Publications des membres du Ceped

2022



  • 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.
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2021


  • Abo Yao, Altman Mathias, Bekelynck Anne, Dahourou Désiré, Simo Fotso Arlette, Godin Zélie, Kadio Kadidiatou, Larmarange Joseph, Sondo Apoline et Valentin Louis (2021) Connaissances, attitudes et pratiques liées à la pandémie COVID-19 des médecins au Burkina Faso Vague 2 : septembre - décembre 2020, Policy brief (2), Ouagadougou : Aphro-Cov, 6 p. https://aphro-cov.com/ressources_liste/connaissances-attitudes-et-pratiques-liees-a-la-pandemie-covid-19-des-medecins-au-burkina-faso-vague-2/.
    Résumé : CAP-CoV-BF : une enquête nationale réalisées auprès des médecins au Burkina Faso Le personnel de santé se trouve au cœur du dispositif élaboré dans le cadre de la réponse à l’épidémie de COVID-19, à la fois en tant qu’acteur essentiel du dispositif de réponse à l’épidémie, et en tant que premières personnes exposées et victimes. Il est ainsi essentiel de s’assurer de la compréhension de cette maladie (symptômes, modes de transmission, mesures de prévention, etc.) et de l’acceptabilité et de l’adaptation des médecins du Burkina Faso face aux mesures de santé publique préconisées. Cela permet d’identifier les difficultés et les barrières qu’ils rencontrent afin d’adopter les mesures de protection adéquates, proposer des interventions adaptées pour les surmonter et prioriser les messages qui leur sont destinés. L’objectif principal de cette étude est de fournir aux acteurs nationaux impliqués dans la gestion de la crise des données probantes régulières et représentatives à l’échelle nationale sur les connaissances, attitudes et pratiques des médecins au Burkina Faso. Une enquête quantitative transversale par téléphone a été mise en place auprès d’un échantillon représentatif de médecins sur l’ensemble du territoire. Une 1ère enquête a été menée en septembre 2020 (n=166) et une 2ème en décembre 2020 (n=190).
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  • Abo Yao, Altman Mathias, Bekelynck Anne, Dahourou Désiré, Simo Fotso Arlette, Godin Zélie, Kadio Kadidiatou, Larmarange Joseph, Sondo Apoline et Valentin Louis (2021) Connaissances, attitudes et pratiques liées à la pandémie COVID-19 des médecins au Burkina Faso - Enquêtes 1, 2 et 3 : septembre 2020 - décembre 2020 – février 2021, Policy brief (3), Ouagadougou : Aphro-Cov, 6 p. https://aphro-cov.com/ressources_liste/enquete-cap-cov-bf-resultats-des-3-vagues-denquete-et-evolutions-observees/.
    Résumé : CAP-CoV-BF : une enquête nationale réalisées auprès des médecins au Burkina Faso Le personnel de santé se trouve au cœur du dispositif élaboré dans le cadre de la réponse à l’épidémie de COVID-19, à la fois en tant qu’acteur essentiel du dispositif de réponse à l’épidémie, et en tant que premières personnes exposées et victimes. Il est ainsi essentiel de s’assurer de la compréhension de cette maladie (symptômes, modes de transmission, mesures de prévention, etc.) et de l’acceptabilité et de l’adaptation des médecins du Burkina Faso face aux mesures de santé publique préconisées. Cela permet d’identifier les difficultés et les barrières qu’ils rencontrent afin d’adopter les mesures de protection adéquates, proposer des interventions adaptées pour les surmonter et prioriser les messages qui leur sont destinés. L’objectif principal de cette étude est de fournir aux acteurs nationaux impliqués dans la gestion de la crise des données probantes régulières et représentatives à l’échelle nationale sur les connaissances, attitudes et pratiques des médecins au Burkina Faso. Une enquête quantitative transversale par téléphone a été mise en place auprès d’un échantillon représentatif de médecins sur l’ensemble du territoire. Une 1ère enquête a été menée en septembre 2020 (n=166) et une 2ème en décembre 2020 (n=190).
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  • Ante-Testard Pearl Anne, Hamidouche Mohamed, Apouey Bénédicte, Baggaley Rachel, Larmarange Joseph, Benmarhnia Tarik, Temime Laura et Jean Kévin (2021) Understanding the pathways leading to socioeconomic inequalities in HIV testing uptake in 18 sub-Saharan African countries: a mediation analysis, 24 p. https://www.medrxiv.org/content/10.1101/2021.09.18.21263768v1.
    Résumé : Introduction Although socioeconomic inequalities in HIV prevention, testing and treatment services have been well documented, their drivers remain poorly understood. Understanding the different pathways between socioeconomic position and HIV testing across different countries could help designing tailored programs aimed at reducing such inequalities. Methods We analysed data from Demographic and Health Surveys conducted between 2010 and 2018 in 18 sub-Saharan African countries (Burkina Faso, Cameroon, Côte d’Ivoire, Congo DR, Ethiopia, Guinea, Kenya, Lesotho, Liberia, Malawi, Mali, Niger, Rwanda, Senegal, Sierra Leone, Tanzania, Zambia and Zimbabwe). Using a potential outcomes framework and the product method, we decomposed the total effect linking wealth and recent (< 12 months) HIV testing into i) direct effects, and ii) indirect effects, via demand-related (related to individual’s ability to perceive need for care and inclination to seek care) or supply-related (related to individual’s ability to reach, pay for and engage in health care) mediators. Multivariable gender-specific modified Poisson models were fitted to estimate proportions mediated, while accounting for exposure-mediator interaction when present. Results A total of 392,044 participants were included in the analysis. Pro-rich wealth-related inequalities were observed in a majority of countries, with nine countries with high levels of inequalities among women and 15 countries among men.The indirect effects of each mediator varied greatly across countries. The proportion mediated tended to be higher for demand-related than for supply-related mediators. For instance, among women, HIV-related knowledge was estimated to mediate up to 12.1% of inequalities in Côte d’Ivoire; this proportion was up to 31.5% for positive attitudes toward people living with HIV (PLHIV) in Senegal. For the four supply-related mediators, the proportion mediated was systematically below 7%. Similar conclusions were found when repeating analyses on men for the demand-related mediators, with higher proportions mediated by positive attitudes toward PLHIV (up to 39.9% in Senegal). Conclusions Our findings suggest that socioeconomic inequalities in HIV testing may be mediated by the demand-side more than supply-side characteristics, with important variability across countries. Overall, the important inter-country heterogeneity in pathways of socioeconomic inequalities in HIV testing illustrates that addressing inequalities requires tailored efforts as well as upstream interventions.A French version of the abstract is available upon request from the corresponding author.
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  • Barnier Julien, Briatte François et Larmarange Joseph (2021) Questionr: Functions to Make Surveys Processing Easier, version 0.7.5. https://CRAN.R-project.org/package=questionr.
    Résumé : Set of functions to make the processing and analysis of surveys easier : interactive shiny apps and addins for data recoding, contingency tables, dataset metadata handling, and several convenience functions.
    Mots-clés : OfficialStatistics.
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  • Becquet Valentine, Nouaman Marcellin, Plazy Mélanie, Agoua Aline, Zébago Clémence, Dao Hervé, Montoyo Alice, Jary Aude, Coffie Patrick A., Eholié Serge, Larmarange Joseph et and the ANRS 12381 PRINCESSE team (2021) « A community-based healthcare package combining testing and prevention tools, including pre-exposure prophylaxis (PrEP), immediate HIV treatment, management of hepatitis B virus, and sexual and reproductive health (SRH), targeting female sex workers (FSWs) in Côte d’Ivoire: the ANRS 12381 PRINCESSE project », BMC Public Health, 21 (1) (décembre 4), p. 2214. DOI : 10.1186/s12889-021-12235-0. https://doi.org/10.1186/s12889-021-12235-0.
    Résumé : Pre-exposure prophylaxis (PrEP) is recommended by the WHO for HIV prevention among female sex workers (FSWs). A study conducted in 2016–2017 in Côte d’Ivoire showed that if PrEP is acceptable, FSWs also have many uncovered sexual health needs. Based on this evidence, the ANRS 12381 PRINCESSE project was developed in collaboration with a community-based organization. The main objective is to develop, document, and analyze a comprehensive sexual and reproductive healthcare package among FSWs in Côte d’Ivoire.
