A comprehensive approach to prevention and access to Mpox care in the Democratic Republic of Congo, Cameroon and Burundi, among HIV key populations and all stakeholders

Background Since the Mpox epidemic resurgence across the six WHO regions in 2022, virus dynamic have evolved, with increasing evidence of sexual transmission in addition to previously known transmission mechanisms, including in Central Africa. This shift raises new challenges in prevention and public health strategies, which must address the needs of healthcare professionals, the general population, and key populations affected by HIV. In 2022, a significant proportion of Mpox cases involved Men who have Sex with Men (MSM), who also presented co-infections with other sexually transmitted infections (STIs), including HIV. The Africa CDC also identified that sex workers (SWs) are particularly exposed to Mpox and may act as transmission vectors through their clients. However, there is limited data on the experiences, knowledge, and perceptions of Mpox in Central Africa, particularly regarding the clade 1b and its interhuman/sexual transmission. Most social science studies on Mpox have been conducted in Western contexts during the 2022 outbreak, and very little data is available in the countries targeted by this study. Objectives This project aims to identify the conditions for implementing an Mpox response strategy that considers both structural and individual factors, including vaccine availability and acceptability, among key populations, people living with HIV, and other affected individuals in Central Africa (Democratic Republic of the Congo, Cameroon, and Burundi). Methods This project is grounded in the theory of social representations (SR), defined as "forms of socially constructed and shared knowledge with a practical purpose, contributing to the construction of a common reality within a social group". The study of SR will allow us to identify how Mpox, and specifically its evolution from a zoonotic disease to a sexually transmitted infection, is perceived and integrated by the different populations involved in this project. It will also analyze how Mpox-related information is disseminated and processed within these groups and how healthcareseeking behaviors are structured. To achieve this, the project will employ qualitative data collection: 36 focus groups and 45 individual interviews will be conducted with HIV key populations (MSM and SWs), healthcare providers and community health workers involved in Mpox response efforts and among general population living in high Mpoxexposure areas. 40 facility-based surveys will be administered to document Mpox-related healthcare facilities. Data collection will take place in two selected areas per country, based on epidemiological and strategic criteria related to the Mpox epidemic. These areas have been identified in collaboration with local stakeholders involved in the project and aligned with the current situation in each country.