Publications des membres du Ceped

2022

  • Boye Sokhna, Kouadio Alexis Brou, Vautier Anthony, Ky-Zerbo Odette, Rouveau Nicolas, Kouvahe Amélé Florence, Maheu-Giroux Mathieu, Larmarange Joseph, Pourette Dolorès et équipe ATLAS (2022) « L’introduction de l’autodépistage du VIH dans les consultations des Infections Sexuellement Transmissibles (IST) peut-elle améliorer l’accès au dépistage des patients IST et leurs partenaires ? Une étude qualitative exploratoire du projet ATLAS à Abidjan/Côte d’Ivoire » (poster #PV340), présenté à AFRAVIH, Marseille.
    Résumé : Objectifs Dans le cadre de son projet d’introduction de l’auto dépistage du VIH (ADVIH), le programme ATLAS a initié une étude pour documenter les modalités de dispensation des kits d’ADVIH aux patient.e.s présentant une Infection Sexuellement Transmissible (IST) et leurs partenaires à Abidjan/Côte d’Ivoire. Matériels et Méthodes Une enquête qualitative a été réalisée entre mars et août 2021 dans trois services dispensant des ADVIH auprès des patient.e.s IST: (1) consultation prénatale (CPN) ; (2) consultation générale incluant IST et (3) dispensaire IST dédié. Les données ont été collectées par (i) des observations de consultations médicales de patient·e·s IST (N=98) et (ii) des entretiens auprès de soignants impliqués dans la dispensation des kits d’ADVIH (N=18), de patient.e.s ayant reçu des kits ADVIH à proposer à leurs partenaires (N=21) et de partenaires de patientes IST ayant réalisé l’ADVIH (N=2). Résultats Les trois services présentent des différences d’organisation du circuit du patient et des modalités de dispensation des kits d’ADVIH. En CPN, le dépistage du VIH est proposé systématiquement à toute femme enceinte lors de la première consultation. Lorsqu’une IST est diagnostiquée, un ADVIH est proposé presque systématiquement pour le partenaire (N=27/29). En consultation générale, il y a eu peu de propositions de dépistage et d’ADVIH aux patient.e.s IST et pour leurs partenaires (N=3/16). Malgré l’existence d’une délégation des tâches du dépistage et l’offre d’ADVIH, il n’y a pas de routinisation du dépistage dans ce service. Au dispensaire IST, le circuit du patient est mieux défini : diffusion de la vidéo ADVIH en salle d’attente, consultation des patient.e.s et référencement aux infirmières pour le dépistage avec proposition fréquente de kits d’ADVIH aux patient.e.s IST pour leurs partenaires (N=28/53). De manière générale, l’ADVIH est accepté lorsqu’il est proposé. Mais, la proposition de l’ADVIH aux partenaires n’est pas toujours facile, surtout pour les femmes : difficultés à aborder la question du VIH avec le conjoint, relation de couple « fragile ». Les soignants en général ont une perception positive des ADVIH, mais, ils soulignent le caractère chronophage de la dispensation des ADVIH et souhaitent une meilleure organisation : délégation des tâches (CPN). Conclusion L’organisation des consultations est déterminante : les contraintes structurelles (organisation du service, délégation des tâches) influent sur la proposition d’un dépistage VIH et l’ADVIH ne suffit pas à les lever. La proposition par les soignants d’un ADVIH pour les partenaires nécessite du temps et un accompagnement des patients.e.s. La proposition est plus systématique quand le dépistage est « routinisé » et concerne tous les patient.e.s. Quand l’ADVIH est proposé, il est en général accepté. Si l’ADVIH constitue une opportunité d’améliorer l’accès au dépistage des patient.e.s et de leurs partenaires, une intégration réussie implique d’améliorer l’organisation des services et de promouvoir la délégation des tâches.


