Publications des membres du Ceped

2023



  • Plazy Mélanie, Diallo Adama, Hlabisa Thabile, Okesola Nonhlanhla, Iwuji Collins, Herbst Kobus, Boyer Sylvie, Lert France, McGrath Nuala, Pillay Deenan, Dabis François, Larmarange Joseph, Orne-Gliemann Joanna et for the ANRS TasP Study Group (2023) « Implementation and effectiveness of a linkage to HIV care intervention in rural South Africa (ANRS 12249 TasP trial) », PLOS ONE, 18 (1) (janvier 20), p. e0280479. DOI : 10.1371/journal.pone.0280479. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0280479.
    Résumé : Background Timely linkage to care and ART initiation is critical to decrease the risks of HIV-related morbidity, mortality and HIV transmission, but is often challenging. We report on the implementation and effectiveness of a linkage-to-care intervention in rural KwaZulu-Natal, South Africa. Methods In the ANRS 12249 TasP trial on Universal Testing and Treatment (UTT) implemented between 2012–2016, resident individuals ≥16 years were offered home-based HIV testing every six months. Those ascertained to be HIV-positive were referred to trial clinics. Starting May 2013, a linkage-to-care intervention was implemented in both trial arms, consisting of tracking through phone calls and/or home visits to “re-refer” people who had not linked to care to trial clinics within three months of the first home-based referral. Fidelity in implementing the planned intervention was described using Kaplan-Meier estimation to compute conditional probabilities of being tracked and of being re-referred by the linkage-to-care team. Effect of the intervention on time to linkage-to-care was analysed using a Cox regression model censored for death, migration, and end of data follow-up. Results Among the 2,837 individuals (73.7% female) included in the analysis, 904 (32%) were tracked at least once, and 573 of them (63.4%) were re-referred. Probabilities of being re-referred was 17% within six months of first referral and 31% within twelve months. Compared to individuals not re-referred by the intervention, linkage-to-care was significantly higher among those with at least one re-referral through phone call (adjusted hazard ratio [aHR] = 1.82; 95% confidence interval [95% CI] = 1.47–2.25), and among those with re-referral through both phone call and home visit (aHR = 3.94; 95% CI = 2.07–7.48). Conclusions Phone calls and home visits following HIV testing were challenging to implement, but appeared effective in improving linkage-to-care amongst those receiving the intervention. Such patient-centred strategies should be part of UTT programs to achieve the UNAIDS 95-95-95 targets.
    Mots-clés : Antiretroviral therapy, Educational attainment, HIV, HIV diagnosis and management, HIV epidemiology, Schools, Viral load, Virus testing.
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2022



