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Morocco's approach to developing palliative care is notably constrained, with an almost complete scarcity of laws and regulations in this area. Despite some progress, palliative care remains fragmented and underdeveloped, with persistent disparities in its accessibility and provision. Nationally, there is a lack of sufficient and detailed information about its progress. This paper aims to fill this gap by offering an overview of the history, infrastructure, education, and legislation framework surrounding palliative care in the country. Significant strides have been made since its implementation, but challenges persist, including the need for a comprehensive legislation framework, more trained professionals, and expanded services beyond oncology to other chronic diseases. Strengthening infrastructure and policies is essential to meet the growing needs of Morocco's population.

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Introduction: Morocco is no exception to the global phenomenon of an ageing population. The number of people aged 60 and over rose from one million to 4.5 million between 1970 and 2022. In terms of health, 64.4% of Moroccan seniors are affected by at least one chronic disease, and almost a third suffer from disability. We aimed to estimate the prevalence and identify the factors associated with frailty among the elderly in the Essaouira province of Morocco. Methods: a descriptive and analytical cross-sectional survey of 384 people aged 65 and over attending health centres in Essaouira province was conducted between March 2022 and January 2023. Data were collected using a self-administered questionnaire. The Fried phenotype was used to assess frailty in the participants. Results: according to Fried's phenotype, 46.4% of the elderly were frail. Multivariate analyses showed that frailty was associated with family type [OR=1.9; 95% CI 1.4-2.6], professional activity [OR=2.2; 95% CI 1.2-3.9], financial difficulties [OR=1.7; 95% CI 1.1-2.8] and undernutrition [OR=2.9; 95% CI 1.7-4.8]. Conclusion: implementing a screening strategy and speeding up the process of generalising social protection are actions that will make it possible to reduce the prevalence of frailty among the elderly, prevent its complications and act on its main determinants in Morocco.

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Objectives: Gonorrhea is a prevalent sexually transmitted infection among men who have sex with men (MSM). In Morocco, the basic laboratory diagnosis of Neisseria gonorrhoeae (NG) is based on microscopy and, in some settings, on culture. However, no nucleic acid amplification test (NAAT) has been implemented for routine diagnosis of gonorrhoeae.The aim of this study is to assess the effectiveness of an in-house real-time PCR test for detecting N. gonorrhoeae DNA in anal swabs samples collected during an Integrated Behavioral and Biological survey. Patients and methods: Samples from 245 MSM, recruited using a Respondent Driven Sampling, were collected and tested for NG infection using GeneXpert CT/NG assay (Cepheid, USA). An In-House real-time PCR technique targeting the pseudo gene porA was developed and used for a parallel investigation of the same infection. The reliability of the in-house RT-PCR was validated through tests of reproducibility, repeatability, limit of detection, and cross-reactivity with other bacteria. The intrinsic performance characteristics of the qRT-PCR were assessed, namely, the sensitivity, the specificity, the positive predictive value (PPV), and the negative predictive value (NPV). The GeneXpert CT/NG assay was adopted as a reference method. Results: For N. gonorrhoeae detection, the in-house real-time PCR assay showed a sensitivity and specificity of 80% and 100%, respectively. The PPV of the assay was 100% and the NPV was 97.3%. Conclusion: The in-house real-time PCR assay has high specificity and sensitivity, and it emerges as a promising approach for detecting N. gonorrhoeae in clinical specimens, particularly in decentralized settings such as regional laboratories.

