to have accelerated the decline in malaria incidence in the region by 42.9%.InterpretationThis innovative international project showed that people with low education can correctly self-manage their malaria symptoms. This strategy could be integrated in the malaria control programs of the countries involved and considered in other regions with residual malaria in remote areas., ContexteLes chercheurs d'or illégaux sont actuellement un réservoir clé du paludisme en Guyane, avec un risque d'émergence de résistance lié à une mauvaise utilisation des combinaisons thérapeutiques à base d'artémisinine (ACT). L'isolement de ces sites miniers clandestins et des contraintes règlementaires entravent leur accès aux soins.MéthodesUn projet de recherche opérationnelle quasi-expérimental (Malakit) a été mis en œuvre aux frontières de la Guyane avec le Brésil et le Suriname. Il visait à déterminer l'efficacité de la distribution de kits d'autodiagnostic et d'autotraitement à des orpailleurs illégaux, après une formation adaptée, dans des zones stratégiques transfrontalières. L'évaluation s'est appuyée sur des questionnaires lors des visites d'inclusion et de suivi, et sur des enquêtes pré/post intervention. L'indicateur principal était la proportion de personnes déclarant avoir utilisé une ACT certifiée après un diagnostic positif de paludisme. Les indicateurs secondaires reposaient sur l'adhérence aux traitements antipaludiques, l'utilisation des kits et l'impact sur l'épidémiologie du paludisme.RésultatsLa proportion de patients déclarant une utilisation d'ACT certifiée après un diagnostic positif a augmenté après l'intervention (OR 1,8, 95%CI [1,1-3,0]). D'avril 2018 à mars 2020, 3 733 personnes ont participé à l'intervention. Le kit a été utilisé correctement par 71,7% [65,8-77,7] des 223 personnes revues en visites de suivi ayant déclaré avoir utilisé un malakit. Aucun événement indésirable grave lié à une mauvaise utilisation du malakit n'a été signalé. L'intervention semble avoir accéléré la diminution de l'incidence du paludisme dans la région de 42,9%.InterprétationCe projet international innovant a montré que les personnes ayant un faible niveau d'éducation peuvent se prendre en charge par eux-mêmes pour des symptômes de paludisme. Cette stratégie pourrait être intégrée dans les programmes de lutte contre le paludisme des pays impliqués et envisagée dans d'autres régions où du paludisme résiduel persiste dans des zones isolées.

Introduction A contexte extraordinaire, reponse innovante. Une recherche operationnelle a grande echelle a ete mise en oeuvre dans un contexte transfrontalier en Amazonie, visant a tester une nouvelle strategie de controle du paludisme dans les zones d’orpaillage illegal. Les orpailleurs constituent un reservoir cle de paludisme dans la region, avec un risque d’emergence de resistances lie au mesusage de combinaisons therapeutiques a base d’artemisinine (ACT) provenant du marche informel. Materiels et methodes Notre etude de recherche operationnelle a evalue l’efficacite de la distribution de kits d’autodiagnostic et d’autotraitement pour augmenter la bonne utilisation des ACT: traitement initie apres un test de diagnostic rapide (TDR) positif, et conduit avec une bonne observance. Les orpailleurs consentant recevaient un kit apres une formation dispensee par des mediateurs sur les zones strategiques de passage transfrontalier. L’evaluation s’est basee sur des questionnaires aux participants lors des visites d’inclusion et de suivi, et sur des etudes transversales pre/post intervention. L’indicateur principal etait la modification des comportements rapportes lors des etudes transversales. Etaient egalement evalues la bonne utilisation des kits et l’impact de la strategie par une analyse de series chronologiques interrompues (ITS) basee sur les donnees de surveillance du paludisme des pays frontaliers. Resultats D’avril 2018 a mars 2020, 3 733 personnes ont participe a l’intervention et 1 098 aux etudes d’evaluation. L’utilisation appropriee d’un traitement precedee d’un diagnostic (en utilisant un kit ou en se tournant vers le systeme de sante) a augmente de 54,2 % a 68,2 % (OR = 1,8, IC95 % [1,1-3,0]) apres l’intervention. L’observance au traitement etait plus elevee lorsque le patient recevait des soins dans un centre de sante (91 % [89-94]) ou utilisait un kit (81 % [67-96]) qu’en cas d’automedication non reglementee (65 % [60-70]) (OR = 5,4 [3,7-7,8]). Parmi les 303 participants declarant avoir utilise un kit lors des visites de suivi, 71,7% [65,8-77,7] l’avaient utilise correctement. La prevalence du Plasmodium par PCR dans cette population a diminue entre 2015 et 2020. L’analyse ITS des donnees de surveillance estime a 46 % (IC95 % [7-62]) la majoration de la reduction de l’incidence du paludisme depuis la mise en oeuvre de la strategie. Peu d’evenements indesirables ont ete signales. La circulation des kits hors protocole est apparue limitee. Conclusion Ce projet international innovant montre que des personnes avec un faible niveau d’instruction peuvent etre formees a la prise en charge autonome du paludisme et changer leur comportement. Cette strategie pourrait constituer un nouvel outil de lutte contre le paludisme dans d’autres regions confrontees a une situation similaire.

