Etude descriptive de l’epidemie de la meningite bacterienne survenue dans le District Sanitaire de Dankpen au Togo durant la periode de Janvier a Mai 2016 : apparition de la souche neisseria meningitidis W135.: Descriptive study of the bacterial meningitis epidemic occurring in the Health District of Dankpen in Togo during the period from January to May 2016 : appearance of the neisseria meningitidis strain W135.

Objectif : Cette étude a pour objectif de décrire l’épidémie de méningite survenue dans le district de Dankpen, au nord-ouest de la région de la Kara (Togo) durant la période de Janvier à Mai 2016.Méthode : Des fiches de données de chaque patient ont été consultées et les résultats des analyses bactériologiques portant sur l’identification des germes responsables en utilisant les techniques de coloration de GRAM, de culture et d’agglutination au latex ont été également collectés.Résultat : Trois cent soixante-cinq (365) cas suspects de méningite ont été notifiés dans le district sanitaire de Dankpen avec une prévalence élevée chez les enfants (72,88%). La répartition des cas selon le sexe est presque équitable soit 50,14% pour le sexe masculin et 49,86% pour le sexe féminin. Cinq (05) formations sanitaires ont enregistré le plus grand nombre de cas suspects avec des fréquences de 34,52 % pour le CHP de Guérin-Kouka, 12,05% pour l’USP de Naware, 8,76% pour l’USP de Kidjaboun, 7,94%pour l’USP Solidarité et 6,85% pour l’USP de Nampoch. Les analyses biologiques ont permis de révéler 37cas positifs au Neisseria meningitidis W135 et un cas positif au Streptococcus pneumoniae.L’épidémie a causé 15 décès surtout chez les enfants qui ont été positifs au Neisseria meningitidis W135 à un taux de 12,78%.Conclusion : Cette épidémie a été essentiellement marquée par l’émergence de la souche de Neisseria meningitidis W135. Elle a été le point de départ d’une épidémie qui a touché toute la région de la Kara, amenant ainsi les autorités sanitaires à prendre des dispositions incluant la couverture de toute la zone affectée et des zones environnantes par de nouveaux vaccins anti-méningite.ABSTRACT:Aim: This descriptive study aims to describe the meningitis epidemic that occurred in the district of Dankpen, northwest of the region of Kara (Togo) during the period January to May 2016.Method: Data sheets for each patient were consulted and results of bacteriological analyzes on identification of causative organisms using GRAM staining, culture and latex agglutination techniques were also collected.Result: Three hundred and sixty-five (365) suspected cases of meningitis were reported in the Health District of Dankpen with a high prevalence among children (72.88%). The distribution of cases by sex is almost equitable, at 50.14% for males and 49.86% for females. Five (05) health facilities recorded the highest number of suspected cases with frequencies of 34.52% for Guérin-Kouka CHP, 12.05% for Naware USP, 8.76% for USP of Kidjaboun, 7.94% for the USP Solidarity and 6.85% for the USP of Nampoch. The biological analyzes revealed 37 positive cases for Neisseria meningitidis W135 and one positive case for Streptococcus pneumoniae. The epidemic caused 15 deaths, especially among children who were positive for Neisseria meningitidis W135 at a rate of 12.78%.Conclusion: This epidemic was essentially marked by the emergence of the Neisseria meningitidis strain W135. It was the starting point for an epidemic that affected the entire Kara region and allowed health authorities to make arrangements including coverage of the entire affected area and surrounding areas with new meningitis vaccines

Transactional sex among men who have sex with men participating in the CohMSM prospective cohort study in West Africa

Although the HIV epidemic is generalized in West Africa, some population groups such as men who have sex with men (MSM), especially those engaged in transactional sex (TS), are thought to be particularly more vulnerable to HIV than others. However, few data are available to help identify their health-related needs with a view to implementing targeted prevention interventions. To fill this knowledge gap, we aimed to characterize MSM reporting TS (MSM-TS) and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM, which was conducted in Burkina Faso, Cote d'Ivoire, Mali and Togo. Three stigmatization sub-scores were constructed (experienced, perceived and internalized). The generalized estimating equation method was used for data analysis. Of the total 630 HIV-negative MSM recruited in CohMSM, 463, 410 and 244 had a follow-up visit at 6, 12 and 18 months, respectively. In a total of 1747 follow-up visits, 478 TS encounters were reported by 289 MSM-TS (45.9%). Of the latter, 91 regularly reported TS (31.5%), 55 (19.0%) stopped reporting TS after baseline, and 53 (18.3%) reported TS after baseline and 90 (31.1%) occasionally reported TS. The following variables, regarding the previous 6 months, were positively associated with TS: being younger (aOR[95%CI]:1.86[1.39-2.50]), less educated (aOR[95%CI]:1.49[1.09-2.03]), unmarried status (aOR[95%CI]:1.79[1.102.93]), satisfaction with current sex life (aOR[95%CI]:1.41[1.06-1.88]), group sex with men (aOR[95%CI]:2.07[1.46-2.94]), multiple male sexual partners (aOR[95%CI]:1.85[1.402.44]), receptive or versatile anal sex with male partners (aOR [95%Cl]:1.48[1.12-1.96]), giving benefits in exchange for sex with a man (aOR[95%CI]:2.80[1.97-3.98]), alcohol consumption (aOR[95%CI]:1.44[1.08-1.93]) and drug use (aOR[95%CI]:1.82[1.24-2.68]) during sex, and finally experiencing stigmatization (aOR [95%Cl]:1.15[1.07-1.25]). Condom use during anal sex (aOR[95%CI]:0.73[0.53-0.99]) was negatively associated with TS