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BACKGROUND: Tuberculosis constitutes a public health problem in Morocco. In an environment where results-based management and the evaluation of public policies become an imperative; the evaluation of the performance of the national tuberculosis control program finds its interest. OBJECTIVES: This study aims to analyze the performance of the tuberculosis control program in the Souss Massa region, based on the systemic approach model over a five-year period 2016-2020. METHODS: This is a descriptive secondary data analysis carried out in the Souss-Massa region in southern Morocco over a five year period 2016-2020. Data collection was carried out through the health information system of the NTCP and the various periodic reports produced by the primary health care establishments and diagnostic centers for tuberculosis and respiratory diseases, the delegations and the regional health directorate of the Ministry of Health. RESULTS: The incidence of tuberculosis has fluctuated between 63 and 72 cases/100,000 inhabitants; the average number of cases detected is 1871 cases per year; the survey completion rate is 57.10%; the therapeutic success rate varies between 82% and 89%, the treatment failure rate varies between 0.62% and 2.32%; the death rate varies between 0.63% and 2.92%; the failure rate for tuberculosis/HIV cases is between 3.10% and 6.09%. CONCLUSIONS: The results of the program tracer indicators at the level of the Souss-Massa region show that the latter combs to achieve the target objectives.

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Cutaneous leishmaniasis is a significant public health concern globally. This study aims to evaluate the impact of cutaneous leishmaniasis on the quality of life of patients in the Draa-Tafilalet region of Morocco. In this cross-sectional study, data were collected from 87 patients between December 2022 and July 2023 using the Skindex-16 questionnaire. The results revealed that cutaneous leishmaniasis has a mild to moderate impact on health-related quality of life, with 26.4 % of participants reporting a low impact and 73.6 % reporting a moderate impact. A significant gender difference was observed in Skindex-16 scores, with moderate impact being more prevalent among females (60.90 % vs. 30.10 %, p = 0.002). Furthermore, facial lesions were associated with a statistically significant reduction in quality of life, particularly in the emotional (p < 0.001) and functioning (p = 0.01) domains. These findings highlight the need for targeted management strategies that address the substantial impact of cutaneous leishmaniasis on patients' quality of life. Future studies with larger sample sizes and extended follow-up periods are warranted to further elucidate the effects of cutaneous leishmaniasis on patients' well-being.

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The fear of being without a mobile phone, known as nomophobia, is a new psychological issue that has arisen with the widespread use of information and communication technologies. To understand this phenomenon, more research is needed. The present study aimed to assess the factor structure of the Moroccan dialect version of the Nomophobia Questionnaire (NMP-Q) among a sample of Moroccan university students. The study included 400 students selected by convenience sampling from two universities (Fez and Rabat). First, an Exploratory Factor Analysis (EFA) was conducted using the principal component method with Varimax rotation. Then, a Confirmatory Factor Analysis (CFA), and Exploratory Structural Equation Modeling (ESEM) were carried out. The results showed that a 20-item, four-factor model was the best fit for the data collected from the sample, indicating cross-cultural validity and the robustness of the NMP-Q's structure. This suggests that the Moroccan version of the NMP-Q is useful for assessing nomophobia behavior among Moroccan university students.

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Klinefelter syndrome (KS) is a common chromosomal abnormality in males, usually presenting as a 47,XXY karyotype and often underdiagnosed. Rarely, KS occurs as mosaic 46,XX/47,XXY. At the same time, ovotesticular disorder of sex development (OT-DSD) is also a rare condition in which both ovarian and testicular structures are present in the same individual, often associated with a 46,XX karyotype. The combination of mosaic 46,XX/47,XXY with OT-DSD is scarce. Herein, we report a new case of a six-month-old infant with unilateral OT-DSD and a 46,XX/47,XXY mosaic karyotype who presented with atypical genitalia at birth. On examination, the external genitalia showed asymmetry of the labioscrotal folds, an empty right fold, a 2.5 cm phallic structure, and a perineal urethral meatus. Imaging studies revealed a uterus and a vaginal cavity, as well as an ovotestis on the left side and an ovarian remnant on the right side. An unexpected increase in testosterone level was observed. Cytogenetics analysis confirmed a mosaic karyotype with 54% of 46,XX and 46% 47,XXY cells. Molecular genetic analysis revealed no mutations in the genes involved in gonadal development. These findings are discussed and the clinical characteristics of the reported cases of 46,XX/47,XXY with OT-DSD are summarized. In conclusion, atypical genitalia leads to the early diagnosis of the rare 46,XX/47,XXY mosaicism with OT-DSD. Mosaicism should be considered in all cryptorchidism cases. Persistent Müllerian structures were common, and the nearly male phenotype of the external genitalia led parents to prefer the male sex of rearing.