Introduction Dans une region d’Amazonie, les orpailleurs clandestins (5000 a 10 000 personne) restent a ce jour une population isolee et vulnerable dont l’etat de sante global, notamment les IST, demeure mal connu. L’objectif de cette etude etait de determiner la prevalence du VIH, des hepatites B, C, D, et de la syphilis dans cette population, et d’etudier leurs pratiques a risque. Materiels et methodes Capitalisant sur les moyens deployes pour etudier le paludisme dans cette population difficile d’acces (illegaux, sites tres isoles), des objectifs secondaires ont ete ajoutes a l’etude pour decrire l’etat de sante global de cette population, dont les IST. L’etude transversale multicentrique s’est deroulee fin 2019. Ont ete realises : pour le VIH, serologie Elisa confirmee par Western Blot si positive ; pour l’hepatite B, AgHBs, et si positif serologie VHD ; pour l’hepatite C, anticorps anti-HCV ; pour la syphilis, anticorps treponemiques, et si resultat positif anticorps non treponemiques. L’examen medical a recueilli des donnees de comportements sexuels a risque et de depistage. Resultats Parmi les 380 inclus, 95,5 % etaient nes au Bresil. Le sexe-ratio etait de 2,7 et l’âge median de 39 ans. Le temps median passe dans l’orpaillage s’elevait a 10 ans. Trente pour cent n’avaient jamais realise de test VIH. La moitie (52,7 %) declarait avoir eu 0 ou 1 partenaire sexuel dans l’annee precedente. Les autres avaient en mediane 5 partenaires [intervalle interquartile = 3–10]. Dans ce dernier groupe, 76,9 % avaient utilise un preservatif lors du dernier rapport sexuel, alors que dans le groupe declarant 0 ou 1 partenaire la proportion etait de 38,1 %. Parmi les inclus, 27,1 % declaraient avoir paye pour leur dernier rapport sexuel (103/380) et 1,8 % (7/380) disaient avoir ete payes. Les analyses ont revele une prevalence du VIH de 0,53 % (2/380, IC 95 % : 0,14–1,89). Six patients (1,58 %, IC 95 % 0,73–3,40) etaient positifs pour l’AgHBs, tous negatifs pour les anticorps anti-VHD. Huit etaient positifs aux anticorps anti-VHC (2,11 %, IC 95 % : 1,7–4,10) dont 7 faiblement. Sur les 47 personnes ayant une serologie treponemique positive (12,37 %, IC 95 % : 9,43–16,06), 13 etaient positives au test non treponemique (3,4 %, IC 95 % : 2,01–5,76). Aucune co-infection VHB/VHC, VIH/VHB, VIH/VHC detectee, mais un patient VIH positif l’etait aussi en test treponemique. Sur 380 inclus, 62 etaient positifs a au moins une IST (16,3 %), et 40,3 % (25/62) declaraient n’avoir pas utilise de preservatif lors du dernier rapport sexuel. Conclusion Cette etude documente pour la premiere fois les comportements sexuels a risque des orpailleurs. Les intervalles de confiance larges rendent difficile leurs interpretations, mais la prevalence du VHC semble plus elevee que dans la population guyanaise (0,67 % en consultations de depistage anonyme et gratuit), tout comme celle de la syphilis (estimee a 0,41 % dans les Ameriques). Des analyses complementaires sont en cours pour etudier les facteurs de risque d’IST dans cette population.