PrEPare_Morocco a successful community-based PrEP delivery demonstration program for men who have sex with men and female sex workers in Morocco.

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool, recommended for persons at substantial risk for HIV, such as female sex workers (FSW) and men who have sex with men (MSM). We present Morocco's and the Middle East/North Africa's first PrEP demonstration project. Our pilot aimed to assess the feasibility and acceptability of a community-based PrEP program for FSW and MSM in Morocco's highest HIV prevalence cities: Agadir, Marrakech, and Casablanca. From May to December 2017, 373 eligible participants engaged in a 5-9 month program with daily oral TDF/FTC and clinic visits. Of these, 320 initiated PrEP, with 119 retained until the study's end. We report an 86% PrEP uptake, 37% overall retention, and 78% retention after 3 months. No seroconversions occurred during follow-up. These results underscore PrEP's need and acceptability among MSM and FSW and demonstrate the effectiveness of a community-based PrEP program in Morocco. These findings informed Morocco's current PrEP program and hold potential for the wider region with similar challenges.

Acceptability and usability of oral fluid-based HIV self-testing among female sex workers and men who have sex with men in Morocco.

BACKGROUND: In 2020, almost 20% of people living with HIV (PLHIV) in Morocco are still unaware of their HIV status. Under these circumstances, HIV self-test (HIVST) can be an efficient additional tool for improving the testing rates in Morocco and reaching the first objective of the UNAIDS 95-95-95 goal. ALCS, a Community-based organization, involved in HIV Testing since 1992, and the Ministry of Health of Morocco conducted, a study on the acceptability and usability of HIVST among Female sex workers (FSW) and MSM (men who have sex with men), using a salivary rapid test. To our knowledge, this is the first study in Morocco exploring these parameters. METHODS: We conducted a pilot study on the usability of the OraQuick HIV-1/2 salivary self-test among MSM and FSW visiting the ALCS centers for standard HIV rapid testing in five Moroccan cities. Participants chose whether or not to be assisted by lay provider HIV testing. The counselors sampled them to perform a standard rapid test and then invited them to a private room to perform the HIV self-test simultaneously. In addition, a questionnaire was administered to collect socio-demographic data and to assess their opinion about the usability of the salivary HIVST. RESULTS: Our study was carried out for 5 months and included 492 participants (257 MSM and 233 FSW). The average age of the participants was 29 years among MSM vs 34 years among FSW. The FSW have a lower educational level, 28,8% of them are Illiterate vs. 6,1% of the MSM. Only 18% of participants were aware of the existence of the HIVST, nevertheless, we recorded a very high rate of acceptability (90,6%) of the HIVST. Performing the HIVST was deemed very easy for 92,2% of MSM versus 80,6% of FSW. Although it was found very difficult for six participants, including five FSW, 4 of them could not read or write. Overall, the study registered a high HIV positivity rate (3,8%) and 100% of concordance between HIVST participants' interpretation and standard HIV testing performed by ALCS lay provider HIV testing. CONCLUSION: Our study shows very high acceptability of HIVST among FSWs and MSM in Morocco, HIV self-testing is still unknown by key populations in Morocco, and the low level of education of FSWs may be a barrier to the use of this test, but with the proposed assistance and adapted demonstration tools, the HIV self-testing will certainly improve access to testing in Morocco.

La recherche communautaire en temps de pandémie : retour sur l'étude multi-pays EPIC.

In 2020, the COVID-19 health crisis affected all regions of the world, not sparing people already vulnerable to other viral epidemics such as HIV or HCV and/or those in precarious or socially marginalized situations. This is particularly the case for drug users or sex workers.Coalition PLUS, a network of associations fighting against HIV and viral hepatitis which defends and promotes the community-based approach, and its partners, have set up a multi-country community-based research project aimed at documenting the impact of the health crisis on the fight against HIV and viral hepatitis (key populations and community workers/activists), as well as the community responses put in place (EPIC survey).The objective of this paper is to reflect on the implementation of this community-based research study during the COVID-19 health crisis, and in particular the unforeseen difficulties to which the community-based research process had to confront and adapt. The goal is to draw lessons on what worked (and what did not work) in order to capitalize on community-based research practices during this pandemic and subsequently, facilitate the implementation of new research projects in similar contexts.

Impact of the COVID-19 Health Crisis on Key Populations at Higher Risk for, or Living With, HIV or Hepatitis C Virus and People Working With These Populations: Multicountry Community-Based Research Study Protocol (EPIC Program).

BACKGROUND: Information concerning the impact of the COVID-19 health crisis on populations most affected by HIV and hepatitis C virus (HCV; or key populations [KP]), and those working with these populations in community settings, is limited. Community-based organizations working in the field of HIV and viral hepatitis are well placed to identify and meet the new needs of KP owing to the health crisis. OBJECTIVE: This study aims to describe the development and implementation of an exploratory and descriptive multicountry, community-based research program, EPIC (Enquêtes Pour évaluer l'Impact de la crise sanitaire covid en milieu Communautaire), within an international network of community-based organizations involved in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on KP or people living with HIV or HCV and people working with these populations at the community level (community health workers [CHWs]) and to identify the key innovations and adaptations in HIV and HCV services. METHODS: A general protocol and study documents were developed and shared within the Coalition PLUS network. The protocol had a built-in flexibility that allowed participating organizations to adapt the study to local needs in terms of the target population and specific themes of interest. Data were collected using surveys or interviews. RESULTS: From July 2020 to May 2022, a total of 79 organizations participated in the EPIC program. Across 32 countries, 118 studies were conducted: 66 quantitative (n=12,060 among KP or people living with HIV or people living with HCV and n=811 among CHWs) and 52 qualitative (n=766 among KP or people living with HIV or people living with HCV and n=136 among CHWs). CONCLUSIONS: The results of the EPIC program will provide data to describe the impact of the health crisis on KP and CHWs and identify their emerging needs. Documentation of innovative solutions that were put into place in this context may help improve the provision of services after COVID-19 and for future health crises. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45204.