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This study aims to contribute to the understanding of the impact of climate change on bioclimatic zones in Morocco, providing insights into potential shifts and emphasizing the need for adaptation measures to protect vulnerable species and ecosystems. To achieve this, we utilized eight general circulation models (GCMs) to simulate climate conditions under two representative concentration scenarios (RCP4.5 and RCP8.5) for two future time points (2050 and 2070). The modeling of bioclimatic zone shifts was accomplished through the implementation of the random forest (RF) algorithm. Our findings indicate that the subhumid and humid areas are expected to experience the most significant shifts, particularly toward the semi-arid zone. Shifts from subhumid to semi-arid were the most pronounced, ranging from 17.91% (RCP8.5 in 2070) to 25.68% (RCP8.5 in 2050), while shifts from humid to semi-arid ranged from 10.16% (RCP4.5 in 2050) to 22.27% (RCP8.5 in 2070). The Saharan and arid zones are expected to be the least affected, with less than 1% and 11% of their original extent expected to change, respectively. Moreover, our results suggest that forest species such as Atlas cedar and oaks are among the most vulnerable to these shifts. Overall, this study highlights the inevitability of climate change's impact on Moroccan ecosystems and provides a basis for adaptation measures, especially considering the species adapted to the bioclimatic conditions that will dominate the respective affected regions.

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Several rural Moroccan people depend on natural remedies such as Smen (ghee) before visiting a health center due to their low cost and accessibility. However, knowledge of Smen traditional medicine is not documented but rather transferred orally from generation to generation. This is the first qualitative ethnomedicinal study that provides and documents information about the medicinal use of Smen in Northern Morocco. The present study aimed to investigate and gather information on the traditional medicinal practices of using Smen among rural people in Northern Morocco for a document and suggest the exploration of this product and its bioactive compounds in medical applications. The investigation was carried out by conducting individual semistructured interviews with 630 elderly people from March to April 2022. Data were analyzed using descriptive statistics and expressed as a percentage of responses to each question in the survey. The study revealed that 66.5% of the people surveyed were aware of the medical benefits of Smen, which had been passed down from their ancestors. It has been used to treat hemorrhoids, common colds, detoxification, rheumatism, and wound/burn injuries. This study showed that Moroccan's ethnomedicinal knowledge is closely related to Ayurveda, ancient Indian traditional medicine. For centuries, Smen has been used traditionally for medical purposes, just as it has been used in cooking. The diversity of ghee medicinal use in Northern Morocco could contribute to the discovery and development of ghee-based drugs, which have fewer side effects.

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BACKGROUND: Cardiovascular diseases (CVD) are the major cause of disability and premature death. This is due to the ascending trend of consuming an unhealthy diet and obesity which increases the risk of hypertension and type 2 diabetes mellitus. The main aim of this review was to fill the knowledge gap by providing an up-to-date overview of the prevalence of CVD risk factors among women and to estimate the pooled prevalence among adolescent and pregnant women in Morocco. METHODS: The review included original cross-sectional studies reporting the prevalence of CVD risk factors in Moroccan women aged ≥ 15 years, published between January 2008 and December 2022. The databases searched included MEDLINE, Scopus, Web of Science, Google Scholar and national government publications (PROSPERO ID: CRD42023426809). RESULTS: Initially, 1471 articles were identified, and 76 studies were included. The most commonly reported CVD risk factor was obesity (reported in 56 studies), the prevalence of obesity varies according to the age groups of women with the rate being particularly high in urban women aged ≥ 35 years (ranging of 14-44.9%). Followed by diabetes (ranging from 7.2 to 12.6%) with a high rate in menopausal women. Hypertension prevalence ranged from 29.8 to 39.29%. Among adolescents, the overall prevalence of obesity was 3.15% (95% CI: 2.6%, 3.7%) and the prevalence of physical inactivity was 56.5% (95% CI: 36.9 - 76%). Among pregnant women, the overall prevalence of obesity was 26.8% (95% CI: 15.5 - 38.2%). Gestational diabetes and hypertension were 15.2% (95% CI: 6.3 - 24.1%) and 7.07% (95% CI: 2.5 - 11.6%), respectively. CONCLUSION: This review highlights the significant burden of CVD risk factors among Moroccan women, with a high prevalences of diabetes, obesity, hypertension. The prevalences of these risk factors varies with age, being notably higher in older age groups. These findings underscore the need for targeted public health interventions to address these risk factors. Future research should focus on longitudinal studies and standardized assessment tools to enhance the robustness of prevalence estimates and inform effective prevention strategies.

