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Background: The World Health Organization (WHO) recommends from September 2015 to use pre-exposure prophylaxis (PrEP) as part of a comprehensive HIV prevention package for people at substantial risk of HIV infection (incidence greater than 3 per 100 person-years in the absence of PrEP). Men who have sex with men (MSM) are one of the most vulnerable populations and may be eligible to PrEP. However, few data are available among this population in Africa. We therefore estimated the incidence of HIV infection among MSM in four West African countries.
Methods: A prospective cohort study was conducted in 2013-2014 in Bamako (Mali), Abidjan (Côte d''Ivoire), Dakar (Senegal) and Bobo-Dioulasso (Burkina Faso). Men over 18 years, reporting at least one sexual relationship with another man within the last three months, and HIV-negative (status confirmed at inclusion in the study) were eligible. A 6-month follow-up was offered to them including a quarterly HIV screening (M3 and M6) along with pre- and post-screening counseling and free condoms. If necessary, treatment for sexually transmitted infections was provided.
Results: A total of 440 HIV-negative MSM were recruited. Of them, 316 (71.8%) had at least one screening test during follow-up: 168 (53.2%) in Mali, 73 (23.1%) in Côte d''Ivoire, 54 (17.1%) in Senegal and 21 (6.6%) in Burkina Faso. The median age was 23.7 years (interquartile range [IQR]: 20.8-28.0). These men were followed up for a total period of 167.9 person-years. During follow-up, HIV screening tests were performed after a median time from inclusion of 3.2 months (IQR: 3.0-3.6) and 6.3 months (IQR: 6.0-6.6). Eight seroconversions were observed (six at the first screening test and two at the second test), giving an incidence rate of 4.8 per 100 person-years (95% confidence interval: 2.4-9.5).
Conclusions: Based on HIV incidence observed in this study, MSM leaving in West African countries are eligible for PrEP according to the WHO-recommended criteria. Operational research is now needed to guide the implementation of specific programs for prevention and comprehensive care including PrEP in this context.