ATLAS • AutoTest VIH, Libre d’Accéder à la connaissance de son Statut VIH

Site projet

https://atlas.solthis.org/

Responsable scientifique

Partenariat

Membres du CEPED participant au projet

Financement

Résumé

Le projet ATLAS vise à réduire les nouvelles infections et la mortalité liée au VIH en améliorant l’accès à l’autotest VIH. Il sera mis en œuvre par l’ONG Solthis dans 3 pays d’Afrique de l’Ouest (Côte d’Ivoire, Mali, Sénégal) pour une durée de 3,5 ans.

Devant la spécificité de l’épidémie en Afrique de l’Ouest (prévalence modérée au sein de la population générale mais importante au sein de certains groupes), il est nécessaire de mettre en place des politiques de dépistage ciblées pour toucher ces populations spécifiques, dans un contexte socioculturel freinant le recours au dépistage.

L’autotest VIH est recommandé par l’OMS, car il apporte discrétion, acceptabilité, et empowerment à ceux qui l’utilisent. C’est une approche innovante pour améliorer le diagnostic des personnes vivant avec le VIH. L’autotest n’a pas vocation à remplacer les stratégies de dépistage existantes mais à les compléter pour parvenir à toucher les populations difficiles à atteindre et qui ne se dépistent pas aujourd’hui.

Le projet ATLAS sera géré par un consortium Solthis-IRD, dont Solthis est le chef de file. Solthis assurera la mise en oeuvre des activités (500 000 auto-tests distribués en trois ans) en partenariat avec les conseils/programme nationaux de lutte contre le sida de chacun des trois pays (Côte d’Ivoire, Mali, Sénégal) et les ONGs locales déjà en charge de la réponse à l’épidémie.

L’IRD est en charge de la mise en œuvre des activités d’évaluation et de recherche opérationnelle du projet. Plusieurs enquêtes, intégrées au projet, sont prévues entre 2018 et 2021, incluant une enquête téléphonique sur les trois pays, deux enquêtes qualitatives, une enquête économique et un travail de modélisation épidémiologique et économique. L’équipe scientifique est composée de plus d’une quinzaine de chercheurs internationaux, francophones et anglophones.

Mots-Clés

Dépistage, auto-tests VIH, recherche interventionnelle.

Zone géographique

Côte d’Ivoire, Mali et Sénégal

Calendrier

2018-2021

Publications

2021



  • Boye Sokhna, Bouaré Seydou, Ky-Zerbo Odette, Rouveau Nicolas, Simo Fotso Arlette, d'Elbée Marc, Silhol Romain, Maheu-Giroux Mathieu, Vautier Anthony, Breton Guillaume, Keita Abdelaye, Bekelynck Anne, Desclaux Alice, Larmarange Joseph et Pourette Dolorès (2021) « Challenges of HIV Self-Test Distribution for Index Testing When HIV Status Disclosure Is Low: Preliminary Results of a Qualitative Study in Bamako (Mali) as Part of the ATLAS Project », Frontiers in Public Health, 9 (mai 19). DOI : 10.3389/fpubh.2021.653543. https://www.frontiersin.org/articles/10.3389/fpubh.2021.653543/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Public_Health&id=653543.
    Résumé : The rate of HIV status disclosure to partners is low in Mali, a West African country with a national HIV prevalence of 1.2%. HIV self-testing (HIVST) could increase testing coverage among partners of people living with HIV (PLHIV). This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests at an HIV care clinic in Bamako, Mali. An ethnographic survey was conducted in 2019. It consisted of (i) individual interviews with 8 health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) 7 observations of peer educator-led PLHIV group discussions. HIVST was discussed in only 9% of the observed consultations (51/591). When HIVST was discussed, the discussion was almost always initiated by the health professional rather than PLHIV. HIVST was discussed infrequently because in most of the consultations, it was not appropriate to propose partner HIVST (e.g., when PLHIV were widowed, did not have partners, or had delegated someone to renew their prescriptions). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three main barriers to HIV self-test distribution when HIV status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering HIVST to PLHIV when they thought or knew that the PLHIV had not disclosed their HIV status to partners; (2) PLHIV were reluctant to offer HIVST to their partners if they had not disclosed their HIV-positive status to them; (3) there was limited use of strategies to support the disclosure of HIV status. In conclusion, it is essential to strengthen strategies to support the disclosure of HIV+ status. It is necessary to develop a specific approach for the provision of HIV self-tests for the partners of PLHIV by rethinking the involvement of stakeholders. This approach should provide them with training tailored to the issues related to the (non)disclosure of HIV status and gender inequalities, and improving counseling for PLHIV.
    Mots-clés : HIV self-testing, HIV status disclosure, Index testing, Knowledge of HIV status, Mali, Partners of PLHIV, People living with HIV, Screening -.


