Knowledge, Attitude and Practices concerning mpox among high-risk groups in the Eastern Mediterranean Region (EMR)

Abstract

Human monkeypox (mpox), a viral zoonotic infectious disease, was declared a public health emergency in July 2022. Men who have sex with men (MSM) are at higher risk of Mpox infection. Limited studies have been conducted in the Eastern Mediterranean Region (EMR) to assess knowledge, attitudes and practices towards mpox; importantly, where none of these studies were among MSM. The aim of this study is to assess the knowledge, attitudes, perceptions/practices concerning mpox among the MSM population in the EMR region. This is a cross-sectional study of MSM residing in the region. Participants were recruited through non-governmental organizations (NGOs), dating applications, and LGBTQ+ websites between July and October 2023. The outcome mpox knowledge (> score of 12 vs ≤12) was investigated. A total of 643 MSM participants of median age 31 (IQR: 26-37) participated in the study. Around 47.7% attended university/college, and 55.8% were employed. Among study participants, 131 (20.4%) had adequate mpox knowledge. The knowledge scores of study participants ranged from 0 to 16 indicating that none of the participants answered all 17 mpox knowledge questions correctly with a median knowledge score of 9 (IQR: 5-12). Most of the participants were knowledgeable about mpox symptoms (66.7%), mode of transmission (64.5%), and the importance of isolation to stop viral spread (61.6%). The key predictors of higher mpox knowledge score detected in our study were older age, being in a relationship, and knowing someone who had/has mpox. Living in a country with higher number of reported mpox cases and having a history of STI or viral hepatitis encouraged safer sex practices and willingness to get the mpox vaccine. Almost 49.2% of participants residing in countries with reported mpox cases did not know where to get tested for mpox compared to 62% of those residing in countries with no reported mpox cases. Vaccination programs and campaigns for MSM should increase in number, and prioritized for high-risk vulnerable groups. Integration of mpox into existing HIV and STI prevention programs is important specifically for vulnerable groups to ensure equitable access to care.