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Rabies is a major zoonotic disease legally notifiable in Morocco and elsewhere. Given the burden of rabies and its impact on public health, several national control programs have been implemented since 1986, without achieving their expected objectives. The aim of this study was to design a predictive analysis of rabies in Morocco. The expected outcome was the construction of probabilistic diagrams that can guide actions for the integrated control of this disease, involving all stakeholders, in the country. Such modeling is an essential step in operational epidemiology to optimize expenditure of public funds allocated to the integrated strategy for fighting this disease. The methodology employed combined the use of geospatial analysis tools (kriging) and artificial intelligence models (Machine Learning). In order to investigate the link between the risk of rabies within a territorial municipality (commune) and its socio-economic situation, the following data were analyzed: (1) health data: reported animal cases of rabies between 2004 and 2021 and data obtained through the ArcGIS kriging tool (Geospatial data); (2) demographic and socio-economic data. We compared several Machine Learning models. Of these, the "Imbalanced-Xgboost" model associated with kriging yielded the best results. After optimizing this model, we mapped our results for better visualization. The obtained results complement and consolidate previous study in this field with greater accuracy, showing a strong correlation between a commune's socio-economic status, its geographical location and its risk level of rabies. From this, 399 out of the 1546 communes have been identified as high-risk areas, accounting for 25.8% of the total number of communes. Under this risk-based approach, the results of these analyses make it practical to take targeted decisions for rabies prevention and control, as well as canine population control, in a territorial commune according to its risk level. Such an approach allows obvious optimized distribution of financial resources and adaptation of the control actions to be taken. The study highlights also the importance of using innovative technologies to refine epidemiological approaches and fill gaps in field data. Through this study, we hope to contribute to eradication of rabies in Morocco by providing reliable data and practical recommendations for control actions against rabies.

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Breast cancer is the first cancer in women in terms of incidence and mortality. In Morocco, it is a public health problem. Its prognosis is strongly linked to the stage at which it is diagnosed. It is a pathology for which diagnosis means are highly developed today, ranging from early detection to the demonstration of infra-clinical lesions, which has markedly improved the prognosis in developed countries. This work aims to identify the factors that lead patients to consult at an advanced stage in our daily practice. It is a retrospective study carried out from January 2018 to December 2018 including 525 patients with breast cancer followed in the medical oncology department of the Mohammed VI University Hospital in Marrakech. The average age was 54. The average time for consultation was 10.3 months. 63% of patients were from rural areas. Delayed diagnosis affected women above 35 years of age (80%). The most common method of detection was self-examination in 74% of cases. Inflammation (2.66%), ulceration (1.14%), signs of metastases (17.14%), and isolated breast nodes (79.4%) were other reasons for consultation. 82.2% of patients were locally advanced at the time of diagnosis. The time for treatment in our study was 3.7 weeks. In our practice, it is the conjunction of ignorance, poverty, socio-cultural habits, and difficult geographical access that are the essential factors in the late diagnosis of breast cancer.