  • d'Elbée Marc, Traore Métogara Mohamed, Badiane Kéba, Vautier Anthony, Simo Fotso Arlette, Kabemba Odé Kanku, Rouveau Nicolas, Godfrey-Faussett Peter, Maheu-Giroux Mathieu, Boily Marie-Claude, Medley Graham Francis, Larmarange Joseph, Terris-Prestholt Fern et ATLAS Team (2021) « Costs and Scale-Up Costs of Integrating HIV Self-Testing Into Civil Society Organisation-Led Programmes for Key Populations in Côte d'Ivoire, Senegal, and Mali », Frontiers in Public Health, 9 (mai 24). DOI : 10.3389/fpubh.2021.653612. https://www.frontiersin.org/articles/10.3389/fpubh.2021.653612/full.
    Résumé : Despite significant progress on the proportion of individuals who know their HIV status in 2020, Côte d’Ivoire (76%), Senegal (78%), and Mali (48%) remain far below, and key populations (KP) including female sex workers (FSW), men who have sex with men (MSM), and people who use injectable drugs (PWuID) are the most vulnerable groups with a HIV prevalence at 5%-30%. HIV self-testing (HIVST), a process where a person collects his/her own specimen, performs an HIV test, and interprets the result, was introduced in 2019 as a new testing modality through the ATLAS project coordinated by the international partner organisation Solthis (IPO). In this paper, we estimate the costs of implementing HIVST through twenty-three civil society organisations (CSO)-led models for KP in Côte d’Ivoire (N=7), Senegal (N=11), and Mali (N=5). We modelled costs for programme transition (2021) and early scale-up (2022-2023). Between July 2019 and September 2020, a total of 51,028, 14,472 and 34,353 HIVST kits were distributed in Côte d’Ivoire, Senegal, and Mali, respectively. Across countries, 64%-80% of HIVST kits were distributed to FSW, 20%-31% to MSM, and 5%-8% to PWuID. Average costs per HIVST kit distributed ranged $12-$15 (FSW), $14-$27 (MSM), and $15-$143 (PWuID), driven by personnel costs at various intervention levels (53%-78% of total costs), and HIVST kits costs (2%-15%). Estimated average costs at scale-up ranged $6-$13 (FSW), $6-$23 (MSM), and $14-$50 (PWuID), and were mainly explained by the spreading of IPO costs over higher HIVST distribution volumes. In all three countries, CSO-led HIVST kit provision to KP showed relatively high costs during the study period related to the progressive integration of the programme to CSO activities and contextual challenges (COVID-19 pandemic, country safety concerns). The analysis of costs at scale suggests that, in the transition to scale-up and further integration of the HIVST programme into CSO existing activities, this model can evolve into an affordable HIV testing strategy. This is particularly relevant as it remains today the most promising strategy for reaching KP of the HIV epidemic, their sexual partners, and FSW clients not accessing HIV testing. Further research will assess the overall cost-effectiveness of this model.
    Mots-clés : Costs and Cost Analysis, Côte d'Ivoire, diagnosis, Female sex workers, HIV self-testing, Key populations, Knowledge of HIV status, Mali, Men who have sex with men, People who use injectable drugs, Scale-up, screening, Senegal, West Africa.