    Mots-clés : Côte d’Ivoire, HIV prevention, Mixed-methods research, Mobile clinics, Pre-exposure prophylaxis (PrEP), Sex work, Sexual and reproductive health, Sexually transmitted infections (STIs), hepatitis B.
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  • 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 -.
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  • 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.
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  • 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.
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  • Fiorentino Marion, Nishimwe Marie, Protopopescu Camelia, Iwuji Collins, Okesola Nonhlanhla, Spire Bruno, Orne-Gliemann Joanna, McGrath Nuala, Pillay Deenan, Dabis François, Larmarange Joseph, Boyer Sylvie et for the ANRS 12249 TaSP Study Group (2021) « Early ART Initiation Improves HIV Status Disclosure and Social Support in People Living with HIV, Linked to Care Within a Universal Test and Treat Program in Rural South Africa (ANRS 12249 TasP Trial) », AIDS and Behavior, 25 (4) (avril), p. 1306-1322. DOI : 10.1007/s10461-020-03101-y. https://doi.org/10.1007/s10461-020-03101-y.
    Résumé : We investigated the effect of early antiretroviral treatment (ART) initiation on HIV status disclosure and social support in a cluster-randomized, treatment-as-prevention (TasP) trial in rural South Africa. Individuals identified HIV-positive after home-based testing were referred to trial clinics where they were invited to initiate ART immediately irrespective of CD4 count (intervention arm) or following national guidelines (control arm). We used Poisson mixed effects models to assess the independent effects of (a) time since baseline clinical visit, (b) trial arm, and (c) ART initiation on HIV disclosure (n = 182) and social support (n = 152) among participants with a CD4 count > 500 cells/mm3 at baseline. Disclosure and social support significantly improved over follow-up in both arms. Disclosure was higher (incidence rate ratio [95% confidence interval]: 1.24 [1.04; 1.48]), and social support increased faster (1.22 [1.02; 1.46]) in the intervention arm than in the control arm. ART initiation improved both disclosure and social support (1.50 [1.28; 1.75] and 1.34 [1.12; 1.61], respectively), a stronger effect being seen in the intervention arm for social support (1.50 [1.12; 2.01]). Besides clinical benefits, early ART initiation may also improve psychosocial outcomes. This should further encourage countries to implement universal test-and-treat strategies.
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  • Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Koné Mariatou, Danel Christine, Desgrées du Loû Annabel, Larmarange Joseph et for the research team ANRS 12323 DOD-CI (2021) « Telephone peer recruitment and interviewing during a respondent-driven sampling (RDS) survey: feasibility and field experience from the first phone-based RDS survey among men who have sex with men in Côte d’Ivoire », BMC Medical Research Methodology, 21 (1) (février 5), p. 25. DOI : 10.1186/s12874-021-01208-x. https://doi.org/10.1186/s12874-021-01208-x.
    Résumé : Many respondent-driven sampling (RDS) methodologies have been employed to investigate hard-to-reach populations; however, these methodologies present some limits. We describe a minimally investigated RDS methodology in which peer recruitment and interviewing are phone-based. The feasibility of the methodology, field experiences, validity of RDS assumptions and characteristics of the sample obtained are discussed.
    Mots-clés : Côte d’Ivoire, Men who have sex with men, Phone-based survey, Respondent-driven sampling.
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  • Iwuji Collins, Baisley Kathy, Orne-Gliemann Joanna, Larmarange Joseph, Plazy Mélanie, Collier Dami, Dreyer Jaco, Mngomezulu T, Herbst Kobus, Hanekom W, Dabis François et Siedner Mark (2021) « Long-term survival among people living with HIV in rural South Africa: results from 6 years of observation in the ANRS 12249 treatment as prevention trial » (poster PEC279), présenté à 11th IAS Conference on HIV Science, Berlin. https://theprogramme.ias2021.org/Abstract/Abstract/2085.
    Résumé : BACKGROUND: Universal test-and-treat trials increased population-level virological suppression across trial sites in sub-Saharan Africa. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer-term survival benefits. METHODS: The TasP trial was a cluster-randomised trial implemented in 22 communities in rural South Africa, from 2012'2016. Households were offered six-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered in trial clinics to all people living with HIV (PLHIV) in the intervention clusters and according to national guidelines in the control clusters. At trial end, individuals attending the intervention clinics were transferred to the public ART programme, with a 'treat-all' strategy adopted in September 2016. Deaths during and two years after trial end were ascertained through annual demographic surveillance. Random effects Poisson regression was used to estimate rate ratios (RR) and 95%CI for the effect of trial arm on mortality among i) all PLHIV regardless of serostatus awareness, ii) PLHIV aware of their status, iii) those not on ART at entry to trial clinics. An interaction term between period and treatment arm was included, to allow the effect of trial arm to differ between periods. RESULTS: Amongst all PLHIV and those aware of their serostatus, there was no effect of immediate ART on mortality (Table). Among individuals who started ART during the trial, there was evidence that the intervention decreased mortality (aRR=0.69, 95%CI=0.45-1.04, p=0.08), although the effect was primarily during the trial (aRR=0.49, 95%CI=0.28-0.85, p=0.01), but not after the trial ended (aRR=1.15, 95%CI=0.59-2.21, p=0.69). CONCLUSIONS: The 'treat-all' strategy resulted in a mortality benefit amongst individuals who started ART within the trial but not in all PLHIV over 6 years of follow-up. To achieve maximum benefit of immediate ART in South Africa, barriers to ART uptake and retention in care need to be addressed.
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  • 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.
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  • Kouassi Arsène Kra, Simo Fotso Arlette, N'Guessan Kouassi Noël, Geoffroy Olivier, Younoussa Sidibé, Kanku Kabemba Odé, Dieng Baidy, Dama Ndeye Pauline, Rouveau Nicolas, Maheu-Giroux Mathieu, Boily Marie-Claude, Silhol Romain, d'Elbée Marc, Vautier Anthony, Larmarange Joseph et on behalf of the ATLAS Team (2021) « Reaching key and peripheral populations: a phone-based survey of HIV self-test users in West Africa » (poster #PEC004), présenté à 21st ICASA, Dakar.
    Résumé : Background In West Africa, community-based strategies focussing on key populations (KP) such as female sex workers (FSW) and men having sex with men (MSM) have significantly improved access to HIV testing for KP. However, some of them (like “occasional FSW” or “hidden MSM”) remain difficult to reach, as well as their sexual partners and clients. HIV self-testing (HIVST) kits can be distributed to primary contacts for personal use and through secondary distribution, where contacts are invited to redistribute kits to their peers, partners, and relatives. Since 2019, the ATLAS program implements such a strategy in Côte d’Ivoire, Mali, and Senegal, including FSW-based and MSM-based activities within the communities. Methods To examine the profiles of actual HIVST users without actively tracking them, we implemented a phone‐based survey. Between March and June 2021, leaflets were distributed in Côte d'Ivoire, Mali and Senegal with the HIV test kits, inviting users to call a free phone number anonymously. Participation was rewarded with $3 USD of phone credit. Each flyer had a unique participation number to indirectly identify the distribution channel (DC), FSW-based or MSM-based. Results A total of 1305 participants were recruited among the FSW-DC and 1100 through MSM-DC across countries out of 44’598 HIVST kits distributed. Of participants, 69% received their self-test kit through primary distribution and 31% received it from a friend (17%), sexual partner (7%), relative (6%) or colleague (1%), which illustrates the feasibility of secondary distribution. In the FSW-DC, 48% of participants were male, and in the MSM-DC 9% were female, showing the capacity of HIVST to reach sexual partners and clients of KP. Only 50% of male participants in the MSM-DC reported to the interviewer that they ever had sex with a man, suggesting that some “hidden MSM” may also be recruited. One third of female participants from the FSW-DC and 45% of male participants from the MSM-DC were testing for the first time. The proportions whose last HIV test was done more than a year were respectively 24% and 14%. These proportions are higher than observed in surveys conducted among FSW and MSM in the same countries. Conclusions HIVST offers a complementary testing approach to increase diagnosis coverage among KP that face barriers to conventional HIV testing strategies. Secondary distribution of HIVST is feasible and has the potential to reach, beyond KP, vulnerable peripheral groups.
