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.

中文翻译：

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通过将PrEP纳入全面的预防计划，使西非的MSM人群更加广泛（CohMSM-PrEP ANRS 12369—法国专家）

背景： 

在西非，一些HIV服务的目标是谁与男性（同性恋者MSM）。2015年，干预性队列CohMSM开始为MSM提供基于社区的预防包。参与者对暴露前预防（PrEP）有兴趣，并证明了他们的资格。2017年，PrEP被添加到已经作为新计划CohMSM- PrEP的一部分提供的服务中，该计划招募了CohMSM参与者和新参与者。我们旨在确定引入PrEP作为额外的预防工具是否会影响参与者注册CohMSM- PrEP的类型。

方法： 

CohMSM- PrEP在马里，科特迪瓦，布基纳法索和多哥的社区诊所招募了HIV阴性MSM。每季度进行一次随访，包括免费的临床检查，PrEP，HIV /性传播感染筛查，同伴教育，避孕套和润滑剂。每3个月使用面对面的问卷调查收集一次社会行为数据。我们的结果是参与者类型：新参与者与CohMSM参与者。进行逻辑回归以识别与成为新参与者有关的因素。

结果： 

CohMSM- PrEP包括的524个MSM中，有41％是新参与者。进行调整后，多因素分析显示，他们在经济上更加不安全，包括财务上的不安全感，社会隔离（包括MSM社区内部的隔离）和风险较高的性行为。

结论： 

PrEP作为一种额外的预防工具的引入以及随着时间的推移使用基于同伴的外联服务影响了在西非签署基于社区的艾滋病毒预防人群的参加者的类型。将这些要素添加到撒哈拉以南非洲的现有干预措施中，可能是使艾滋病毒/艾滋病预防和关怀计划边缘化的男男性接触者的关键。