  • d'Elbée Marc, Traore Métogara Mohamed, Badiane Kéba, Vautier Anthony, Simo Fotso Arlette, Kanku Kabemba Odé, Rouveau Nicolas, Godfrey-Faussett Peter, Maheu-Giroux Mathieu, Boily Marie-Claude, Medley Graham Francis, Larmarange Joseph et Terris-Prestholt Fern (2021) « Costs and costs-at-scale of provision of HIV self-testing kits by civil society organisations to key populations and their sexual partners in Côte d'Ivoire, Senegal and Mali » (poster PED500), présenté à 11th IAS Conference on HIV Science, Berlin. https://theprogramme.ias2021.org/Abstract/Abstract/476.
    Résumé : BACKGROUND: Despite significant progress on the proportion of individuals who know their HIV status in 2020, Côte d'Ivoire (76%), Senegal (78%), and Mali (48%) remain far below the 90-90-90 targets. Key populations including female sex workers (FSW), men who have sex with men (MSM), and people who use drugs (PWUD) are the most vulnerable groups with HIV prevalence at 5%-30%. HIV self-testing (HIVST) was introduced in West Africa in 2019 as a new testing modality through the ATLAS project coordinated by the international partner organisation Solthis (IPO). METHODS: We estimated the costs of implementing HIVST through twenty-three civil society organisations (CSO)-led models in Côte d'Ivoire (N=7), Senegal (N=11), and Mali (N=5). We modelled costs for programme transition (2021) and early scale-up (2022-2023). RESULTS: Between July-2019 and September-2020, a total of 51,028, 14,472 and 34,353 HIVST kits were distributed in Côte d'Ivoire, Senegal, and Mali, respectively. Across countries, 64%-80% of HIVST kits were distributed to FSW, 20%-31% to MSM, and 5%-8% to PWUD. Cost per HIVST kit distributed ranged from $12-$15 (FSW), $14-$27 (MSM), to $15-$143 (PWUD), driven by personnel costs at various intervention levels (53%-78% of total costs), and HIVST kit costs (2%-15%). Predicted costs at scale-up ranged from $5-$13 (FSW), $5-$24 (MSM), to $13-$53 (PWUD), and were mainly explained by the spreading of IPO costs over higher HIVST distribution volumes. CONCLUSIONS: In all countries, CSO-led HIVST kit provision to key populations showed relatively high costs related to the progressive integration of the programme to CSO activities and contextual challenges (e.g. country security issues). In the transition to scale-up and further integration of the HIVST programme into CSO activities, this model can become less costly. This is particularly relevant as it remains today the most promising strategy for reaching key populations and their sexual partners not accessing HIV testing.


  • Kouassi Arsène Kra, Colin Géraldine, Diop Papa Moussa, Simo Fotso Arlette, Rouveau Nicolas, Hervé Kouakou Kouamé, Geoffroy Olivier, Diallo Bakary, Kabemba Odé Kanku, Dieng Baidy, Diallo Sanata, Vautier Anthony, Larmarange Joseph et ATLAS Team (2021) « Introducing and Implementing HIV Self-Testing in Côte d'Ivoire, Mali, and Senegal: What Can We Learn From ATLAS Project Activity Reports in the Context of the COVID-19 Crisis? », Frontiers in Public Health (juillet 20), p. 1-14. DOI : 10.3389/fpubh.2021.653565. https://www.frontiersin.org/articles/10.3389/fpubh.2021.653565/full.
    Résumé : Background: The ATLAS program promotes and implements HIVST in Côte d’Ivoire, Mali, and Senegal. Priority groups include members of key populations – female sex workers (FSW), men having sex with men (MSM), and people who use drugs (PWUD) – and their partners and relatives. HIVST distribution activities, which began in mid-2019, were impacted in early 2020 by the COVID-19 pandemic. Methods: This article, focusing only on outreach activities among key populations, analyzes quantitative and qualitative program data collected during implementation to examine temporal trends in HIVST distribution and their evolution in the context of the COVID-19 health crisis. Specifically, we investigated the impact on, the adaptation of, and the disruption of field activities. Results: In all three countries, the pre-COVID-19 period was marked by a gradual increase in HIVST distribution. The period corresponding to the initial emergency response (March-May 2020) witnessed an important disruption of activities: a total suspension in Senegal, a significant decline in Côte d’Ivoire, and a less pronounced decrease in Mali. Secondary distribution was also negatively impacted. Peer educators showed resilience and adapted by relocating from public to private areas, reducing group sizes, moving night activities to the daytime, increasing the use of social networks, integrating hygiene measures, and promoting assisted HIVST as an alternative to conventional rapid testing. From June 2020 onward, with the routine management of the COVID-19 pandemic, a catch-up phenomenon was observed with the resumption of activities in Senegal, the opening of new distribution sites, a rebound in the number of distributed HIVST kits, a resurgence in larger group activities, and a rebound in the average number of distributed HIVST kits per primary contact. Conclusions: Although imperfect, the program data provide useful information to describe changes in the implementation of HIVST outreach activities over time. The impact of the COVID-19 pandemic on HIVST distribution among key populations was visible in the monthly activity reports. Focus groups and individual interviews allowed us to document the adaptations made by peer educators, with variations across countries and populations. These adaptations demonstrate the resilience and learning capacities of peer educators and key populations.
    Mots-clés : Côte d'Ivoire, COVID-19, HIV self-testing, Key populations, Mali, Senegal, West Africa.