  • Ky-Zerbo Odette, Desclaux Alice, Boye Sokhna, Vautier Anthony, Rouveau Nicolas, Kouadio Brou Alexis, Fotso Arlette Simo, Pourette Dolorès, Maheu-Giroux Mathieu, Sow Souleymane, Camara Cheick Sidi, Doumenc-Aïdara Clémence, Keita Abdelaye, Boily Marie Claude, Silhol Romain, d’Elbée Marc, Bekelynck Anne, Gueye Papa Alioune, Diop Papa Moussa, Geoffroy Olivier, Kamemba Odé Kanku, Diallo Sanata, Ehui Eboi, Ndour Cheick Tidiane, Larmarange Joseph et for the ATLAS team (2022) « Willingness to use and distribute HIV self-test kits to clients and partners: A qualitative analysis of female sex workers’ collective opinion and attitude in Côte d’Ivoire, Mali, and Senegal », Women's Health, 18 (avril 17), p. 1-11. DOI : 10.1177/17455057221092268. https://doi.org/10.1177/17455057221092268.
    Résumé : Background:In West Africa, female sex workers are at increased risk of HIV acquisition and transmission. HIV self-testing could be an effective tool to improve access to and frequency of HIV testing to female sex workers, their clients and partners. This article explores their perceptions regarding HIV self-testing use and the redistribution of HIV self-testing kits to their partners and clients.Methods:Embedded within ATLAS, a qualitative study was conducted in Côte-d?Ivoire, Mali, and Senegal in 2020. Nine focus group discussions were conducted. A thematic analysis was performed.Results:A total of 87 participants expressed both positive attitudes toward HIV self-testing and their willingness to use or reuse HIV self-testing. HIV self-testing was perceived to be discreet, confidential, and convenient. HIV self-testing provides autonomy from testing by providers and reduces stigma. Some perceived HIV self-testing as a valuable tool for testing their clients who are willing to offer a premium for condomless sex. While highlighting some potential issues, overall, female sex workers were optimistic about linkage to confirmatory testing following a reactive HIV self-testing. Female sex workers expressed positive attitudes toward secondary distribution to their partners and clients, although it depended on relationship types. They seemed more enthusiastic about secondary distribution to their regular/emotional partners and regular clients with whom they had difficulty using condoms, and whom they knew enough to discuss HIV self-testing. However, they expressed that it could be more difficult with casual clients; the duration of the interaction being too short to discuss HIV self-testing, and they fear violence and/or losing them.Conclusion:Overall, female sex workers have positive attitudes toward HIV self-testing use and are willing to redistribute to their regular partners and clients. However, they are reluctant to promote such use with their casual clients. HIV self-testing can improve access to HIV testing for female sex workers and the members of their sexual and social network.
    Mots-clés : ATLAS, female sex workers, HIV self-testing, partners, perception, secondary distribution, West Africa.
  • Ky-Zerbo Odette, Desclaux Alice, Vautier Anthony, Boye Sokhna, Gueye Papa Alioune, Rouveau Nicolas, Maheu-Giroux Mathieu, Kouadio Alexis Brou, Camara Cheick Sidi, Sow Souleymane, Geoffroy Olivier, Kabemba Odé Kanku, Keita Abdelaye, Ehui Eboi, Ndour Cheick Tidiane, Larmarange Joseph et équipe ATLAS (2022) « Utilisation et redistribution de l’autodépistage du VIH parmi les populations clés et leurs réseaux en Afrique de l’Ouest : pratiques et expériences vécues dans le projet ATLAS » (communication orale #CO8.1), présenté à AFRAVIH, Marseille.
    Résumé : Objectifs L’autodépistage du VIH (ADVIH), notamment la distribution dans les réseaux des personnes en contact avec des programmes de prévention (distribution secondaire), permet de rejoindre des personnes ayant faiblement accès au dépistage. Dans le cadre du projet ATLAS, une analyse des pratiques d’utilisation et de redistribution de l’ADVIH parmi les hommes qui ont des rapports sexuels avec des hommes (HSH), les travailleuses du sexe (TS), les usagers de drogues (UD) et leurs partenaires a été réalisée en Côte d’Ivoire, au Mali et au Sénégal. Matériels et Méthodes Une enquête qualitative a été conduite de janvier à juillet 2021. Des entretiens face-à-face et par téléphone ont été réalisés avec des utilisateurꞏtrices de l’ADVIH identifiéꞏes par (i) des pairsꞏes éducateurꞏtrices HSH, TS et UD ou (ii) via une enquête téléphonique anonyme. Résultats Au total 80 personnes ont été interviewées (65 en face-à-face, 15 par téléphone). À la première utilisation, la majorité a réalisé l’ADVIH sans la présence d’unꞏe professionnelꞏle (2/3). Ils l’ont justifié par la facilité de réalisation de l’ADVIH et l’existence d’outils de supports. La majorité a redistribué des kits d’ADVIH à des partenaires sexuelsꞏles, pairꞏes/amiꞏes, clients pour les TS et d’autres types de relations sans difficulté majeure. Leur motivation commune était l’intérêt de la connaissance du statut VIH pour l’utilisateurꞏtrice finalꞏe. Cependant vis-à-vis des partenaires sexuelsꞏles et des clients des TS, il s’agissait surtout de s’informer du statut de ce/cette dernier-ère pour décider des mesures préventives à adopter. Les réactions des utilisateurꞏtrices secondaires étaient majoritairement positives parce que ce nouvel outil répondait à une attente liée au besoin de connaître leur statut VIH, certainꞏes n’ayant par ailleurs jamais fait de dépistage VIH. Quelques cas de refus ont été rencontrés, surtout de la part des clients occasionnels pour les TS. Un cas de violence physique de la part d’un client a été rapporté. Les raisons de non-proposition de l’ADVIH à son réseau variaient suivant les catégories de populations clés et les utilisateurꞏtrices secondaires. Les trois populations clés, surtout les UD, ont rapporté des craintes de réactions négatives de certainꞏes partenaires sexuelsꞏles. Les HSH et les UD en ont moins distribué à leurs pairꞏes/amiꞏes par rapport aux partenaires sexuelꞏles parce qu’ils/elles estimaient que ceux/celles-ci étaient dans les mêmes réseaux de distribution des kits d’ADVIH et en avaient donc déjà reçus. Chez les TS, l’ADVIH était moins souvent proposé aux clients et aux partenaires qui acceptaient l’utilisation du préservatif. Conclusion Les résultats montrent une bonne acceptation de l’ADVIH tant en distribution primaire que secondaire. La redistribution de l’ADVIH dans les réseaux des populations clés peut permettre d’accroitre l’accès au dépistage parmi les populations peu dépistées, sans répercussion négative pour les personnes qui le proposent.


