Assessing mpox knowledge and sexual behaviours within high-risk populations in the Democratic Republic of the Congo

BackgroundHistorically, the Democratic Republic of the Congo (DRC) has faced the greatest public health burden from mpox, including more than 70,000 probable cases from 01 January 2024 to 02 February 2025. However, there has been a relative paucity of investigation focused on mpox community engagement in DRC, including assessments of disease knowledge and risk perception. MethodsGiven the ongoing Clade I mpox public health emergency of international concern, and the linkage between sustained human-to-human transmission and dense sexual networks, we sought to investigate mpox knowledge and sexual behaviours among key populations. Between March 20, 2024, and August 25, 2024, we recruited 2794 participants distributed across Kinshasa, Kwango and North Kivu provinces, with a focus in urban centers where mpox risk was considered high. ResultsMost participants were considered other at-risk populations (1035; 37.0%), followed by men who have sex with men (MSM, 831; 29.7%) and sex workers (810; 29.0%). Mpox knowledge, including transmission routes, as well as sexual and health-seeking behaviours were evaluated through questionnaires led by peer educators. Overall, only 6.1% of all participants reported prior mpox knowledge. Among this participant subset, zoonosis ("direct contact with infected animals") and "people living in high-risk areas" were the most frequently selected options in regard to mpox transmission and populations at risk, respectively. When considering at-risk behaviors for mpox, those that identified as sex workers reported significantly higher risk sexual activities including multiple sexual partners (80.3% of sex work participants), engaging in transactional sex (84.7.0%), and anonymous sex (80.8%) compared to MSM. However, both sex workers (44.8%) and MSM (56.7%) reported the highest health seeking behaviors for a suspected sexually transmitted infection. ConclusionOur results highlight that community engagement which incorporates both mpox knowledge and risk perception activities and is inclusive of at-risk populations are needed for ongoing mpox containment and mitigation efforts.