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Abstract
Objectives Although oral pre-exposure prophylaxis (PrEP) for HIV is being rolled out in West Africa, data on sexually transmitted infections (STIs) in PrEP users are scarce. We assessed the prevalence, incidence and determinants of bacterial STIs in men who have sex with men (MSM) taking PrEP in Burkina Faso, Côte d’Ivoire, Mali and Togo.
Methods A prospective cohort study among MSM initiating PrEP as part of a comprehensive HIV prevention package was conducted between 2017 and 2021 in community-based clinics in the four study countries. Molecular screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) was performed at months 0, 6 and 12. Serological testing for syphilis was performed every 3 months over the first year of follow-up. Determinants of CT and/or NG incidence were identified using Poisson generalised linear mixed models.
Results A total of 598 participants with a median age of 24.7 years were included. Prevalence of CT and/or NG was 24.4% (95% CI 21.0 to 28.1), 22.4% (95% CI 18.4 to 26.8) and 29.0% (95% CI 24.2 to 34.1) at months 0, 6 and 12, respectively. The prevalence of syphilis ranged from 0.2% (95% CI 0.0 to 0.9) at month 0 to 0.8% (95% CI 0.2 to 2.4) at month 12. Ninety incident CT and/or NG infections occurred during a total follow-up time of 280.6 person-years (incidence rate 32.1 per 100 person-years, 95% CI 25.8 to 39.4). Three incident syphilis infections were detected during a total follow-up time of 459.7 person-years (incidence rate 0.7 per 100 person-years, 95% CI 0.1 to 1.9). CT and/or NG incidence was associated with condomless insertive anal sex (adjusted incidence rate ratio 1.96, 95% CI 1.04 to 3.71, p=0.038).
Conclusions CT and NG were frequent but syphilis was very infrequent in MSM using HIV PrEP in West Africa. HIV programme managers should integrate STI services into PrEP programmes.
- gonorrhoea
- syphilis
- PrEP
- Africa
- Chalmydia trachomatis
Data availability statement
Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.
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Data availability statement
Data are available on reasonable request. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.
Footnotes
Handling editor Mark Charles Atkins
BV and CL contributed equally.
Correction notice This article has been corrected since it was first published online. In the original article, the captions for figures 1 & 2 had been omitted. These have now been included.
Collaborators CohMSM-PrEP Study Group: Christian Laurent, Issifou Yaya, Sayouba Ouedraogo, Bruno Granouillac, Benjamin Cuer, Laetitia Serrano, Martine Peeters, Clotilde Couderc (IRD, Inserm, University of Montpellier, TransVIHMI, Montpellier, France); Bruno Spire, Luis Sagaon-Teyssier, Marion Mora, Gwenaëlle Maradan, Michel Bourrelly, Cyril Berenger, Sylvie Boyer (Inserm, IRD, University of Aix-Marseille, SESSTIM, Marseille, France); Daniela Rojas Castro, Lucas Riegel, Paméla Palvadeau (Coalition PLUS, Pantin, France); Bea Vuylsteke, Irith De Baetselier, Thijs Reyniers, Tania Crucitti (Institut de Médecine Tropicale, Anvers, Belgique); 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, Bakary Coulibaly (ARCAD Santé PLUS, Bamako, Mali); Camille Anoma, Malan Jean-Baptiste Kouamé, Rachelle Kotchi, Niamkey Thomas Aka, Kpassou Julien Lokrou, Noufo Hamed Coulibaly, Ekessi Jean Armel Koffi, Dibi Frédéric N’guessan, Stéphane-Alain Babo Yoro, Adama Cissé (Espace Confiance, Abidjan, Côte d’Ivoire); Ter Tiero Elias Dah, Issa Traoré, Camille Rajaonarivelo, Fayçal Rodrique Ouedraogo, Joseph Ouedraogo, Christian Coulibaly, Mamadou Ouedraogo, Ousseni Ilboudo, Abdoulazziz Traoré, Honoré Comsiambo (Association African Solidarité, Ouagadougou, Burkina Faso); 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 (Espoir Vie Togo, Lomé, Togo); Claver Anoumou Dagnra, Kokou Dominique Tegueni (BIOLIM, University of Lomé, Lomé, Togo).
Contributors TTED coordinated the study in Burkina Faso, and wrote the first draft of the manuscript. IDB supervised the implementation of the STI component. BC analysed the data. CA coordinated the study in Côte d’Ivoire. EM coordinated the study in Togo. AK, SD, CAD, HYF-K and AY coordinated the STI testing in their counties. IY contributed to the coordination of the study and oversaw data collection. BS coordinated the social science component. BDK coordinated the study in Mali and was the co-principal investigator. TC was the responsible for the central laboratory of the Institute of Tropical Medicine in Antwerp, Belgium for external quality control. CL was the study’s co-principal investigator. CL and BV supervised the analysis and interpretation of the data and the writing of the manuscript. All authors reviewed the manuscript.
Funding This study was supported by the ANRS (France Recherche Nord and Sud Sida-hiv Hépatites; ANRS 12369) and Expertise France (Initiative 5%). TTED was the recipient of a doctoral fellowship from ANRS (ANRS 12324-B99).
Competing interests CL has received a travel grant and fees for a meeting from Gilead Sciences. The other authors have no conflict of interest to declare.
Provenance and peer review Not commissioned; externally peer reviewed.