Using routine programmatic data to estimate the population-level impacts of HIV self-testing: The example of the ATLAS program in Cote d'Ivoire
type: Report
item type: report
publisher: medRxiv
authors: Person
  surname: Fotso
  given name: Arlette Simo
authors: Person
  surname: Johnson
  given name: Cheryl
authors: Person
  surname: Vautier
  given name: Anthony
authors: Person
  surname: Kouame
  given name: Konan Blaise
authors: Person
  surname: Diop
  given name: Papa Moussa
authors: Person
  surname: Silhol
  given name: Romain
authors: Person
  surname: Maheu-Giroux
  given name: Mathieu
authors: Person
  surname: Boily
  given name: Marie-Claude
authors: Person
  surname: Rouveau
  given name: Nicolas
authors: Person
  surname: Doumenc-Aidara
  given name: Clemence
authors: Person
  surname: Baggaley
  given name: Rachel
authors: Person
  surname: Ehui
  given name: Eboi
authors: Person
  surname: Larmarange
  given name: Joseph
authors: Person
  surname: Team
  given name: Atlas
abstract: Background HIV self-testing (HIVST) is recommended by the World Health Organization as an additional HIV testing approach. Since 2019, it has been implemented in Cote d'Ivoire through the ATLAS project, including primary and secondary distribution channels. While the discreet and flexible nature of HIVST makes it appealing for users, it also makes the monitoring and estimation of the population-level programmatic impact of HIVST programs challenging. We used routinely collected data to estimate the effects of ATLAS HIVST distribution on access to testing, conventional testing (self-testing excluded), diagnoses, and antiretroviral treatment (ART) initiations in Cote d'Ivoire. Methods We used the ATLAS project's programmatic data between the third quarter (Q) of 2019 (Q3 2019) and Q1 2021, in addition to routine HIV testing services program data obtained from the President's Emergency Plan for AIDS Relief dashboard. We performed ecological time series regression using linear mixed models. Findings The results are presented for 1000 HIVST kits distributed through ATLAS. They show a negative but nonsignificant effect of the number of ATLAS HIVST on conventional testing uptake (-190 conventional tests [95% CI: -427 to 37, p=0.10]). We estimated that for 1000 additional HIVST distributed through ATLAS, +590 [95% CI: 357 to 821, p<0.001] additional individuals have accessed HIV testing, assuming an 80% HIVST utilization rate (UR) and +390 [95% CI: 161 to 625, p<0.001] assuming a 60% UR. The statistical relationship between the number of HIVST and HIV diagnoses was significant and positive (+8 diagnosis [95% CI: 0 to 15, p=0.044]). No effect was observed on ART initiation (-2 ART initiations [95% CI: -8 to 5, p=0.66]). Interpretations Social network-based HIVST distribution had a positive impact on access to HIV testing and diagnoses in Cote d'Ivoire. This approach offers a promising way for countries to assess the impact of HIVST programs. Funding Unitaid 2018-23-ATLAS
date: 2022-02-09
pages: 2022.02.08.22270670
identifier: DOI 10.1101/2022.02.08.22270670
citation key: fotsoUsingRoutineProgrammatic2022
date submitted: 2022-02-10 12:06:11
short title: Using routine programmatic data to estimate the population-level impacts of HIV self-testing
language: en
library catalog: medRxiv
rights: © 2022, Posted by Cold Spring Harbor Laboratory. This pre-print is available under a Creative Commons License (Attribution-NoDerivs 4.0 International), CC BY-ND 4.0, as described at http://creativecommons.org/licenses/by-nd/4.0/
description: Type: article