  • Ky-Zerbo Odette, Desclaux Alice, Kouadio Brou Alexis, Rouveau Nicolas, Vautier Anthony, Sow Souleymane, Camara Cheick Sidi, Boye Sokhna, Pourette Dolorès, Younoussa Sidibé, Maheu-Giroux Mathieu, Larmarange Joseph et for the ATLAS Team (2021) « Introducing HIV self-testing (HIVST) among key populations in West Africa: a baseline qualitative analysis of key stakeholders' attitudes and perceptions in Côte d'Ivoire, Mali, and Senegal » (poster PEC320), présenté à 11th IAS Conference on HIV Science, Berlin. https://theprogramme.ias2021.org/Abstract/Abstract/972.
    Résumé : BACKGROUND: HIV self-testing (HIVST) is a way to improve HIV status knowledge and access to HIV testing. Since 2019, the ATLAS project has introduced, promoted, and delivered HIVST in Côte d'Ivoire, Mali, and Senegal, in particular among female sex workers (FSW), men who have sex with men (MSM), people who use drugs (PWUD), these key populations being particularly vulnerable to HIV and stigmatized in West Africa. Stakeholders involved in HIV testing activities targeting key populations are essential for the deployment of HIVST. Here, we analyze their perceptions of the introduction of HIVST in their countries. METHODS: A qualitative survey was conducted from September to November 2019 within three months of HIVST distribution initiation. Individual interviews were conducted with 60 stakeholders (Côte d'Ivoire, 19; Mali, 20; Senegal, 21). Semi-structured interviews were recorded, translated when necessary, and transcribed. Data were coded using Dedoose"© software for thematic analyses. RESULTS: In the three countries, stakeholders express enthusiasm and willingness to introduce HIVST for several reasons. HIVST is considered able to reduce stigma, preserve anonymity and confidentiality, especially for MSM and PWUD; reach key populations that do not access testing via usual strategies and HIV+ key populations; remove spatial barriers; save time for providers and users, notably for FSW; and empower users with autonomy and responsibility. HIVST is noninvasive and easy to use. Secondary distribution of HIVST seems appropriate for reaching partners of MSM, with confidentiality. However, stakeholders expressed doubts about key populations' ability, particularly PWUD, to correctly use HIVST kits, ensure quality secondary distribution, accept a reactive test result, and use confirmation testing and care services. They also mentioned that FSW might have difficulties redistributing HIVST to their clients and partners. CONCLUSIONS: HIVST is considered an attractive strategy to improve access to HIV testing for key populations. The doubts about users' capacities could be a matter of reflective communication with stakeholders before HIVST implementation in other western African countries.

  • Larmarange Joseph (2021) « From Key Populations to beyond : using HIV self-testing to increasingly reach vulnerable groups in West-Africa » (communication orale), présenté à 11th IAS Conference on HIV Science, Berlin. https://theprogramme.ias2021.org/Programme/Session/163.