  • Simo Fotso Arlette, Kra Arsène Kouassi, Maheu-Giroux Mathieu, Boye Sokhna, d’Elbée Marc, Ky-zerbo Odette, Rouveau Nicolas, N’Guessan Noel Kouassi, Geoffroy Olivier, Vautier Anthony, Larmarange Joseph et for the ATLAS Team (2022) « Is it possible to recruit HIV self-test users for an anonymous phone-based survey using passive recruitment without financial incentives? Lessons learned from a pilot study in Côte d’Ivoire », Pilot and Feasibility Studies, 8 (4) (janvier 6), p. 1-7. DOI : 10/gn3cjj. https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-021-00965-2.
    Résumé : Background:  Due to the discreet and private nature of HIV self-testing (HIVST), it is particularly challenging to moni‑tor and assess the impacts of this testing strategy. To overcome this challenge, we conducted a study in Côte d’Ivoire to characterize the profile of end users of HIVST kits distributed through the ATLAS project (AutoTest VIH, Libre d’Accéder à la connaissance de son Statut). Feasibility was assessed using a pilot phone-based survey. Methods:  The ATLAS project aims to distribute 221300 HIVST kits in Côte d’Ivoire from 2019 to 2021 through both primary (e.g., direct distribution to primary users) and secondary distribution (e.g., for partner testing). The pilot survey used a passive recruitment strategy—whereby participants voluntarily called a toll-free survey phone number—to enrol participants. The survey was promoted through a sticker on the HIVST instruction leaflet and hotline invitations and informal promotion by HIVST kit-dispensing agents. Importantly, participation was not financially incentivized, even though surveys focussed on key populations usually use incentives in this context. Results:  After a 7-month period in which 25,000 HIVST kits were distributed, only 42 questionnaires were completed. Nevertheless, the survey collected data from users receiving HIVST kits via both primary and secondary distribution (69% and 31%, respectively). Conclusion:  This paper provides guidance on how to improve the design of future surveys of this type. It discusses the need to financial incentivize participation, to reorganize the questionnaire, the importance of better informing and training stakeholders involved in the distribution of HIVST, and the use of flyers to increase the enrolment of users reached through secondary distribution.

