Objective Although men who have sex with men (MSM) are at high risk of STI, their access to tailored healthcare services remains limited in West Africa. We assessed the change in STI symptoms incidence over time among MSM enrolled in a quarterly HIV prevention and care programme in four cities in Burkina Faso, Côte d’Ivoire, Mali and Togo.
Methods We performed a prospective cohort study in MSM followed up between 2015 and 2019. Men aged over 18 who reported anal sex with another man within the previous 3 months were offered quarterly syndromic diagnosis and treatment for STI, as well as HIV testing, peer-led counselling and support. Condoms and lubricants were also provided. The change in STI symptoms incidence during follow-up was investigated using a non-parametric trend test and mixed-effect Poisson regression models.
Results 816 participants were followed for a total duration of 1479 person-years. 198 participants (24.3%) had at least one STI symptom during follow-up. Overall, STI symptoms incidence was 20.4 per 100 person-years (95% CI 18.4 to 22.6), ranging from 15.3 in Abidjan to 33.1 in Ouagadougou (adjusted incidence rate ratio (aIRR) 2.39, 95% CI 1.55 to 3.69, p<0.001). STI symptoms incidence was 16.8 and 23.0 per 100 person-years in HIV-positive and HIV-negative participants, respectively (aIRR 0.77, 95% CI 0.57 to 1.04, p=0.087). STI symptoms incidence decreased significantly from 29.9 per 100 person-years in the first 6 months to 8.6 at 30–35 months of follow-up (aIRR per 6-month increase 0.84, 95% CI 0.77 to 0.92, p<0.001).
Conclusion STI symptoms incidence decreased over time but the overall burden of STI appeared to be very high in MSM followed up in West Africa. STI services including counselling, diagnosis and treatment should be reinforced. Laboratory tests that allow accurate diagnosis of STI are required. Strengthening STI services will be critical for controlling the HIV and STI epidemics in this vulnerable population and in the general population.
Trial registration number NCT02626286.
- sexual health
- preventive health services
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Handling editor Nicola Low
Collaborators CohMSM Study Group. Christian Laurent, Issifou Yaya, Sayouba Ouedraogo, Bruno Granouillac, Laetitia Serrano, Martine Peeters, Clotilde Couderc (IRD, INSERM, Univ Montpellier, TransVIHMI, Montpellier, France); Bruno Spire, Luis Sagaon-Teyssier, Marion Mora, Gwenaëlle Maradan, Michel Bourrelly, Pierre-Julien Coulaud, Cyril Berenger (INSERM, IRD, Univ Aix-Marseille, SESSTIM, Marseille, France); Daniela Rojas Castro, Adeline Bernier, Paméla Palvadeau (Coalition Internationale Sida, Pantin, France); 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 (ARCAD-SIDA, Bamako, Mali); Camille Anoma, Malan Jean-Baptiste Kouame, Ochoh Rachelle Kotchi, Niamkey Thomas Aka, Kpassou Julien Lokrou, Noufo Hamed Coulibaly, Jean Armel Ekessi Koffi, Frédéric Dibi 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, Elisabeth Thio, Ousseni Ilboudo, Abdoulazziz Traoré, Honoré Comsiambo (Association African Solidarité, Ouagadougou, Burkina Faso); Ephrem Mensah, Richard 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 Yaotsè Dagnra (BIOLIM, Univ Lomé, Lomé, Togo).
Contributors IY contributed to data collection, analysed the data and wrote the first draft of the manuscript. FD, MJBK, MKA, IT, AC, KM and MM contributed to data collection. PP contributed to study implementation. TTED coordinated the study in Burkina Faso. EM coordinated the study in Togo. CA coordinated the study in Côte d’Ivoire. BDK coordinated the study in Mali and was the co-principal investigator of the study. BS coordinated the social science component. CL was the co-principal investigator of the study, and 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 & Sud Sida-hiv Hépatites; ANRS 12324) and Expertise France (Initiative 5%). TTED is the recipient of a doctoral fellowship from the ANRS (12324-B99).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study protocol was approved by the national ethics committees of Burkina Faso (N°2015-3-037), Côte d’Ivoire (N°021/MSLS/CNER-dkn), Mali (N°2015/32/CE/FMPOS) and Togo (N°008/2016/MSPSCAB/SG/DPML/CBRS), and the institutional ethics committee of the French Institut de Recherche pour le Développement. All participants signed an informed consent form.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.
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