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Introduction: Tobacco use is the major preventable cause of premature death worldwide, responsible for about 8 million deaths per year, mostly in low- and middle-income countries, such as Morocco. Adolescents' tobacco use is a matter of concern, because early initiation increases the risk of becoming a lifelong user. There exists a notable gap in the synthesis of evidence concerning tobacco use among Moroccan adolescents. Thus, the purpose of this study was to provide a comprehensive view of the prevalence of tobacco products' use and associated factors among adolescents in Morocco. Methods: We systematically searched PubMed, Scopus, Web of Science and ScienceDirect for relevant studies reporting prevalence rates of tobacco products' use among Moroccan adolescents, published until June 2024, using inclusion and exclusion criteria in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Additional searches were completed on other sources to reach unpublished reports. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of included studies. Results: After the final screening, 22 papers met the inclusion criteria. Life-time prevalence of tobacco use ranged from 7.8% to 20.4% for cigarettes smoking, from 10.6% to 21.9% for waterpipe, from 7.9% to 9.1% for chewing tobacco and from 9.2% to 12.4% for snuff. The last 12-month prevalence of cigarette smoking was comprised between 6.9% and 10.8%. As for the prevalence of current use, ranges of (1.8%-16.4%) and (4.9%-8.4%) were noted for cigarettes and waterpipe, respectively. The most commonly highlighted risk factors for tobacco use included male sex, older age, having friends or family members who use tobacco and low perception of risk associated with tobacco use. Conclusion: Our findings reveal an alarming situation of tobacco use among Moroccan adolescents. Therefore, it is crucial that all stakeholders engage in concerted efforts to develop and implement evidence-based preventive interventions among early adolescents.

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INTRODUCTION: Hemodialysis patients' adherence to hemodialysis sessions, medication, diet and, fluid restriction is an essential condition to ensure effective treatment. Therefore, this study aimed to assess the overall adherence of hemodialysis patients in the Marrakech-Safi region of Morocco. METHODS: A quantitative cross-sectional study of hemodialysis patients at the Safi, Youssoufia and Ibn Tofail public hemodialysis centers was conducted in the last trimester of 2023 using a questionnaire (ESRD-AQ), which was completed by analyzing patient records and interviewing patients during the hemodialysis session. RESULTS: A total of 199 patients were included in this study. Women accounted for 53.3% of patients, 73.9% were under 65 years, 55.8% had been on hemodialysis for more than 5 years, and 62.8% had an Inter-dialytic-weight (IDW) ≥ 2.5 kg. Mean scores for adherence to hemodialysis, medication, diet and fluid restriction were 534.92 ± 98.71 out of 600, 113.32 ± 50.86 out of 200, 75.38 ± 42.00 out of 200 and 52.51 ± 53.59 out of 200, respectively. Regarding overall adherence, 24.1% had low adherence, 63.8% had moderate adherence, and 12.1% had good adherence, with a mean score of 793.99 ± 151.28 out of 1200. Our results showed that male gender (p = 0.010, ORa = 5.61), young age (p = 0.004, ORa = 8.48), and short duration on hemodialysis (p = 0.001, ORa = 23.91) were risk factors for low overall adherence. CONCLUSION: Our results justify the increased need for educational programs aimed at improving the overall adherence of hemodialysis patients.