  • Rouveau Nicolas, Ky-Zerbo Odette, Boye Sokhna, Simo Fotso Arlette, d’Elbée Marc, Maheu-Giroux Mathieu, Silhol Romain, Kouassi Arsène Kra, Vautier Anthony, Doumenc-Aïdara Clémence, Breton Guillaume, Keita Abdelaye, Ehui Eboi, Ndour Cheikh Tidiane, Boilly Marie-Claude, Terris-Prestholt Fern, Pourette Dolorès, Desclaux Alice, Larmarange Joseph et ATLAS Team (2021) « Describing, analysing and understanding the effects of the introduction of HIV self-testing in West Africa through the ATLAS programme in Côte d’Ivoire, Mali and Senegal », BMC Public Health, 21 (1) (janvier 21), p. 181. DOI : 10.1186/s12889-021-10212-1. https://doi.org/10.1186/s12889-021-10212-1.
    Résumé : The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Côte d’Ivoire, Mali, and Senegal. During 2019–2021, in close collaboration with the national AIDS implementing partners and communities, ATLAS plans to distribute 500,000 HIVST kits through eight delivery channels, combining facility-based, community-based strategies, primary and secondary distribution of HIVST. Considering the characteristics of West African HIV epidemics, the targets of the ATLAS programme are hard-to-reach populations: key populations (female sex workers, men who have sex with men, and drug users), their clients or sexual partners, partners of people living with HIV and patients diagnosed with sexually transmitted infections and their partners. The ATLAS programme includes research support implementation to generate evidence for HIVST scale-up in West Africa. The main objective is to describe, analyse and understand the social, health, epidemiological effects and cost-effectiveness of HIVST introduction in Côte d’Ivoire, Mali and Senegal to improve the overall HIV testing strategy (accessibility, efficacy, ethics). Methods ATLAS research is organised into five multidisciplinary workpackages (WPs): Key Populations WP: qualitative surveys (individual in-depth interviews, focus group discussions) conducted with key actors, key populations, and HIVST users. Index testing WP: ethnographic observation of three HIV care services introducing HIVST for partner testing. Coupons survey WP: an anonymous telephone survey of HIVST users. Cost study WP: incremental economic cost analysis of each delivery model using a top-down costing with programmatic data, complemented by a bottom-up costing of a representative sample of HIVST distribution sites, and a time-motion study for health professionals providing HIVST. Modelling WP: Adaptation, parameterisation and calibration of a dynamic compartmental model that considers the varied populations targeted by the ATLAS programme and the different testing modalities and strategies. Discussion ATLAS is the first comprehensive study on HIV self-testing in West Africa. The ATLAS programme focuses particularly on the secondary distribution of HIVST. This protocol was approved by three national ethic committees and the WHO’s Ethical Research Committee.
    Mots-clés : Côte d’Ivoire, HIV self-testing, HIV/AIDS, Mali, Senegal, West Africa.

2020


  • Boye Sokhna, Bouaré Seydou, Ky-Zerbo Odette, Rouveau Nicolas, Simo Fotso Arlette, d'Elbée Marc, Silhol Romain, Keita Adbelaye, Bekelynck Anne, Desclaux Alice, Larmarange Joseph, Pourette Dolorès et ATLAS Team (2020) « Challenges of HIV self-tests distribution for index testing in a context where HIV status disclosure is low: preliminary experience of the ATLAS project in Bamako, Mali » (poster PED1255), présenté à 23rd AIDS International Conference, San Francisco (virtual). https://cattendee.abstractsonline.com/meeting/9289/Presentation/2271.
    Résumé : BACKGROUND: In Côte d''Ivoire, Mali and Senegal, ATLAS project has introduced HIV self-testing (HIVST) as an index testing strategy, distributing HIVST kits to people living with HIV (PLHIV) during consultations for secondary distribution to their partners. Here, we present preliminary results of an ethnographic survey conducted in one HIV clinic in Bamako, Mali, where most HIV patients have not disclosed their HIV status to their partner(s), notably for women for fear of jeopardizing their relationships. In such a context, how non-disclosure affect the distribution of HIVST kits? METHODS: The study was conducted from September 25 to November 27, 2019, and included individual interviews with 8 health workers; 591 observations of medical consultations; and 7 observations of patient groups discussions led by peer educators. RESULTS: Three principal barriers to HIVST distribution for index testing were identified. (1) Reluctance of PLHIV to offer HIVST to partners to whom they have not (yet) disclosed their status and desire to learn tactics for offering testing without disclosing their HIV status. (2) Near-universal hesitancy among health workers to offer HIVST to persons who, they believe, have not disclosed their HIV status to their partner(s). (3) Absence of strategies, among health workers, to support discussion of status disclosure with PLHIV. In the rare cases where HIVST was offered to a PLHIV whose partner did not know their status, either the PLHIV declined the offer or the provider left it to the patient to find a way to deliver the HIVST without disclosing his/her status. CONCLUSIONS: HIV self-testing distribution could serve as an opportunity for PLHIV to disclose their HIV status to partners. The continuing reluctance of PLHIV to heed advice to share their status and promote secondary HIV self-testing distribution highlights the structural factors (social inequalities and stigma) that limit awareness of HIV status and that favour the persistence of the epidemic.

