ANRS PRINCESSE cohort

PrEP, sexually transmitted infections, contraception, viral hepatitis B, sexual health for sex workers in Côte d'Ivoire

Published on 22 July 2024

What is the ANRS Princesse cohort?

The PRINCESSE research project is an interventional cohort that aims to offer comprehensive sexual and reproductive health care to FSWs in the San Pedro region, in collaboration with Ivorian community stakeholders.
The project arose from the results of the PrEP-CI exploratory project (ANRS 12361), which studied the feasibility and relevance of a PrEP programme for female sex workers (FSWs) in Côte d’Ivoire between October 2016 and March 2017, and which showed that all female sex workers had unmet sexual and reproductive health needs, whether or not they were infected with HIV and whether or not they wanted to initiate PrEP.
The PRINCESSE project was therefore developed on the basis of these findings.

The originality of the PRINCESSE project

The originality of PRINCESSE lies in the combination of several health services: PrEP for HIV-positive sex workers, early care for HIV-positive women, screening, vaccination and treatment for hepatitis B (HBV), as well as screening and treatment for sexually transmitted infections (STIs). The program also includes contraception services, advice on menstrual management, and identification of dependency situations. PRINCESSE was implemented in partnership with the community-based NGO Aprosam, using its fixed clinic and a mobile clinic to provide quarterly monitoring on prostitution sites.

In brief

Main investigators
North Project Leader: Dr. Joseph LARMARANGE (IRD/CEPED)
South Project Leader: Prof. Serge EHOLIE (PAC-CI Programme)

Pathologies
HIV, HBV, STIs

Sponsorship
ANRS MIE

Status
Completed (analysis phase)

What is the aim of the ANRS Princesse cohort?

The main aim of PRINCESSE is to develop, document and analyse a community-based healthcare offer combining screening, prevention (including PrEP), immediate treatment of HIV, management of hepatitis B and sexual and reproductive health. The aim is to reduce exposure to HIV among FSWs and their partners in Côte d’Ivoire.

Secondary objectives include analyzing access to care and retention of participants, measuring changes in their health status, assessing initiation, use and adherence to PrEP, comparing HIV management under the PRINCESSE scheme with routine care, and documenting the unintended impacts of the program on participants’ lives and on the sex work market.

Methodology of the ANRS Princesse cohort

PRINCESSE is a single-arm interventional cohort that included 489 sex workers in San Pedro.
Data were collected using four integrated methods: clinical and pharmacovigilance data, socio-behavioral questionnaires, biological data, and in-depth interviews with participants.
Outside the cohort, additional data collection included capturing the activity logs of peer educators, the medical records of HIV+ patients not participating in the cohort, interviews with key informants in the sex workers community, and interviews with PRINCESSE follow-up workers.

Main points

The PRINCESSE intervention aimed to provide comprehensive sexual and reproductive health care, accessible via mobile clinics for quarterly follow-up and a fixed clinic, allowing each participant to choose her mode of follow-up. This integrated, community-based approach could become a model for sexual and reproductive health programs in West Africa.

Main publications

Here are the latest scientific publications from the Princesse project. You can find all the publications associated with the project on the HAL open archives.

Amir Mohareb, Menan Gérard Kouamé, Marcellin Nouaman, Arthur Kim, Joseph Larmarange, Anne Neilan, Karine Lacombe, Kenneth Freedberg, Anders Boyd, Patrick Coffie, and Emily Hyle. What does the scale-up of long-acting HIV pre-exposure prophylaxis mean for the global hepatitis B epidemic? Journal of the International AIDS Society, 27(3):e26218, March 2024. doi: 10.1002/jia2.26218. URL https://hal.science/hal-04491666.
Marcellin N. Nouaman, Valentine Becquet, M’elanie Plazy, Patrick A. Coffie, Clemence Z’ebago, Alice Montoyo, Camille Anoma, Serge Eholie, François Dabis, and Joseph Larmarange. Incidence of HIV infection and associated factors among female sex workers in Côte d’Ivoire, results of the ANRS 12361 PrEP-CI study using recent infection assays. PLoS ONE, 17(11):e0271988, 2022a. doi: 10.1371/journal.pone.0271988. URL https://hal.science/hal-03860637.
Valentine Becquet, Marcellin Nouaman, Mélanie Plazy, Aline Agoua, Clémence Zébago, Herv’e Dao, Alice Montoyo, Aude Jary, Patrick A. Coffie, Serge Eholi’e, and Joseph Larmarange. A communitybased healthcare package combining testing and prevention tools, including pre-exposure prophylaxis (PrEP), immediate HIV treatment, management of hepatitis B virus, and sexual and reproductive health (SRH), targeting female sex workers (FSWs) in Côte d’Ivoire: the ANRS 12381 PRINCESSE project. BMC Public Health, 21(1):2214, December 2021. doi: 10.1186/s12889-021-12235-0. URL https://hal.science/hal-03467822.
Valentine Becquet, Marcellin Nouaman, M’elanie Plazy, Jean-Marie Masumbuko, Camille Anoma, Soh Kouame, Christine Danel, Serge Eholi’e, and Joseph Larmarange. Sexual health needs of female sex workers in Cˆote d’Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention. BMJ Open, 10(1):e028508 (1-12), January 2020. doi: 10.1136/bmjopen-2018-028508. URL https://hal.science/hal-02433994.
Joseph Larmarange, Marcellin Nouaman, Hector Juliard, Evelyne Kissi, Rose-Marcelle Dedocoton, Valentine Becquet, and Mélanie Plazy. Restitution of the scientific results of the PRINCESSE project. In Atelier de restitution du projet ANRS 12381 PRINCESSE, Abidjan, Côte d’Ivoire, June 2024. PAC-CI and Onusida. URL https://hal.science/hal-04609403.
Marcellin Nouaman, Evelyne Kissi, Patrick Coffie, Melanie Plazy, Valentine Becquet, Serge Eholie, and Joseph Larmarange. “In the past, we treated patients blindly, with syndromic diagnoses. “Perceptions des médecins dans une prise en charge globale des infections sexuellement transmissibles chez des travailleuses du sexe en Cˆote d’Ivoire. In 12e Conférence Internationale Francophone AFRAVIH, Yaoundé, Cameroon, April 2024. AFRAVIH. URL https://hal.science/hal-04539834.
Mélanie Plazy, Valentine Becquet, Esther Maouhoub, Carla Meertens, Remi Mouquin, Hasna Youssoufa, Marcellin N Nouaman, Patrick Coffie, and Joseph Larmarange. PrEP among female sex workers: where are we? A literature review identifying knowledge gaps to guide the future research agenda. In AIDS Impact Conference, Stockholm, Sweden, June 2023. URL https://hal.science/hal-04120001
Valentine Becquet, Mélanie Plazy, Evelyne Kissi, Marcellin N Nouaman, Patrick Coffie, Serge Eholi’e, and Joseph Larmarange. “It’s hard to take it every day”: initiations, discontinuations & perceptions of oral pre-exposure prophylaxis among female sex workers in Côte d’Ivoire. In AIDS Impact Conference, Stockhlom, Sweden, June 2023. URL https://hal.science/hal-04119974