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  • 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.
    Pièce jointe Ky-Zerbo et al. - 2021 - Enthusiasm for Introducing and Integrating HIV Sel.pdf 652.9 ko (source)
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  • 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.
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  • 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.

  • Larmarange Joseph (2021) « Enseigner R sur YouTube en temps de Covid : retours d’expérience des webin-R » (communication orale), présenté à Journées d'étude : Compter, Mesurer, Calculer.. Raisonner ? Enseigner le quanti en sciences sociales dans le supérieur : pratiques et défis", Nantes. https://quanti.hypotheses.org/2157.
    Résumé : En raison du contexte sanitaire, plusieurs formations intensives sur l’analyse d’enquêtes avec R et RStudio à destination de mastorants, doctorants et post-doctorants en sciences sociales que je devais animer en France et en Afrique de l’Ouest ont dues être annulées ou reportées. En réponse, a été mis en place à partir de novembre 2019 un webinaire en ligne hebdomadaire d’enseignement à R : les webin-R. Face à la demande (plus de 400 inscrits à la mailing liste dédiée mise en place début novembre 2020), il a été choisi de diffuser le webin-R en live sur YouTube, avec possibilité de visionnage en différé. Les séances durent entre 1h30 et 2h. L’intervenant partage son écran pour tester le code R en direct et permettre aux participants de visualiser l’interface RStudio. Comme les interactions avec les participants sont limitées (uniquement le chat YouTube pendant le live), des sessions interactives du type Foire aux questions (FAQ) sont organisées sur Zoom tous les 4 à 6 séances, enregistrées et rediffusées sur YouTube. YouTube a également été choisi pour sa facilité d’utilisation, sa bande passante élevée (notamment pour les spectateurs africains) et la possibilité de visionner les vidéos dans différentes qualités (dont en HD 1080p, indispensable pour que la capture d’écran et le code R soient bien lisibles). La captation vidéo est réalisée avec le service https://streamyard.com/ qui permet un flux video live en 1080p, le suivi en direct du chat et la possibilité d’afficher à l’image des commentaires choisis par l’intervenant. Les webin-R s’accompagnent d’une mailing listes dédiée, d’une chaîne YouTube et d’un site d’accompagnement (https://larmarange.github.io/webin-R/) où pour chaque séance sont fournies des ressources additionnelles, notamment les scripts R des séances et des liens vers des chapitres analyse-R (https://larmarange.github.io/analyse-R/), une sorte de manuel pratique en ligne existant depuis une dizaine d’années (les contenus correspondent à l’équivalent d’un ouvrage de plus de 1200 pages et le site enregistre ~50 000 pages vues par mois). L’ensemble des contenus des webin-R et d’analyse-R sont accessibles gratuitement et sous licence libre Creative Commons. Les webin-R n’ont pas pour vocation d’enseigner les statistiques proprement dites mais plutôt comment réaliser des statistiques avec les logiciels R et RStudio. Ils se focalisent sur la mise en œuvre pratique, l’objectif étant de donner les clés de départ pour permettre aux participants de pouvoir continuer à s’autoformer par la suite. Au 1er mars 2021, la chaîne YouTube des webinaires totalisait 485 abonnés, 11 vidéos (9 webin-R et 2 FAQ) et 8213 vues. Selon les données analytiques des 90 derniers jours : le nombre moyen de vue par spectateur est de 4,0 et les abonnés représentent 48% des vues. Mi-février 2021, après les neuf premières séances, une enquête a été mené auprès des participants aux webin-R. Il s’agissait d’un questionnaire en ligne dont la promotion a été réalisée via la liste de diffusion : 152 questionnaires complets ont été reçus. Les répondants étaient en majorité des hommes (61%). Ils étaient âgés de 33 ans en médiane (IQR : 28-41). Les deux tiers (64%) résident en France, 31% en Afrique francophone. Ils relèvent de situations diverses : étudiant·e·s en licence (1%), mastorant·e·s (16%), doctorant·e·s (29%), post-doctorant·e·s (5%), ingénieur·e·s de recherche (15%), chercheur·e·s ou enseignant-chercheur·e·s (14%), personnes travaillant dans le secteur privé (19%). Les disciplines sont toutes aussi variées : épidémiologie (19%), sociologie (15%), démographie (14%), économie (11%), statistique (9%), géographie (6%), … En termes de participation, on observe un léger phénomène de fatigue, avec un taux de participation de 80-90% pour les premières séances et de 61-76% pour les dernières séances. Surtout, la proportion suivant les séances en direct a diminué au profit d’un suivi en différé. Parmi les points forts mentionnés par les participants : visualisation en direct de la mise en œuvre du code via l’écran partagé ; la mise à disposition des scripts et de ressources en ligne ; l’approche pratique et pragmatique ; le fait que les vidéos et les ressources soient en français ; la possibilité de revoir les vidéos en différé ; l’existence du site analyse-R en complément des vidéos (78% l’utilisent régulièrement) ; l’existence de sessions FAQ… Parmi les points faibles sont mentionnés : l’absence d’exercice ; la non-possibilité de valider des crédits d’enseignement ; le fait que toutes les explications données pendant les vidéos ne sont pas forcément reprises sur analyse-R ; le souhait de plus d’applications concrètes sur des données existantes ; un temps insuffisant consacré à l’interprétation des résultats ; une organisation et structuration des sessions FAQ à améliorer… Une enquête complémentaire est prévue en mai 2021. La présentation portera sur les leçons apprises de l’expérience des webin-R, ses atouts et ses limites.
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  • Larmarange Joseph (2021) « Initier la communauté de recherche à l’analyse d’enquêtes avec R et RStudio : retours d’expériences d’analyse-R et des webin-R » (communication orale), présenté à Semaine Data SHS 2021, Paris. https://progedo.hypotheses.org/1787.

  • Larmarange Joseph, Ludecke Daniel, Wickham Hadley, Bojanowski Michal et Briatte François (2021) Labelled: Manipulating Labelled Data, version 2.9.0. https://CRAN.R-project.org/package=labelled.
    Résumé : Work with labelled data imported from 'SPSS' or 'Stata' with 'haven' or 'foreign'. This package provides useful functions to deal with "haven_labelled" and "haven_labelled_spss" classes introduced by 'haven' package.
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  • Larmarange Joseph et pour l'équipe ATLAS (2021) « Au-delà des populations clés : la distribution secondaire de kits d’autodépistage du VIH en Afrique de l’Ouest » (communication orale (symposium ATLAS), présenté à 21st ICASA conference, Durban.

  • Larmarange Joseph et Sjoberg Daniel D. (2021) Broom.helpers: Helpers for Model Coefficients Tibbles, version 1.5.0. https://CRAN.R-project.org/package=broom.helpers.
    Résumé : Provides suite of functions to work with regression model 'broom::tidy()' tibbles. The suite includes functions to group regression model terms by variable, insert reference and header rows for categorical variables, add variable labels, and more.
