HIV prevention in Africa: Pre-exposure prophylaxis (PrEP) in men who have sex with men (MSM)

Access to HIV pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) is a strategic public health priority supported by UNAIDS, the WHO, the Global Fund to Fight AIDS, Tuberculosis and Malaria, PEPFAR, etc.

However, its implementation in Africa is faced with multiple obstacles such as the absence of data on PrEP in MSM and the lack of targeted prevention programmes.

This is true in particular in West Africa, where countries suffer from mixed epidemics, with a relatively low HIV prevalence in the general population (1% - 3%) but much higher in MSM (15% - 20%). Data suggests that sex between men can be instrumental in the dynamics of the epidemic in this region.

Consequently, the question arises as to “how to implement a PrEP package tailored to MSM in this context?”.

The primary objective of this study is to assess the acceptability and feasibility of PrEP for MSM as part of a combined prevention package in community health centres of West Africa.

To do this, an open-label, multidisciplinary and multi-centre interventional cohort study will be conducted in Burkina Faso, Côte d’Ivoire, Mali and Togo.

• This study will be carried out within the CohMSM operational research programme, which it will supplement.
• It will be proposed to seronegative MSM included in CohMSM with a high risk of contracting HIV (men over the age of 18 who reported having at least one anal sexual intercourse with another man without using a condom in the past 6 months).
• Where appropriate, other MSM will be recruited to reach a total of 500 MSM on PrEP.
• All MSM will benefit from a combined prevention package including quarterly clinical examinations, STI screening and treatment, HIV testing, PrEP (on a daily basis or on demand, at the participants’ discretion), hepatitis B vaccination, individual support by peer educators, discussion groups and the distribution of condoms and lubricants.
• These activities will be undertaken by pioneering associations in combating HIV, notably in MSM.
• The study will last 3 years.

Since PrEP was implemented in the study sites, 514 MSM have opted for this prevention strategy (104 in Togo; 105 in Burkina Faso; 101 in Côte d’Ivoire; 204 in Mali). 392 opted for the on-demand PrEP strategy upon inclusion, and 122 for the continuous strategy. Programme retention is currently very high as 92% of expected visits were completed after 6 months. There are currently 7 seroconversions in total.