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BACKGROUND: The global prevalence of metabolic syndrome (MetS) increases susceptibility to non-communicable diseases such as obesity, type 2 diabetes, and cardiovascular disease, posing significant health risks. Effective prevention and management require objective tools. The hypertriglyceridemic waist (TG+WC+) phenotype is proposed as a less expensive approach to identify individuals with metabolic syndrome and other cardiovascular risk factors. OBJECTIVE: The current aim of this investigation is to study the epidemiological characteristics of the hypertriglyceridemic waist phenotype and their correlations with cardiovascular risk factors and MetS in the Moroccan Amazigh ethnic group from the Souss region of Morocco. MATERIAL AND METHODS: A total of 827 Amazigh adults from the Sousse region of Morocco were divided into four distinct phenotype groups: TG-WC-, TG+WC-, TG-WC+, and TG+WC+ (normal TG- or high TG+ triglycerides/normal WC- or high WC+ waist circumference). The association of the different phenotypes with MetS and other cardiovascular risk factors was established by logistic regression analysis. RESULTS: The prevalence of the TG+WC+ phenotype was 27.7% and varied according to age group and sex. Among subjects with the TG+WC+ phenotype, most were 41-60 years old (53.3%) and in women (74.2%). Participants with the TG+WC+ phenotype had the highest prevalence of dyslipidemia (87.3%), hypoHDLaemia (69.9%), and general obesity (37.12%). The three phenotypes TG-WC-, TG+WC- and TG-WC+ were less associated with MetS and other cardiovascular risk factors. Moreover, people with the TG+WC+ phenotype had a very high odds ratio for MetS. CONCLUSION: These findings suggest that the TG+WC+ phenotype exhibits a robust correlation with MetS and additional variables connected to cardiovascular risk. The TG+WC+ phenotype serves as a valuable clinical instrument for detecting individuals vulnerable to MetS and cardiovascular diseases.

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Introduction: high blood pressure, commonly known as hypertension, is one of the most widespread chronic diseases in the world. It is a serious problem whose management is essential to maintain stable blood pressure levels in the short term, and to prevent neuro-cardio-vascular complications in the long term. This study aims firstly to explore the characteristics of uncontrolled blood pressure among patient´s residents of rural areas in Settat City, and secondly to determine its prevalence and identify associated risk factors. Methods: this is a cross-sectional, descriptive, and analytical study which took place between March and August 2023, and targeted a population of hypertensive patients following up at primary healthcare facilities in rural areas in Settat City. A questionnaire was developed and evaluated to ensure its reliability before being administered to study participants, anthropometric measurements and blood pressure readings were also taken. Results: four hundred hypertensive patients were surveyed, 53% (212) of whom had uncontrolled blood pressure, with a mean age of 56.94 (±13.10 years), and a marked female preponderance, illustrated by 72.3% (289) were female. The risk factors associated with uncontrolled blood pressure were: male gender (aOR: 2.53, 95% CI 1.13-5.65), monthly income (aOR: 5.64, 95% CI 3.04-10.46), diabetes (aOR: 3.16, 95% CI 1.77-5.63), monotherapy (aOR: 8.42, 95% CI 2.85-24.90), poor compliance with medication (aOR: 7.48, 95% CI 4.21-13.29), and stress (aOR: 2.22, 95% CI 1.14-4.33). Conclusion: the level of blood pressure control was unsatisfactory in this population, underscoring the imperative of educating hypertensive patients about management measures and reinforcing the quality of primary health services.

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Accurate prediction of Particulate Matter (PM 10) levels, an indicator of natural pollutants such as those resulting from dust storms, is crucial for public health and environmental planning. This study aims to provide accurate forecasts of PM 10 over Morocco for five days. The Analog Ensemble (AnEn) and the Bias Correction (AnEnBc) techniques were employed to post-process PM 10 forecasts produced by the Copernicus Atmosphere Monitoring Service (CAMS) global atmospheric composition forecasts, using CAMS reanalysis data as a reference. The results show substantial prediction improvements: the Root Mean Square Error (RMSE) decreased from 63.83 µg/m 3 in the original forecasts to 44.73 µg/m 3 with AnEn and AnEnBc, while the Mean Absolute Error (MAE) reduced from 36.70 µg/m 3 to 24.30 µg/m 3. Additionally, the coefficient of determination (R 2) increased more than twofold from 29.11% to 65.18%, and the Pearson correlation coefficient increased from 0.61 to 0.82. This is the first use of this approach for Morocco and the Middle East and North Africa and has the potential for translation into early and more accurate warnings of PM 10 pollution events. The application of such approaches in environmental policies and public health decision making can minimize air pollution health impacts.