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  • Robinson David, Hayes Alex, Couch [aut Simon, cre, Patil Indrajeet, Chiu Derek, Gomez Matthieu, Demeshev Boris, Menne Dieter, Nutter Benjamin, Johnston Luke, Bolker Ben, Briatte Francois, Arnold Jeffrey, Gabry Jonah, Selzer Luciano, Simpson Gavin, Preussner Jens, Hesselberth Jay, Wickham Hadley, Lincoln Matthew, Gasparini Alessandro, Komsta Lukasz, Novometsky Frederick, Freitas Wilson, Evans Michelle, Brunson Jason Cory, Jackson Simon, Whalley Ben, Whiting Karissa, Rosseel Yves, Kuehn Michael, Cimentada Jorge, Holgersen Erle, Werner Karl Dunkle, Christensen Ethan, Pav Steven, PJ Paul, Schneider Ben, Kennedy Patrick, Medina Lily, Fannin Brian, Muhlenkamp Jason, Lehman Matt, Denney Bill, Crane Nic, Bates Andrew, Arel-Bundock Vincent, Hayashi Hideaki, Tobalina Luis, Wang Annie, Tham Wei Yang, Wang Clara, Smith Abby, Cooper Jasper, Krauska E. Auden, Wang Alex, Barrett Malcolm, Gray Charles, Wilber Jared, Gegzna Vilmantas, Szoecs Eduard, Aust Frederik, Moore Angus, Williams Nick, Barth Marius, Wundervald Bruna, Cahoon Joyce, McDermott Grant, Zarca Kevin, Kuriwaki Shiro, Wallrich Lukas, Martherus James, Xiao Chuliang, Larmarange Joseph, Kuhn Max, Bojanowski Michal, Malmedal Hakon, Wang Clara, Oller Sergio, Sonnet Luke, Hester Jim, Brunson Cory, Schneider Ben, Gray Bernie, Averick Mara, Jacobs Aaron, Bender Andreas, Templer Sven, Buerkner Paul-Christian, Kay Matthew, Pennec Erwan Le, Junkka Johan, Zhu Hao, Soltoff Benjamin, Saldana Zoe Wilkinson, Littlefield Tyler, Gray Charles T., Banks Shabbh E., Robinson Serina, Bivand Roger, Ots Riinu, Williams Nicholas, Jakobsen Nina, Weylandt Michael, Lendway Lisa, Hailperin Karl, Rodriguez Josue, Bryan Jenny, Jarvis Chris, Macfarlane Greg, Mannakee Brian, Tyre Drew, Singh Shreyas, Geffert Laurens, Ooi Hong, Bengtsson Henrik, Szocs Eduard, Hugh-Jones David, Stigler Matthieu, Tavares Hugo, Vervoort R. Willem, Wiernik Brenton M., Yamamoto Josh, Lee Jasme et Sanders Taren (2021) Broom: Convert Statistical Objects into Tidy Tibbles, version 0.7.10. https://CRAN.R-project.org/package=broom.
    Résumé : Summarizes key information about statistical objects in tidy tibbles. This makes it easy to report results, create plots and consistently work with large numbers of models at once. Broom provides three verbs that each provide different types of information about a model. tidy() summarizes information about model components such as coefficients of a regression. glance() reports information about an entire model, such as goodness of fit measures like AIC and BIC. augment() adds information about individual observations to a dataset, such as fitted values or influence measures.
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  • 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.
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  • Schloerke Barret, Cook Di, Larmarange Joseph, Briatte Francois, Marbach Moritz, Thoen Edwin, Elberg Amos, Toomet Ott, Crowley Jason, Hofmann Heike et Wickham Hadley (2021) GGally: Extension to 'ggplot2', version 2.1.2. https://CRAN.R-project.org/package=GGally.
    Résumé : The R package 'ggplot2' is a plotting system based on the grammar of graphics. 'GGally' extends 'ggplot2' by adding several functions to reduce the complexity of combining geometric objects with transformed data. Some of these functions include a pairwise plot matrix, a two group pairwise plot matrix, a parallel coordinates plot, a survival plot, and several functions to plot networks.
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  • Silhol Romain, Maheu-Giroux Mathieu, Soni Nirali, Simo Fotso Arlette, Rouveau Nicolas, Vautier Anthony, Doumenc-Aïdara Clémence, Larmarange Joseph, Boily Marie-Claude et for the ATLAS Team (2021) « Modelling the population-level impact of a national HIV self-testing strategy among key populations in Côte d’Ivoire » (poster #PEC029), présenté à 21st ICASA conference, Durban.
    Résumé : Background: A third of people living with HIV (PLHIV) in Western Africa are not diagnosed, hindering progress towards HIV elimination. Scaling-up HIV self-testing (HIVST) among key populations (KP) such as female sex workers (FSW), their clients, and men who have sex with men (MSM), may further curb HIV transmission in this region. Using data from the ATLAS program in Côte d’Ivoire, we projected the potential impact of a national HIVST strategy among KP in the country. Methods: A deterministic model of HIV transmission and different testing modalities among key and lower-risk populations was parameterized following a review of demographic, behavioural, HIV and intervention data of the epidemic in Côte d’Ivoire over time. The model was then calibrated to empirical outcomes, including HIV prevalence, the fractions of PLHIV ever HIV tested, diagnosed, and treated, by risk group. Based on interim ATLAS HIVST programme data among KP in southern Côte d’Ivoire, we assumed that ~440,000 HIVST are distributed annually (i.e. ~10% of all tests in the country), including 29%, 22%, 32%, and 18% to FSW, their clients, MSM, and lower-risk populations, respectively. We predicted the potential impact of this HIVST strategy on new HIV infections and deaths, and new diagnoses over 10 years. Results: After 10 years, the HIVST strategy is expected to increase the fraction of all PLHIV diagnosed by 18%-points in both FSW (86% vs 69% without HIVST) and MSM (95% vs 77%), resulting in small increases overall (85% vs 83%). Overall, this strategy may avert 10,800 (5,100-24,200) new HIV infections over 10 years; equivalent to one infection averted per ~400 HIVST distributed. This corresponds to a relative decrease in new infections of 10% (5-17%), 9% (4-21%), and 32% (23-48%) among FSW, their clients, and MSM, respectively, and 5% (3-10%) overall. However, given the larger population size, two-thirds (63%; 44-78%) of all infections prevented over 10 years were among all lower-risk populations, reflecting the indirect effects of prioritizing KP. HIV mortality among FSW and MSM may be reduced by around 15% over 10 years, vs 4% among FSW clients and 2% overall (i.e. 2700 (1400-5600) total deaths averted). Conclusions and recommendations: A national HIVST strategy may prevent 3-10% of new HIV infections in Côte d’Ivoire, especially among FSW clients and MSM. This would help reduce disparities in HIV burden by reaching key populations and addressing their unmet treatment needs.
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  • Sjoberg Daniel D., Curry Michael, Larmarange Joseph, Lavery Jessica, Whiting Karissa, Zabor Emily C., Bai Xing, Drill Esther, Flynn Jessica, Hannum Margie, Lobaugh Stephanie et Wainberg Gustavo Zapata (2021) Gtsummary: Presentation-Ready Data Summary and Analytic Result Tables, version 1.5.0. https://CRAN.R-project.org/package=gtsummary.
    Résumé : Creates presentation-ready tables summarizing data sets, regression models, and more. The code to create the tables is concise and highly customizable. Data frames can be summarized with any function, e.g. mean(), median(), even user-written functions. Regression models are summarized and include the reference rows for categorical variables. Common regression models, such as logistic regression and Cox proportional hazards regression, are automatically identified and the tables are pre-filled with appropriate column headers.
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  • Sjoberg Daniel D., Whiting Karissa, Curry Michael, Lavery Jessica A. et Larmarange Joseph (2021) « The R Journal: Reproducible Summary Tables with the gtsummary Package », The R Journal, 13 (1) (août), p. 570-580. DOI : 10.32614/RJ-2021-053. https://doi.org/10.32614/RJ-2021-053/.
    Résumé : The gtsummary package provides an elegant and flexible way to create publication-ready summary tables in R. A critical part of the work of statisticians, data scientists, and analysts is summarizing data sets and regression models in R and publishing or sharing polished summary tables. The gtsummary package was created to streamline these everyday analysis tasks by allowing users to easily create reproducible summaries of data sets, regression models, survey data, and survival data with a simple interface and very little code. The package follows a tidy framework, making it easy to integrate with standard data workflows, and offers many table customization features through function arguments, helper functions, and custom themes.
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  • Spinu Vitalie, Grolemund Garrett, Wickham Hadley, Vaughan Davis, Lyttle Ian, Costigan Imanuel, Law Jason, Mitarotonda Doug, Larmarange Joseph, Boiser Jonathan, Lee Chel Hee et Inc Google (2021) Lubridate: Make Dealing with Dates a Little Easier, version 1.8.0. https://CRAN.R-project.org/package=lubridate.