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 -.


  • Ky-Zerbo Odette, Desclaux Alice, Kouadio Alexis Brou, Rouveau Nicolas, Vautier Anthony, Sow Souleymane, Camara Sidi Cheick, Boye Sokhna, Pourette Dolorès, Sidibé Younoussa, Maheu-Giroux Mathieu, Larmarange Joseph et on behalf of the ATLAS Team (2021) « Enthusiasm for Introducing and Integrating HIV Self-Testing but Doubts About Users: A Baseline Qualitative Analysis of Key Stakeholders' Attitudes and Perceptions in Côte d'Ivoire, Mali and Senegal », Frontiers in Public Health, 9 (octobre 18). DOI : 10.3389/fpubh.2021.653481. https://www.frontiersin.org/article/10.3389/fpubh.2021.653481.
    Résumé : Since 2019, the ATLAS project, coordinated by Solthis in collaboration with national AIDS programs, has introduced, promoted and delivered HIV self-testing (HIVST) in Côte d'Ivoire, Mali and Senegal. Several delivery channels have been defined, including key populations: men who have sex with men, female sex workers and people who use injectable drugs. At project initiation, a qualitative study analyzing the perceptions and attitudes of key stakeholders regarding the introduction of HIVST in their countries and its integration with other testing strategies for key populations was conducted. The study was conducted from September to November 2019 within 3 months of the initiation of HIVST distribution. Individual interviews were conducted with 60 key informants involved in the project or in providing support and care to key populations: members of health ministries, national AIDS councils, international organizations, national and international non-governmental organizations, and peer educators. Semi structured interviews were recorded, translated when necessary, and transcribed. Data were coded using Dedoose© software for thematic analyses. We found that stakeholders' perceptions and attitudes are favorable to the introduction and integration of HIVST for several reasons. Some of these reasons are held in common, and some are specific to each key population and country. Overall, HIVST is considered able to reduce stigma; preserve anonymity and confidentiality; reach key populations that do not access testing via the usual strategies; remove spatial barriers; save time for users and providers; and empower users with autonomy and responsibility. It is non-invasive and easy to use. However, participants also fear, question and doubt users' autonomy regarding their ability to use HIVST kits correctly; to ensure quality secondary distribution; to accept a reactive test result; and to use confirmation testing and care services. For stakeholders, HIVST is considered an attractive strategy to improve access to HIV testing for key populations. Their doubts about users' capacities could be a matter for reflective communication with stakeholders and local adaptation before the implementation of HIVST in new countries. Those perceptions may reflect the West African HIV situation through the emphasis they place on the roles of HIV stigma and disclosure in HIVST efficiency.

  • 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.


  • 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.

2019



  • Desclaux Alice et Boye Sokhna (2019) « Subjectivités et constructions sociales d’un risque iatrogène : (in)visibilités des lipodystrophies au Sénégal », Anthropologie et Santé, 19 (novembre 3). DOI : 10.4000/anthropologiesante.5134. http://journals.openedition.org/anthropologiesante/5134.
    Résumé : Les perceptions individuelles du risque d’effets indésirables associés aux médicaments, qu’elles soient anticipées en amont de l’initiation d’un traitement ou réajustées en cours de traitement, sont étroitement liées aux représentations sociales du dommage. L’analyse ethnographique menée au Sénégal à propos des lipodystrophies dues à certains antirétroviraux met en lumière des perceptions subjectives très diverses de ces troubles, et leurs rapports spécifiques au contexte social. Elle révèle aussi une dynamique collective d’invisibilisation basée d’une part sur une logique micro-sociale d’évitement de la souffrance en l’absence de traitement curatif, et d’autre part sur une logique idéelle de « prix à payer » pour bénéficier de l’efficacité des antirétroviraux. Le modèle de « mise en balance » par les patients du risque iatrogène et de l’efficacité du médicament n’apparaît pertinent que si ce dernier est appréhendé à travers son inscription sociale complexe, en mobilisant à la fois les concepts de vie sociale et de biographie politique du médicament.
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