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Olea pollen is considered one of the most critical causes of respiratory allergic disease in the Mediterranean region, contributing to different symptoms in allergic sufferers. Due to the high increase in the prevalence of olive pollen caused by the expansion of cultivated areas especially in the Mediterranean region, the aim of this study was to examine the Olea pollen sampling efficiency between gravimetric and volumetric pollen traps over the period 2018-2022. Our data demonstrated that Olea pollen season start-date was generally recorded earlier with volumetric trap than shown with gravimetric method. Moreover, the peak dates occurred mainly in May for the years studied. Across the entire period, the greatest pollen concentrations were reached in the week 11th and >60 % of the total Olea pollen were already reached after the ninth week of sampling in 2020. In general, the evolution of pollen sampling for both methods demonstrates similar temporal development. Variations in the seasonal pollen integral could be attributed to the elevation above ground level at which the traps were placed, exposure to regional winds, the influence of long-range transported pollen and the mode of pollen transport. The findings indicate that the gravimetric method was equally practical as the volumetric method in estimating airborne pollen.

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PURPOSE: Immersive simulation is an innovative training approach in health education that enhances student learning. This study examined its impact on engagement, motivation, and academic performance in nursing and midwifery students. METHODS: A comprehensive systematic search was meticulously conducted in 4 reputable databases­Scopus, PubMed, Web of Science, and Science Direct­following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research protocol was pre-registered in the PROSPERO registry, ensuring transparency and rigor. The quality of the included studies was assessed using the Medical Education Research Study Quality Instrument. RESULTS: Out of 90 identified studies, 11 were included in the present review, involving 1,090 participants. Four out of 5 studies observed high post-test engagement scores in the intervention groups. Additionally, 5 out of 6 studies that evaluated motivation found higher post-test motivational scores in the intervention groups than in control groups using traditional approaches. Furthermore, among the 8 out of 11 studies that evaluated academic performance during immersive simulation training, 5 reported significant differences (P<0.001) in favor of the students in the intervention groups. CONCLUSION: Immersive simulation, as demonstrated by this study, has a significant potential to enhance student engagement, motivation, and academic performance, surpassing traditional teaching methods. This potential underscores the urgent need for future research in various contexts to better integrate this innovative educational approach into nursing and midwifery education curricula, inspiring hope for improved teaching methods.

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In 2017, Morocco became the first Arab country to incorporate pre-exposure prophylaxis (PrEP) in its HIV-prevention program. Yet no research has been published on PrEP from Morocco. Although female sex workers are one of the target populations of PrEP in Morocco, their enrollment in PrEP is lower than men who have sex with men. In this study, we conducted 38 semi-structured interviews with female sex workers, physicians who prescribe PrEP, policymakers, and community advocates to identify problems associated with access to and use of PrEP. We also investigated preferences for daily oral, vaginal ring, and long-acting injectable PrEP. A reflexive thematic analysis revealed seven themes: PrEP stigma; stigmatization and criminalization of sex work; one size doesn't fit all; knowledge and misconceptions about PrEP; economic burden; inconvenience of PrEP pills; and preferred PrEP modalities. This paper discusses the implications of the findings for increasing access and use of PrEP in Morocco.

Factors that Influence Uptake of Oral PrEP among Female Sex Workers One of the most recent scientific advancements in the history of the HIV pandemic was the introduction of pre-exposure prophylaxis (PrEP). However, the uptake of PrEP in the Arab world is low. In this paper we interviewed female sex workers, physicians who prescribe PrEP, policymakers, and community advocates to identify problems associated with access to and use of PrEP. Several barriers were identified including stigma attached to PrEP, misconceptions about PrEP, and financial burden. Although most female sex workers in our study were interested in using PrEP, the delivery methods of PrEP should be tailored to fit the lifestyle and personal circumstances of potential users.

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