    Résumé : Functions to work with date-times and time-spans: fast and user friendly parsing of date-time data, extraction and updating of components of a date-time (years, months, days, hours, minutes, and seconds), algebraic manipulation on date-time and time-span objects. The 'lubridate' package has a consistent and memorable syntax that makes working with dates easy and fun. Parts of the 'CCTZ' source code, released under the Apache 2.0 License, are included in this package. See <https://github.com/google/cctz> for more details.
    Mots-clés : ReproducibleResearch, TimeSeries.
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  • Xie [aut Yihui, cre, Sarma Abhraneel, Vogt Adam, Andrew Alastair, Zvoleff Alex, http://www.andre-simon.de) Andre Simon (the CSS files under inst/themes/ were derived from the Highlight package, Atkins Aron, Wolen Aaron, Manton Ashley, Yasumoto Atsushi, Baumer Ben, Diggs Brian, Zhang Brian, Yapparov Bulat, Pereira Cassio, Dervieux Christophe, Hall David, Hugh-Jones David, Robinson David, Hemken Doug, Murdoch Duncan, Campitelli Elio, Hughes Ellis, Riederer Emily, Hirschmann Fabian, Simeon Fitch, Fang Forest, inst/misc/Sweavel.sty) Frank E. Harrell Jr (the Sweavel package at, Aden-Buie Garrick, Detrez Gregoire, Wickham Hadley, Zhu Hao, Jeon Heewon, Bengtsson Henrik, Yutani Hiroaki, Lyttle Ian, Daniel Hodges, Burkhead Jake, Manton James, Lander Jared, Punyon Jason, Luraschi Javier, Arnold Jeff, Bryan Jenny, inst/misc/docco-classic.css) Jeremy Ashkenas (the CSS file at, Stephens Jeremy, Hester Jim, Cheng Joe, Ranke Johannes, Honaker John, Muschelli John, Keane Jonathan, Allaire J. J., Toloe Johan, Sidi Jonathan, Larmarange Joseph, Barnier Julien, Zhong Kaiyin, Slowikowski Kamil, Forner Karl, Smith Kevin K., Mueller Kirill, Takahashi Kohske, Walthert Lorenz, Gallindo Lucas, Hofert Marius, Modrák Martin, Chirico Michael, Friendly Michael, Bojanowski Michal, Kuhlmann Michel, Patrick Miller, Caballero Nacho, Salkowski Nick, Hansen Niels Richard, Ross Noam, Mahdi Obada, Krivitsky Pavel N., Li Qiang, Vaidyanathan Ramnath, Cotton Richard, Krzyzanowski Robert, Francois Romain, Williamson Ruaridh, Kostyshak Scott, Meyer Sebastian, Brouwer Sietse, Bernard Simon de, Rousseau Sylvain, Wei Taiyun, Assus Thibaut, Lamadon Thibaut, Leeper Thomas, Mastny Tim, Torsney-Weir Tom, Davis Trevor, Veitas Viktoras, Zhu Weicheng, Wu Wush et Foster Zachary (2021) Knitr: A General-Purpose Package for Dynamic Report Generation in R, version 1.37. https://CRAN.R-project.org/package=knitr.
    Résumé : Provides a general-purpose tool for dynamic report generation in R using Literate Programming techniques.
    Mots-clés : ReproducibleResearch.
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2020


  • Abo Yao, Altman Mathias, Bekelynck Anne, Dahourou Désiré, Simo Fotso Arlette, Godin Zélie, Kadio Kadidiatou, Larmarange Joseph, Sondo Apoline et Valentin Louis (2020) Connaissances, attitudes et pratiques liées à la pandémie COVID-19 des médecins au Burkina Faso, Policy brief (1), Ouagadougou : Aphro-Cov, 6 p. https://aphro-cov.com/ressources_liste/connaissances-attitudes-et-pratiques-liees-a-la-pandemie-covid-19-des-medecins-au-burkina-faso/.
    Résumé : CAP-CoV-BF : une enquête nationale réalisées auprès des médecins au Burkina Faso Le personnel de santé se trouve au cœur du dispositif élaboré dans le cadre de la réponse à l’épidémie de COVID-19, à la fois en tant qu’acteur essentiel du dispositif de réponse à l’épidémie, et en tant que premières personnes exposées et victimes. Il est ainsi essentiel de s’assurer de la compréhension de cette maladie (symptômes, modes de transmission, mesures de prévention, etc.) et de l’acceptabilité et de l’adaptation des médecins du Burkina Faso face aux mesures de santé publique préconisées. Cela permettra d’identifier les difficultés et les barrières qu’ils rencontrent afin d’adopter les mesures de protection adéquates, proposer des interventions adaptées pour les surmonter et prioriser les messages qui leur sont destinés. L’objectif principal de cette étude est de fournir aux acteurs nationaux impliqués dans la gestion de la crise des données probantes régulières et représentatives à l’échelle nationale sur les connaissances, attitudes et pratiques des médecins au Burkina Faso. Une enquête quantitative transversale par téléphone a été mise en place, menée auprès d’un échantillon représentatif de 166 médecins sur l’ensemble du territoire. Elle sera répétée trois fois à intervalles réguliers. Ce document “Policy Brief” (téléchargeable au lien ci-dessous) présente de façon synthétique les résultats de l’analyse de la 1ère vague d’appels réalisée en Septembre 2020.
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  • Assoumou Nelly, Bekelynck Anne, Carillon Séverine, Kouadio Alexis, Ouantchi Honoré, Doumbia Mohamed, Larmarange Joseph et Kone Mariatou (2020) « Organisation du financement du dépistage du VIH à base communautaire en Côte d'Ivoire : une recherche d'efficience potentiellement contre-productive ? » (poster), présenté à INTEREST 2020, online. http://interestworkshop.org/.
    Résumé : Contexte: Depuis le début des années 2010, le President’s Emergency Plan for AIDS Relief (Pepfar) et le Fonds mondial de lutte contre le VIH/ sida, la tuberculose et le paludisme, ont accentué leurs stratégies d’efficience basées sur la gestion axée sur les résultats (GAR). L’objectif ici est d’analyser les effets de ces stratégies sur la mise en oeuvre locale des activités, à travers l’exemple du dépistage du VIH à base communautaire. Matériels et Méthodes: L’étude a été menée en 2015 et 2016 dans trois districts sanitaires de la Côte d’Ivoire. Une cartographie des acteurs impliqués dans le dépistage à base communautaire et des entretiens semi-directifs ont été réalisés auprès de dix-huit membres des ONG dites «communautaires» : coordonnateurs de projet (8), chargés de suivi et évaluation (5), superviseur des activités (1), conseillers communautaires (4). Résultats: Les deux bailleurs mettent en place des systèmes de financement qui se déclinent sous forme de chaines à plusieurs maillons d’acteurs (bailleurs, organisations intermédiaires, ONG communautaires), de trois niveaux pour le Pepfar à quatre ou cinq pour le Fonds mondial. A chaque niveau, des comptes rendus et validations des données mensuelles, trimestrielles et annuelles sont exigées comme conditions de décaissements des fonds. Leur caractère chronophage, conjugué au manque de ressources humaines et/ou techniques des ONG communautaires génèrent d’importants retards. Au final, sur une année, seuls huit à neuf mois (sur douze) sont généralement consacrés à la mise en oeuvre effective des activités de dépistage ; et chaque mois, seules deux semaines (sur quatre) y sont dédiées. Conclusion: Tandis que les bailleurs de fonds portent une attention croissante à l’obtention de données précises et actualisées dans le but d’améliorer l’efficience de leurs stratégies, celles-ci produisent des effets contre-productifs, qui tendent à nuire à la mise en oeuvre effective des activités. Un juste équilibre entre mise en oeuvre et suivi et évaluation est ainsi à trouver, en fonction des capacités humaines et techniques des acteurs.
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  • Becquet Valentine, Nouaman Marcellin, Plazy Mélanie, Masumbuko Jean-Marie, Anoma Camille, Kouame Soh, Danel Christine, Eholie Serge Paul et Larmarange Joseph (2020) « Sexual health needs of female sex workers in Côte d’Ivoire: a mixed-methods study to prepare the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention », BMJ Open, 10 (1) (janvier), p. e028508. DOI : 10.1136/bmjopen-2018-028508. http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2018-028508.