Changes in risky sexual behaviours among West African MSM enrolled in a quarterly HIV testing and counselling prevention programme (CohMSM ANRS 12324 - Expertise France).

International audienceOBJECTIVES: Whether regular HIV testing and counselling reduce risky sexual behaviours in African men who have sex with men (MSM) is still a matter for debate. We aimed to identify behavioural trajectories based on HIV risk exposure (HRE) and factors affecting their evolution.METHODS: Data were collected from 621 HIV-negative West African MSM (Mali, Cote d'Ivoire, Burkina Faso and Togo) included in a community-based cohort providing quarterly HIV testing and counselling. Sociobehavioural data were collected every 6 months. HRE was defined as reporting inconsistent condom use during receptive anal sex with male partners of unknown HIV status in the previous 6 months. Using 18-month follow-up data, group-based trajectory modelling helped identify behavioural trajectories and determine the factors associated with their evolution. HIV seroconversions (n=67) were specified in each group trajectory.RESULTS: Two distinct group trajectories were identified: medium-risk exposure MSM (ME-MSM) (61%, 6.4% of whom having seroconverted) and high-risk exposure MSM (HE-MSM) (39%, 17.5% of whom having seroconverted). A significant declining trend in the probability of reporting HRE over time ((95% CI)) was observed for HE-MSM (from 0.59 (0.48 to 0.70) at M0 to 0.31 (0.22 to 0.41) at M18), while it remained constant for ME-MSM (0.034 (0.0 to 0.079)). This can be explained by a progressive use of risk reduction strategies (less receptive anal sex, better knowledge of their partners' status and increasing condom use). Being younger, living in Burkina Faso, self-considering both a man and a woman and reporting a higher level of depression were all associated with HE membership. Among HE-MSM, HRE was higher in those practising transactional or group sex and those experiencing psychological harassment.CONCLUSIONS: Quarterly HIV testing and counselling seem to reduce risky sexual behaviours in HIV-negative MSM at greatest risk of infection. Specific support for young MSM, focusing on identity and mental health, is needed to strengthen HIV prevention in West African MSM

Male clients of male sex workers in West Africa : a neglected high-risk population

Research on male clients of male sex workers (MCMSW) has been neglected for a long time globally. We aimed to characterize MCMSW and to identify factors associated with their sexual practices using data from the prospective cohort study CohMSM conducted in Burkina Faso, Cote d'Ivoire, Mali and Togo. Our study focused on HIV-negative men who have sex with other men (MSM), recruited between 06/2015 and 01/2018 by a team of trained peer educators. Scheduled study visits at 6, 12 and 18 months included medical examinations, HIV screening, risk-reduction counselling and face-to-face interviews to collect information on their sociodemographic characteristics, sexual behaviours, and HIV risk-reduction strategies (HIV-RRS). Three stigmatization sub-scores were constructed (experienced, perceived and internalized). Mixed-effects logistic regression was used for data analysis. Of the 280 participants recruited at baseline, 238, 211 and 118, respectively, had a follow-up visit at 6, 12 and 18 months. Over a total of 847 visits, 47 transactional sex (TS) encounters were reported by 38 MCMSW (13.6%). Of the latter, only one participant reported systematic TS (2.6%), 18 (47.4%) stopped reporting TS after baseline, while 6 (15.8%) reported TS after baseline. Thirteen participants (34.2%) reported occasional TS. After adjusting for country of study and age, the following self-reported factors were associated with a greater likelihood of being MCMSW: protected anal sex, exclusively insertive anal sex with male sexual partners, avoidance of sex after consuming psychoactive products and experiencing stigmatization (all during the previous 6 months). The majority of MCMSW in this study practiced HIV-RRS with male sexual partners, including engaging in protected anal sex, avoidance of sex when consuming psychoactive products, and practising exclusively insertive anal sex

