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Context:

Implementing partner: NGO Soutoura
Technical and Financial Partners :

Funded by PEPFAR through USAID
Technical assistance provided by FHI360 and CSLSTBH/MOH

Implementation Sites of Soutoura :

Six (6) health districts: Bamako, Bougouni, Kolondieba, Selingue, Yanfolila and Niono

Targeted Populations:

MSM : Three (3) DIC (since mid-Septembre 2021)
FSW: Six (6) DIC (since octobre 1, 2022)
PLHIV and their contact.

Data : Data collection, analysis and use through KOLOCHI (DHIS2 e-tracker)
Data HIV prévalence:

GP: 1,1%
MSM: 12,6%
FSW: 8,7%

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Under MoH (CSLSTBH) leadership, EpiC Mali supported:

National PrEP Materials development (Guidelines, training Materials, sensitization tools, job aids);
Training of trainers on PrEP;
Printing and dissemination of national PrEP Materials;
Training of field staff (medical doctor, nurse, Peer Educator and Peer Navigator) based at DIC.

Methodology 1/1: Launch of PrEP in Mali

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Demand creation:

Community cadres during outreach and HIV testing activities
DIC Medical doctor during medical consultations HIV testing activities
PrEP champions strategy.

PrEP screnning :

Community cadres at DIC, hotspot and home level
Health care workers at DIC level.

PrEP initiation :

Health care workers at DIC level.

Different PrEP regimens :

- Continuous PrEP

- PrEP on demand or intermittent

PrEP refill:

Health care workers at DIC level
Community-based distribution
PrEP monthly adherence meeting.

Methodology 1/2: Launch of PrEP in Mali

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Results 1/1: PrEP Cascade MSM

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Results 2/2: Continuity of PrEP

MSM	Initiation	M1	rate	M3	rate	M6	rate
≤ 25 ans	237	237	100%	119	50%	78	33%
≥ 25 ans	337	337	100%	172	51%	115	34%
Total	574	574	100%	291	51%	195	34%

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At the end of the evaluation, 99.80% of MSM were eligible for PreP, demonstrating the relevance of the intervention;
Nearly half of MSM eligible for PreP have initiated it in the introductory phase, which shows that it is well accepted;
Continuous PreP was the most widely used option, with 67.30% (preferred option);
Six-month follow-up of the cohort shows a decrease in MSM on continuous PreP due to non-adherence;
Two cases (2) of seroconversion were identified only in MSM who used PreP on demand, showing that continuous PreP provides better protection.

Discussion

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Lessons learned :

CSLSTBH (MoH)’s leadership for the introduction of PrEP has enabled us to have guidelines for the implementation of PrEP;
The results obtained by SOUTOURA in the introduction phase show that PreP is well accepted by MSM;
PrEP initiation at DIC level has enabled us to improve the PrEP use;
PrEP refill at community level has enabled us to keep MSM on continuous PreP.

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PrEP is an effective intervention and should be offered as part of a combined HIV prevention approach, enabling the national HIV program to reduce new HIV infections.
However, programs need to consider strategies specific to the difficulties involved in keeping targeted populations on PreP in order to achieve optimal collective protection against HIV.

Lessons learned :

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Acknowledgements

PrEP adherence meeting in Bamako

Risk assessment of a MSM at home level .

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