    Résumé : OBJECTIVE: To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population. DESIGN AND SETTING: The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d'Ivoire. PARTICIPANTS: A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs' risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services. RESULTS: Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner's HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication. CONCLUSIONS: Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d'Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
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  • Bekelynck Anne et Larmarange Joseph (2020) « PEPFAR’s 3.0 HIV testing policy in Côte d'Ivoire reveals fragmentation, acceleration and disconnection », Aidspan, 376, avril 1. https://www.aidspan.org/gfo_article/pepfar%E2%80%99s-30-hiv-testing-policy-c%C3%B4te-divoire-reveals-fragmentation-acceleration-and.

  • Bekelynck Anne et Larmarange Joseph (2020) « La politique de dépistage du VIH de Pepfar 3.0 en Côte d'Ivoire (2014 à 2018) : fragmentation, accélération et déconnexion », Aidspan, 96, février 28. https://www.aidspan.org/fr/node/5224.

  • 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.
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  • 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.
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  • Gantner Pierre, Laurent Christian, Larmarange Joseph et Ghosn Jade (2020) « Prophylaxie préexposition (PrEP) », in VIH, Hépatites virales, Santé sexuelle, par Christine Katlama, Jade Ghosn, et Gilles Wandeler, Paris : AFRAVIH, EDP sciences, p. 715-726. ISBN : 978-2-7598-2403-8. https://www.livre-afravih.org/.


  • Havlir Diane, Lockman Shahin, Ayles Helen, Larmarange Joseph, Chamie Gabriel, Gaolathe Tendani, Iwuji Collins, Fidler Sarah, Kamya Moses, Floyd Sian, Moore Janet, Hayes Richard, Petersen Maya, Dabis Francois et on behalf of the (Universal Test, Treat Trials) UT3 Consortium (2020) « What do the Universal Test and Treat trials tell us about the path to HIV epidemic control? », Journal of the International AIDS Society, 23 (2). DOI : 10.1002/jia2.25455. https://onlinelibrary.wiley.com/doi/abs/10.1002/jia2.25455.
    Résumé : Introduction Achieving HIV epidemic control globally will require new strategies to accelerate reductions in HIV incidence and mortality. Universal test and treat (UTT) was evaluated in four randomized population-based trials (BCPP/Ya Tsie, HPTN 071/PopART, SEARCH, ANRS 12249/TasP) conducted in sub-Saharan Africa (SSA) during expanded antiretroviral treatment (ART) eligibility by World Health Organization guidelines and the UNAIDS 90-90-90 campaign. Discussion These three-year studies were conducted in Botswana, Zambia, Uganda, Kenya and South Africa in settings with baseline HIV prevalence from 4% to 30%. Key observations across studies were: (1) Universal testing (implemented via a variety of home and community-based testing approaches) achieved >90% coverage in all studies. (2) When coupled with robust linkage to HIV care, rapid ART start and patient-centred care, UTT achieved among the highest reported population levels of viral suppression in SSA. Significant gains in population-level viral suppression were made in regions with both low and high baseline population viral load; however, viral suppression gains were not uniform across all sub-populations and were lower among youth. (3) UTT resulted in marked reductions in community HIV incidence when universal testing and robust linkage were present. However, HIV elimination targets were not reached. In BCPP and HPTN 071, annualized HIV incidence was approximately 20% to 30% lower in the intervention (which included universal testing) compared to control arms (no universal testing). In SEARCH (where both arms had universal testing), incidence declined 32% over three years. (4) UTT reduced HIV associated mortality by 23% in the intervention versus control communities in SEARCH, a study in which mortality was comprehensively measured. Conclusions These trials provide strong evidence that UTT inclusive of universal testing increases population-level viral suppression and decreases HIV incidence and mortality faster than the status quo in SSA and should be adapted at a sub-country level as a public health strategy. However, more is needed, including integration of new prevention interventions into UTT, in order to reach UNAIDS HIV elimination targets.
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  • Inghels Maxime, Carillon Séverine, Desgrées du Loû Annabel et Larmarange Joseph (2020) « Effect of organizational models of provider-initiated testing and counseling (PITC) in health facilities on adult HIV testing coverage in sub-Saharan Africa », AIDS Care, 32 (2) (février 1), p. 163-169. DOI : 10.1080/09540121.2019.1626339. https://doi.org/10.1080/09540121.2019.1626339.
    Résumé : The purpose of this paper is to identify which Provider-Initiated HIV Testing and Counseling (PITC) organizational models are the most efficient to maximize testing coverage. We conducted a systematic literature review to identify published articles that evaluated routine PITC programs implemented in adult health facilities in Sub-Saharan Africa. We considered only articles measuring PITC offer, PITC acceptability and PITC coverage. Adjusted meta-regression models were performed to measure the association between PITC offer, acceptability and coverage with PITC organizational model. A total of 30 articles were included in the meta-analysis. Overall, 85.4% [95%CI: 77.2–93.5] of patients were offered a test, and 87.1% [82.4–91.7] accepted the test resulting in a PITC coverage of 74.3% [66–82.6]. Four types of PITC organizational models were identified: PITC initiated and performed during the consultation (model A), PITC initiated before consultation (model B), PITC referred on-site (model C) and PITC referred off-site (model D). Compared to model A, model B had a similar coverage (aOR: 1.02 [0.82–1.26]). However, coverage was lower for model C (aOR: 0.81 [0.68–0.97]) and model D (aOR: 0.58 [0.44–0.77]). Initiating the testing process before or during medical consultation is recommended for maximizing testing coverage among patients.
    Mots-clés : HIV testing, organizational models, Provider initiated testing and counseling, Sub-Saharan Africa, testing cover.
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  • Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Danel Christine, Kone Mariatou, Desgrées du Loû Annabel et Larmarange Joseph (2020) « Cascade of Provider-Initiated Human Immunodeficiency Virus Testing and Counselling at Specific Life Events (Pregnancy, Sexually Transmitted Infections, Marriage) in Côte dʼIvoire: », Sexually Transmitted Diseases, 47 (1) (janvier), p. 54-61. DOI : 10.1097/OLQ.0000000000001084. http://Insights.ovid.com/crossref?an=00007435-202001000-00012.
    Résumé : BACKGROUND: Despite the implementation of Provider Initiated Testing and Counselling (PITC) in 2009, PITC coverage remains low in Cote d'Ivoire. The purpose of this study is to determine whether an human immunodeficiency virus (HIV) test was offered and performed at specific life events where PITC is recommended by national guidelines. METHODS: In 2017, a cross-sectional telephone survey was conducted among a representative sample of 3,867 adults from the general population in Côte d'Ivoire. The occurrences of the following events over the past 5 years were documented: pregnancy (event A) or partner's pregnancy (event B) of the last child, sexually transmitted infection (event C) and marriage (event D). For each of these events, participants were asked (i) if they consulted a health care professional, (ii) if they were offered an HIV test during that consultation and (iii) if they accepted it. RESULTS: Consulting a health care provider was reported by 94.9%, 58.3%, 70.3% and 19.1% of those who reported events A, B, C and D respectively. In case of medical consultations following events A, B, C and D, respectively 70.1%, 33.1%, 28.1%, and 78.8% of individuals were offered an HIV test. The testing acceptance was high regardless of the event. Overall, testing coverage was 63.7%, 16.9%, 13.4% and 14.5% for events A, B, C and D respectively. CONCLUSIONS: Increasing HIV testing coverage in Côte d'Ivoire requires (i) facilitating attendance to health services in case of sexually transmitted infections, marriage and pregnancy-for men-and (ii) strengthening routine testing offer on these occasions.