Combined sexual behavioral profiles in HIV-seronegative men who have sex with men in West Africa (CohMSM ANRS 12324-Expertise France)

Understanding the dynamics of HIV infection in men who have sex with men (MSM) can help improve efficiency in existing prevention strategies. We aimed to identify and describe the sexual behaviors of MSM most at risk of HIV infection in West Africa. HIV-negative MSM were provided a quarterly preventive follow-up package in the community-based cohort CohMSM. They completed face-to-face sociobehavioral questionnaires every 6 months. This sub-study on 520 participants used a baseline, 6-, 12- and 18-month data cluster analysis to categorize two profiles (high risk [HRE] and moderate risk [MRE] of exposure to HIV) based on three risky sexual practices over the previous 6 months. HRE-MSM (61%) were more engaged in receptive practices, had a higher proportion of inconsistent condom use during anal sex, and reported more sexual partners than MRE-MSM (39%). The proportion of HIV seroconversions observed during the first 18 months of follow-up using sexual behavioral profiles (92% are HRE-MSM) was higher than using the three risky sexual practices separately. Factors associated with the HRE-MSM profile were being younger (18-21 years), reporting stigma, and having had no female partner while being attracted only to men. Our findings suggest that in order to identify MSM most at risk of HIV infection, several risky sexual practices need to be evaluated in a combined approach. Prevention programs should pay particular attention to younger MSM, and implement activities addressing questions of MSM identity and stigma in order to reduce the dynamic of HIV infection in Western African MSM

Hepatitis B virus prevalence and vaccination in men who have sex with men in West Africa (CohMSM ANRS 12324-expertise France)

Background. Although men who have sex with men (MSM) are at high risk of hepatitis B virus (HBV) infection, they do not have access to vaccination in West Africa, which is a highly endemic region. We investigated HBV prevalence and associated factors, as well as acceptability and difficulties of vaccination in MSM enrolled in an operational research program in Burkina Faso, Cote d'Ivoire, Mali, and Togo. Methods. We followed up 779 MSM in 2015-2018. Participants who were negative for both hepatitis B surface antigen (HBsAg) and antibodies (anti-HBs) at enrollment were offered HBV vaccination. Factors associated with HBV infection were identified using logistic regression models. Results. Overall, HBV prevalence was 11.2% (95% confidence interval [CI], 9.0%-13.6%). It was lower in Togo than in Cote d'Ivoire (2.7% vs 17.3%; adjusted odds ratio [aOR], 0.12; 95% CI, 0.02-0.28) and higher in participants with 6+ recent male sexual partners (21.0% vs 9.3%; aOR, 1.48; 95% CI, 1.12-1.97). Of 528 participants eligible for vaccination, 484 (91.7%) were willing to be vaccinated and received at least 1 dose (ranging from 68.2% in Abidjan to 96.4% in Bamako; P < .001). Of the latter, 390 (80.6%) received 3 or 4 doses. The proportion of participants for whom the minimum required time between each dose was respected ranged from 10.9% in Bamako to 88.6% in Lome (P < .001). Conclusions. MSM in West Africa should be targeted more for HBV screening and vaccination. Although vaccination is well accepted by MSM, greater training of health care workers and education of MSM are required

Taking empowerment into account : the response of community-based organisations to the HIV care needs of men who have sex with men in West Africa (CohMSM ANRS 12324-Expertise France)

Empowerment is an ongoing process through which individuals and communities appropriate power and acquire the capability to function autonomously. Research on empowerment in men who have sex with men (MSM) is lacking in community-based contexts. We investigated the relationship between willingness to be empowered and HIV care needs in West African MSM accessing community-based organisations' (CBO) services. Fifty-three interviews were administered to HIV-negative MSM participating in the CohMSM study (Mali, Burkina Faso, Cote d'Ivoire, Togo). Five indicators of empowerment were identified from a discourse analysis: (i) motivation to access HIV services, (ii) willingness to improve HIV services, (iii) desire to be involved in new activities, (iv) desire to participate in such services, (v) willingness to collaborate in decision making. Based on these indicators, participants were classified into two profiles: high (19/53, 36%) and low (34/53, 64%) level of willingness to be empowered (HWE, LWE). Using a thematic analysis, HWE participants were focused on collective benefit (preventive follow-up, questions about MSM identity), while LWE participants were centred on individual benefit (medical care). CBOs should consider empowerment as a tool to advance collective health benefits for MSM. To improve empowerment in MSM, specific training on issues regarding sexual identity and stigma is needed for CBO providers