  • d'Elbée Marc, Badiane Kéba, Ky-Zerbo Odette, Boye Sokhna, Kanku Kabemba Odé, Traore Mohamed, Simo Fotso Arlette, Pourette Dolorès, Desclaux Alice, Larmarange Joseph et Terris-Prestholt Fern (2020) « Can task shifting improve efficiency of HIV self-testing kits distribution? A case study in Mali » (poster), présenté à INTEREST 2020, online. http://interestworkshop.org/.
    Résumé : Background: The ATLAS project introduced HIV self-testing (HIVST) in consultations of people living with HIV (PLHIV) at public health facilities in Côte d'Ivoire, Mali and Senegal for secondary distribution to their partners. Preliminary data from a qualitative study (observations of consultations, interviews with distributing agents) carried out in two clinics in Mali highlight implementation challenges associated with the counselling on self-testing and kit distribution currently done by the medical staff (doctor/nurse) and reported time-consuming. While implementation teams are considering the possibility of delegating certain tasks, it is important to consider the cost of alternative delivery models. Materials & Methods: We analysed preliminary economic costs data for the provision of rapid HIV testing services (HTS) (analysis period: October 2018 – September 2019) and HIVST services (August 2019 – October 2019) in these same two Malian clinics. Above service level costs are excluded. We then modelled the costs of provision using alternative cadres of medical and non-medical staff (psychosocial counsellors/peer educators) and the consumables used to simulate task shifting scenarios for the provision of HTS and HIVST services. The three scenarios correspond to 1. partial delegation: individual counselling done by non-medical staff and HIVST distribution by the medical staff ; 2. total delegation: individual counselling and distribution done by non-medical staff only; and 3. total delegation with group counselling: where group counselling and distribution are done by non-medical staff only. Results: Findings show that the unit costs per HIVST provided for the observed model are 58% higher than those of a conventional rapid test: $7,50 and $4.75, respectively. The costs are less high in scenarios of partial ($5.45, +15%) or total ($5.29, +11%) delegation but always higher than those of a rapid test due to the greater costs of consumables (HIVST kit). Finally, in the case where counselling on self-testing were carried out in a group, the costs per kit provided ($4.44, -6%) would become slightly lower than those of a rapid test, where counselling is always done individually. Conclusion: Task delegation from medical to non-medical staff can generate substantial cost savings. These preliminary results can guide the implementation strategy of HIVST in care consultations, to ensure sustainability from early introduction through scale-up.

  • Ky-Zerbo Odette, Desclaux Alice, Doumenc Aïdara Clémence, Rouveau Nicolas, Boye Sokhna, Kanku Kabemba Odé, Diallo Sanata, Geoffroy Olivier, Kouadio Brou Alexis, Sow Jules Souleymane, Camara Cheick Sidi et Larmarange Joseph (2020) « “When you provide an HIV self-testing kit […] you also need to know the results”: lay providers’ concerns on HIV self-testing provision to peers, ATLAS project » (poster), présenté à INTEREST 2020, online. http://interestworkshop.org/.
    Résumé : Background: HIV self-testing (HIVST) is a process in which a person collects his or her own specimen (oral fluid or blood), using a simple rapid HIV test and then performs the test and interprets the result, often in a private setting, either alone or with someone he/she trusts (WHO, 2018). HIVST is convenient to reach stigmatized groups such as key populations. In the ATLAS project, provision of HIVST kits is done by lay providers to sex workers, drug users and men who have sex with men, or through secondary distribution by primary contacts to their partners and other peers. There is a shifting of paradigm because the result of an HIVST is not necessarily shared with the lay provider. How do lay providers responsible for HIVST kits distribution to key populations in West Africa adopt this new testing strategy? This abstract discusses the concerns of lay providers who offer HIVST kits to peers in the ATLAS Project (Cote d’Ivoire, Mali and Senegal). Material and Methods: We conducted seven focus group discussions with fifty-six lay providers who had experience in offering HIVST to peers (sex workers, men who have sex with men, drug users) in the three countries two months after the ATLAS project started. Results: Lay providers report no major opposition or conflict in offering HIVST kits. Testimonies from primary recipients also suggest that the HIVST was performed correctly in the case of secondary distribution. However, lay providers’ concerns remain with the lack of knowledge of the self-test results. In previous HIV testing strategies, providers usually played a key role to support their client during pre- and post-test counselling, especially when the test result was positive. Therefore, their question is how can they continue to support peers while respecting the private nature of self-testing? The concern is at two levels. At the individual level, lay providers fear that the continuum of care is not guaranteed and peers who self-test with a reactive test result may stay alone. At the collective level, lay providers fear to miss their performance objectives linked to the number of new HIV-positive cases they found and requested by some donors. Consequently, alongside HIVST provision, lay providers share their phone numbers, call back their primary recipients, or apply other indirect strategies to know the self-test result of their recipients. Conclusion: Lay providers develop strategies to learn about the issue of the HIVST they offer and to provide support to their peers following HIVST provision. Is this behaviour related to a cultural context that values social relationships or a sign of empathy to key populations and people living with HIV in a context of high stigmatization? Or is it related to existing performance objectives for new HIV-positive cases finding requested by donors? The meanings of this practice call for a deep reflection on whether or not the WHO guidelines need to be adapted to this context.