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  • Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Danel Christine, Koné Mariatou, Desgrées du Loû Annabel, Larmarange Joseph et ANRS 12323 DOD-CI Study Group (2020) « Pratiques et facteurs associés au dépistage récent du VIH en population générale, Côte d’Ivoire. Résultats de l’étude ANRS 12323 DOD-CI », Bulletin De La Societe De Pathologie Exotique (1990), 113 (5) (décembre 28), p. 268-277. DOI : 10.3166/bspe-2021-0154. https://bspe.revuesonline.com/article.jsp?articleId=42002.
    Résumé : With 2.9% of HIV prevalence in the general population, Côte d'Ivoire is one of the countries most affected by the HIV epidemic in West Africa. In this country, only 63% of people infected with HIV are aware of their status. A cross-sectional phone survey was conducted with a representative sample of 3,867 individuals to describe the practices and factors associated with a recent HIV testing (≤ 1 year) in Côte d'Ivoire. Data relative to the last done HIV test as well as the socio-demographic characteristics, sexual behavior, access to information, perceptions, capacities and autonomy as well as social and geographical environment of the participants were collected. Logistical regression models were used to identify the associated factors with a recent HIV test (≤ 1 year). Lack of information is one of the main barriers to HIV testing (only 60% of individuals know a place to get tested). For men, despite the fact that HIV testing is free of charge, poor economic conditions seem to be a barrier to testing. The social environment, including peer influence, also appears to have an effect on testing among men. For women, testing is associated with their perceptions of HIV exposure. There is a need to rethink the current HIV testing communication in Côte d'Ivoire and to identify economic or social incentives to remove access barriers to HIV testing.
    Mots-clés : Africa, Western, Afrique subsaharienne, Cote d'Ivoire, Côte d’Ivoire, Cross-Sectional Studies, Dépistage, Enquête téléphonique, Female, HIV Infections, HIV Testing, Humans, Male, Population générale, Sexual Behavior, VIH.
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  • Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Danel Christine, Kone Mariatou, Desgrees du Lou Annabel, Larmarange Joseph et for the ANRS 12323 DOD-CI Study Group (2020) « Practices and Obstacles to Provider-Initiated HIV Testing and Counseling (PITC) Among Healthcare Providers in Côte d’Ivoire », AIDS and Behavior (mai 24). DOI : 10.1007/s10461-020-02923-0. https://doi.org/10.1007/s10461-020-02923-0.
    Résumé : Practices of Provider-Initiated HIV Testing and Counseling (PITC) remains suboptimal in Côte d’Ivoire. The aim of this survey was to identify the practices and obstacles to PITC among healthcare professionals in Côte d'Ivoire. A nationally representative cross-sectional survey was conducted in 2018 by telephone among three separate samples of midwives, nurses and physicians practicing in Côte d'Ivoire. The number of HIV tests proposed during consultation in the month preceding the survey was collected for each professional. Factors associated with the number of proposed tests were identified through ordinal logistic regression models. A total of 298 midwives, 308 nurses and 289 physicians were interviewed. Midwives proposed the test more frequently, followed by nurses and physicians. Among midwives, a higher number of proposed tests was associated with the perception that HIV testing does not require specific consent compared to other diseases (aOR 4.00 [95% CI 1.37–14.29]). Among nurses, having received HIV training and the presence of community HIV counselors were associated with a higher number of proposed tests (aOR 2.01 [1.31–3.09] and aOR 1.75 [1.14–2.70], respectively). For physicians, the presence of a voluntary testing center was associated with a higher number of proposed tests (aOR 1.69 [1.01–2.86]). PITC practices and barriers differed across professions. Beyond improving environmental opportunities such as dedicated staff or services, strengthening the motivations and capabilities of healthcare professionals to propose testing could improve PITC coverage.
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  • Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Koné Mariatou, Danel Christine, Desgrées du Loû Annabel et Larmarange Joseph (2020) « Perceptions, préférences et recours aux offres communautaires de dépistage du VIH chez les hommes ayant des relations sexuelles avec d’autres hommes (HSH) en Côte d’Ivoire » (communication orale (session SPD1), présenté à AFRAVIH 2020, Dakar. http://www.afravih2020.org/.
    Résumé : Objectifs Depuis la fin des années 2000, se sont développées des offres de dépistage dédiées à destination des HSH. Portées par des ONG communautaires et favorisées par la formation de pairs éducateurs à la réalisation de tests rapides, ce dépistage communautaire serait plus adapté pour atteindre cette population. Mais qu’en est-il du point de vue des intéressés eux-mêmes ? Matériels et Méthodes Une enquête par téléphone de type Respondent driven sampling (RDS) auprès de 518 HSH a été réalisée en 2018 en Côte d’Ivoire. Le questionnaire portait, entre autres, sur la connaissance, la pratique, la satisfaction et les préférences concernant les offres de dépistage dédiées aux HSH. Résultats Seule la moitié des enquêtés (47 %) ont déclaré connaître un lieu de dépistage dédié aux HSH. Parmi ceux-ci, 79 % en avaient déjà fréquenté un. Ces derniers ont rapporté avoir été bien accueillis, s’être sentis en confiance, que la confidentialité avait été respectée et 95 % ont déclaré qu’ils y retourneraient. En termes de préférences, 37 % des enquêtés ont déclaré préférer les lieux de dépistage indifférenciés (c.-à-d. accueillant tout type de patient), 34 % les lieux communautaires et 29 % sans préférence. Ceux préférant le dépistage communautaire mentionnaient une meilleure écoute et s’y sentir plus en confiance, notamment du fait de la présence d’autres HSH. À l’inverse, ceux préférant une offre généraliste mentionnaient le manque de discrétion et d’anonymat des offres communautaires et vouloir éviter le regard des autres. Les hommes les plus éloignés du « milieu HSH », se définissant comme bisexuels/hétérosexuels, attirés principalement par des femmes, ne connaissant pas une association HSH ou n’ayant pas dévoilé leur homosexualité ont plus tendance à préférer un lieu généraliste. Conclusion Si le dépistage communautaire est bien adapté aux HSH qui y ont recours, le maintien d’une offre de dépistage indifférenciée reste essentiel.
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  • Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Koné Mariatou, Danel Christine, Desgrées du Loû Annabel et Larmarange Joseph (2020) « Perceptions, preferences and access to community-based HIV testing services among Men who have Sex with Men (MSM) in Côte d'Ivoire » (communication orale (présentation orale de poster), présenté à INTEREST 2020, online. http://interestworkshop.org/.
    Résumé : Background: Dedicated HIV testing settings have been developed for Men who have Sex with Men (MSM) since the end of the 2000s. These facilities are supported by community-based NGOs and promoted by peer educators, who are trained in the use of rapid HIV tests. As such, this community-based HIV-testing should be adapted to reach the MSM populations. However, little is known about the direct MSM’ point of view regarding such community-based services. Materials and methods: A respondent-driven sampling telephone survey of 518 MSM was conducted in 2018 in Côte d'Ivoire. The questionnaire examined knowledge, practice, satisfaction, and preferences regarding MSM-community-based HIV testing services. Results: Only half of the respondents (47%) reported knowing a community-based HIV testing site dedicated to MSM. Of these, 79% had already attended one. They reported that they were welcomed, that they felt confident, that confidentiality was respected, and 95% said they would return to one of these sites. In terms of preferences, 37% of respondents said they preferred undifferentiated HIV testing sites (i.e., “all patients” or “general population” HIV testing sites), 34% preferred community-based sites, and 29% had no preference. Those who preferred community-based HIV testing reported better listening and feeling more confident, particularly because of the presence of other MSM. Conversely, those preferring undifferentiated HIV testing sites mentioned the lack of discretion and anonymity of community-based sites and wanting to avoid the gaze of others. They feared to be recognized by other patients in a context where they want to keep secret their sexual preferences. Men who were furthest away from the MSM community, defining themselves as bisexual/heterosexual, attracted primarily to women, not knowing a dedicated MSM NGO, or not having disclosed their homo/bisexuality to one member of their family were more likely to prefer undifferentiated HIV testing sites. Conclusion: Community-based HIV testing is well suited for MSM who identify as homosexual and those close to the MSM community while maintaining undifferentiated HIV testing is essential for others. Both types of activities need to be maintained and developed. It is also crucial that healthcare professionals in undifferentiated HIV testing sites are properly trained in non-judgemental reception of people with diverse sexual practices and identities.
