Access to PrEP for cis and transgender women: Developing and implementing a community-based intervention adapted to populations exposed to HIV in Mali, Morocco, and Mauritius

<i>Background</i>: Pre-exposure prophylaxis (PrEP) is recommended as part of a comprehensive HIV prevention approach, but its uptake among women, particularly those in key populations, remains limited.<i>Methods</i>: A mixed-methods community-based study was conducted in Mali, Mauritius, and Morocco to assess barriers and facilitators to PrEP implementation among cis and transgender women at high risk of HIV infection. Quantitative data collected included demographic information, awareness, willingness to use PrEP, and perceived barriers. The qualitative component included in-depth interviews with key populations, policymakers, healthcare workers, and community stakeholders to better determine the barriers to PrEP implementation and scale-up for women. Data analysis and processing were performed using software adapted to the respondent-driven sampling technique.<i>Results</i>: Between 15 February and 15 March, 2020, a survey was conducted involving 1 003 female participants. The results indicated varying levels of awareness of PrEP across different populations, with transgender women in Mauritius exhibiting the highest awareness (54%). Moreover, there was generally a high willingness to use PrEP among participants, with rates of 77% and 84% among female sex workers in Morocco and Mali, respectively, and 71% among female partners of people who inject drugs, as well as 50% among transgender women in Mauritius. Additionally, qualitative insights revealed prevailing barriers such as issues related to accessibility, stigma, and the legal frameworks in the respective countries.<i>Conclusion</i>: This study provides critical insights into the challenges and opportunities for PrEP implementation among women in Mali, Mauritius, and Morocco. The findings underscore the importance of community-based research and the need for tailored interventions to improve PrEP awareness and uptake among women, particularly those in key populations. The results may inform advocacy efforts and the provision of adapted services within comprehensive HIV prevention programs to better address the needs of these populations.