  • Larmarange Joseph (2020) « L’autotest est-il une réponse à l’accès aux soins en temps de COVID-19 ? Opportunités et défis » (communication orale), présenté à Séminaire scientifique virtuel de l’IAS Educational Fund : Comment atteindre les populations clés du VIH pendant la pandémie COVID-19 en Afrique de l'ouest et du centre ?, en ligne. https://joseph.larmarange.net/?article283.

  • Vautier Anthony, Rouveau Nicolas, Diallo Sanata, Traore Marinette, Geoffroy Olivier, Kanku Kabemba Odé, Doumenc Aïdara Clémence et Larmarange Joseph (2020) « Is manufacturer’s Instructions-For-Use sufficient in a multilingual and low literacy context? The example of HIV self-testing in West Africa » (poster), présenté à INTEREST 2020, online. http://interestworkshop.org/.
    Résumé : Background: The ATLAS project aims to promote the use of HIV self-testing (HIVST) in Côte d'Ivoire, Mali and Senegal. In order to ensure accurate HIVST use, it was necessary to evaluate if the manufacturer’s Instructions-For-Use (IFUs), standardized at the international level, provides complete, accessible and adapted information in the 3 countries’ contexts. Materials & Methods: In December 2018, cognitive interviews were conducted with 64 participants, mostly Men who have Sex with Men (40,6%) and Female Sex Workers (43,8%) in Côte d'Ivoire, Mali and Senegal. Among them, 17,2 % never performed HIV test before and 38% of participants cannot read. They were invited to perform an oral HIVST (OraQuick®) and were requested, at each step of the procedure to share their understanding of the IFU for HIVST use, of the result interpretation and of related actions to be taken. All participants had in hands the manufacturer's IFUs in French, including the free national hotline number. Half of them additionally received manufacturer's demonstration video translated into local languages. Directive interviews guide included 50 questions to collect participants’ perception of what was missing or unclear in the supporting tools. The methodology was validated with all national AIDS programmes and ministries of health. Results: Out of 64 HIVST performed, 5 results were positive (7,8%) and confirmed with additional tests. Overall, the IFU was well understood: 58 participants (92%) were able to interpret their HIVST result correctly without assistance. However, some misuses were observed at various stages, particularly for people who cannot read, with some instructions misunderstood or perceived as not adapted. Only participants who can read have access to information as “do not eat” or “do not use the test if you are on ART” as it is not illustrated in the IFUs. Most of the participants did not spontaneously identify the promotion of the free hotline number and/or the link to the demonstration video. Some procedure’s steps were misinterpreted: 7 participants (11%) did not swab correctly the flat pad along the gum, 3 participants (5%) have read the result at inaccurate time (at 20 seconds, at 5 minutes or after 40 minutes), 13 participants (20%) did not put the stand (for the tube including the liquid) in the right way and 8 other participants struggled to slide tube into the stand. Among 42 participants who can not read and/or who had not seen the video beforehand, 14 of them (33%) had at least one difficulty to interpret the result or to understand what to do after the test/result. On the other hand, the results of the cognitive interviews showed that demonstration video provides a real added value to the user’s understanding and accurate HIVST use (31 participants out of 32 found it very easy to understand with 9 of them who felt they do not need the IFUs if they previously watched the demonstration video). The video translation into local languages, produced by the ATLAS project, was very much appreciated by the participants. Conclusion: The manufacturer's IFUs alone appear not to be sufficient in a multilingual, low-literacy context to ensure accurate HIVST use. Access to additional supporting tools (complementary leaflet, demonstration video or free hotline) is essential in the 3 countries’ contexts.

2019

2018

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