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  • Iwuji Collins, Chimukuche Rujeko Samanthia, Zuma Thembelihle, Plazy Melanie, Larmarange Joseph, Orne-Gliemann Joanna, Siedner Mark, Shahmanesh Maryam et Seeley Janet (2020) « Test but not treat: Community members’ experiences with barriers and facilitators to universal antiretroviral therapy uptake in rural KwaZulu-Natal, South Africa », PLOS ONE, 15 (9) (septembre 24), p. e0239513. DOI : 10.1371/journal.pone.0239513. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239513.
    Résumé : Introduction Antiretroviral therapy (ART) has revolutionised the care of HIV-positive individuals resulting in marked decreases in morbidity and mortality, and markedly reduced transmission to sexual partners. However, these benefits can only be realised if individuals are aware of their HIV-positive status, initiated and retained on suppressive lifelong ART. Framed using the socio-ecological model, the present study explores factors contributing to poor ART uptake among community members despite high acceptance of HIV-testing within a Treatment as Prevention (TasP) trial. In this paper we identify barriers and facilitators to treatment across different levels of the socio-ecological framework covering individual, community and health system components. Methods This research was embedded within a cluster-randomised trial (ClinicalTrials.gov, number NCT01509508) of HIV treatment as Prevention in rural KwaZulu-Natal, South Africa. Data were collected between January 2013 and July 2014 from resident community members. Ten participants contributed to repeat in-depth interviews whilst 42 participants took part in repeat focus group discussions. Data from individual interviews and focus group discussions were triangulated using community walks to give insights into community members’ perception of the barriers and facilitators of ART uptake. We used thematic analysis guided by a socio-ecological framework to analyse participants’ narratives from both individual interviews and focus group discussions. Results Barriers and facilitators operating at the individual, community and health system levels influence ART uptake. Stigma was an over-arching barrier, across all three levels and expressed variably as fear of HIV disclosure, concerns about segregated HIV clinical services and negative community religious perceptions. Other barriers were individual (substance misuse, fear of ART side effects), community (alternative health beliefs). Facilitators cited by participants included individual (expectations of improved health and longer life expectancy following ART, single tablet regimens), community (availability of ART in the community through mobile trial facilities) and health system factors (fast and efficient service provided by friendly staff). Discussion We identified multiple barriers to achieving universal ART uptake. To enhance uptake in HIV care services, and achieve the full benefits of ART requires interventions that tackle persistent HIV stigma, and offer people with HIV respectful, convenient and efficient services. These interventions require evaluation in appropriately designed studies.
    Mots-clés : Antiretroviral therapy, Health care facilities, HIV, HIV diagnosis and management, HIV prevention, Religion, South Africa, Virus testing.
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  • Kouadio Brou Alexis, Carillon Séverine, Bekelynck Anne, Assi Adjoa Nelly Assoumou, Danel Christine, Ouantchi Honoré, Doumbia Mohamed, Koné Mariatou, Larmarange Joseph et Équipe projet DOD-CI ANRS 12323 (2020) « Outreach strategies of HIV testing in Côte d’Ivoire: Community providers under pressure », Sante Publique, 32 (1) (juin 29), p. 103-111. DOI : 10/gnsx45. https://www.cairn-int.info/journal-sante-publique-2020-1-page-103.htm.
    Résumé : Background: Outreach HIV testing strategies have significantly contributed to the increase in the number of people knowing their HIV status in sub-Saharan Africa. This article analyzes the articulation of donor and field constraints on the implementation of outreach HIV testing strategies in C&#244;te d&#8217;Ivoire.Methods: Qualitative research was conducted in three health districts (Man, Cocody-Bingerville and Aboisso) in C&#244;te d&#8217;Ivoire in&#160;2015-2016, through in-depth interviews with community providers, local leaders and people tested and through observation of outreach HIV testing activities.Results: Implementing organizations feel &#8220;under pressure&#8221; to meet donors&#8217; objectives that are deemed unattainable, as well as the lack of training and funding. As a result, providers do not observe systematically the rules of the &#8220;three Cs&#8221; (counselling, informed consent, confidentiality), and propose testing to individuals who are &#8220;off-target&#8221; (in terms of locations and populations).Discussion: Implementing NGOs experience two types of constraints those resulting from the functioning of international aid (inadequate funding compared to actual costs, objectives too high, the important chain of intermediaries) and those related to the local context (spaces not adapted to guarantee confidentiality and the professional activity of target populations).Conclusion: The pressure that is exerted at different levels on implementing NGOs is detrimental to the quality of HIV testing. It is now essential to develop a more qualitative approach in defining strategies and evaluation criteria.
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  • Kouadio Brou Alexis, Carillon Séverine, Bekelynck Anne, Assoumou Assi Adjoa Nelly, Danel Christine, Ouantchi Honoré, Doumbia Mohamed, Koné Mariatou, Larmarange Joseph et Équipe projet DOD-CI ANRS (2020) « Dépistage du VIH hors les murs en Côte d’Ivoire : des prestataires communautaires sous pression », Santé Publique, 32 (1), p. 103. DOI : 10.3917/spub.201.0103. http://www.cairn.info/revue-sante-publique-2020-1-page-103.htm?ref=doi.
    Résumé : Background: Outreach HIV testing strategies have significantly contributed to the increase in the number of people knowing their HIV status in sub-Saharan Africa. This article analyzes the articulation of donor and field constraints on the implementation of outreach HIV testing strategies in Cote d'lvoire. Methods: Qualitative research was conducted in three health districts (Man, Cocody-Bingerville and Aboisso) in Cote d'lvoire in 2015-2016, through in-depth interviews with community providers, local leaders and people tested and through observation of outreach HIV testing activities. Results: Implementing organizations feel "under pressure" to meet donors' objectives that are deemed unattainable, as well as the lack of training and funding. As a result, providers do not observe systematically the rules of the "three Cs" (counselling, informed consent, confidentiality), and propose testing to individuals who are "off-target" (in terms of locations and populations). Discussion: Implementing NGOs experience two types of constraints those resulting from the functioning of international aid (inadequate funding compared to actual costs, objectives too high, the important chain of intermediaries) and those related to the local context (spaces not adapted to guarantee confidentiality and the professional activity of target populations). Conclusion: The pressure that is exerted at different levels on implementing NGOs is detrimental to the quality of HIV testing. It is now essential to develop a more qualitative approach in defining strategies and evaluation criteria.
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  • 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.
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  • Larmarange Joseph (2020) « Catégories épidémiologiques, catégories sociales et catégories d'actions : doit-on repenser les "populations clés" de la lutte contre le VIH ? » (communication orale), présenté à Conférence Anthropo-Med "Dissonances et Convergences entre Anthropologie et Santé Publique", Marseille. https://imera.univ-amu.fr/fr/conference-anthropo-med-dissonances-convergences-entre-anthropologie-sante-publique.
    Résumé : Dans de nombreux pays, les populations clés (en particulier les hommes ayant des rapports sexuels avec d'autres hommes, les professionnel(le)s du sexe et les consommateurs de drogues) sont massivement touchées par le VIH et de nombreux programmes se concentrent sur elles. En raison de la modélisation épidémiologique et de la planification des politiques, ces groupes sont trop souvent considérés comme des groupes socialement homogènes plutôt que des catégories hétérogènes aux contours flous. Les identités, la vie sociale, les pratiques sexuelles, l'exposition au VIH varient au sein de ces groupes, en particulier entre le noyau et les périphériques. Leurs réseaux sexuels sont également interconnectés avec des personnes qui ne sont pas perçues comme appartenant à ces "populations clés" : partenaires féminines d'hommes bisexuels, partenaires réguliers et clients de professionnel(le)s du sexe, partenaires sexuels de consommateurs de drogues... Entre les catégories épidémiologiques, les catégories sociales et identitaires et les catégories d'action, comment pouvons-nous appréhender la diversité des populations clés ? La notion de populations périphériques peut-elle faire sens ? Quel est le rôle de ces populations périphériques dans la dynamique des populations clés et comment les prendre en compte dans la riposte au VIH ?
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