  • Baisley Kathy, Orne-Gliemann Joanna, Larmarange Joseph, Plazy Melanie, Collier Dami, Dreyer Jaco, Mngomezulu Thobeka, Herbst Kobus, Hanekom Willem, Dabis Francois, Siedner Mark J. et Iwuji Collins (2022) « Early HIV treatment and survival over six years of observation in the ANRS 12249 Treatment as Prevention Trial », HIV Medicine, 23 (8) (février 26), p. 922-928. DOI : 10.1111/hiv.13263. https://onlinelibrary.wiley.com/doi/abs/10.1111/hiv.13263.
    Résumé : Objectives Population-based universal test and treat (UTT) trials have shown an impact on population-level virological suppression. 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-randomized trial in South Africa from 2012 to 2016. All households were offered 6-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered through trial clinics to all people living with HIV (PLHIV) in intervention clusters and according to national guidelines in control clusters. After the trial, individuals attending the trial clinics were transferred to the public ART programme. Deaths were ascertained through annual demographic surveillance. Random-effects Poisson regression was used to estimate the effect of trial arm on mortality among (i) all PLHIV; (ii) PLHIV aware of their status and not on ART at trial entry; and (iii) PHLIV who started ART during the trial. Results Mortality rates among PLHIV were 9.3/1000 and 10.4/1000 person-years in the control and intervention arms, respectively. There was no evidence that the intervention decreased mortality among all PLHIV [adjusted rate ratio (aRR) = 1.10, 95% confidence interval (CI) = 0.85–1.43, p = 0.46] or among PLHIV who were aware of their status but not on ART. Among individuals who initiated ART, the intervention decreased mortality during the trial (aRR = 0.49, 95% CI = 0.28–0.85, p = 0.01), but not after the trial ended. Conclusions The ‘treat all’ strategy reduced mortality among individuals who started ART but not among all PLHIV. To achieve maximum benefit of immediate ART, barriers to ART uptake and retention in care need to be addressed.
    Mots-clés : HIV, immediate antiretroviral therapy, mortality, South Africa, test and treat.
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  • Bousmah Marwân-al-Qays, Iwuji Collins, Okesola Nonhlanhla, Orne-Gliemann Joanna, Pillay Deenan, Dabis François, Larmarange Joseph et Boyer Sylvie (2022) « Costs and economies of scale in repeated home-based HIV counselling and testing: Evidence from the ANRS 12249 treatment as prevention trial in South Africa », Social Science & Medicine, 305 (juillet 1), p. 115068. DOI : 10.1016/j.socscimed.2022.115068. https://www.sciencedirect.com/science/article/pii/S0277953622003744.
    Résumé : Universal HIV testing is now recommended in generalised HIV epidemic settings. Although home-based HIV counselling and testing (HB-HCT) has been shown to be effective in achieving high levels of HIV status awareness, little is still known about the cost implications of universal and repeated HB-HCT. We estimated the costs of repeated HB-HCT and the scale economies that can be obtained when increasing the population coverage of the intervention. We used primary data from the ANRS 12249 Treatment as Prevention (TasP) trial in rural South Africa (2012–2016), whose testing component included six-monthly repeated HB-HCT. We relied on the dynamic system generalised method of moments (GMM) approach to produce unbiased short- and long-run estimates of economies of scale, using the number of contacts made by HIV counsellors for HB-HCT as the scale variable. We also estimated the mediating effect of the contact quality – measured as the proportion of HIV tests performed among all contacts eligible for an HIV test – on scale economies. The mean cost (standard deviation) of universal and repeated HB-HCT was $24.2 (13.7) per contact, $1694.3 (1527.8) per new HIV diagnosis, and $269.2 (279.0) per appropriate referral to HIV care. The GMM estimations revealed the presence of economies of scale, with a 1% increase in the number of contacts for HB-HCT leading to a 0.27% decrease in the mean cost. Our results also suggested a significant long-run relationship between mean cost and scale, with a 1% increase in the scale leading to a 0.36% decrease in mean cost in the long run. Overall, we showed that significant cost savings can be made from increasing population coverage. Nevertheless, there is a risk that this gain is made at the expense of quality: the higher the quality of HB-HCT activities, the lower the economies of scale.
    Mots-clés : AIDS/HIV, Clinical trials, Cost of care, Economies of scale, Interventions, Prevention, South Africa.
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2021



  • 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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  • 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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2020



  • 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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2019



  • Gosset Andréa, Protopopescu Camelia, Larmarange Joseph, Orne-Gliemann Joanna, McGrath Nuala, Pillay Deenan, Dabis François, Iwuji Collins et Boyer Sylvie (2019) « Retention in Care Trajectories of HIV-Positive Individuals Participating in a Universal Test-and-Treat Program in Rural South Africa (ANRS 12249 TasP Trial) », JAIDS Journal of Acquired Immune Deficiency Syndromes, 80 (4) (avril 1), p. 375. DOI : 10/gftjcf. https://journals.lww.com/jaids/Fulltext/2019/04010/Retention_in_Care_Trajectories_of_HIV_Positive.2.aspx.
    Résumé : Objective: To study retention in care (RIC) trajectories and associated factors in patients eligible for antiretroviral therapy (ART) in a universal test-and-treat setting (TasP trial, South Africa, 2012–2016). Design: A cluster-randomized trial whereby individuals identified HIV positive after home-based testing were invited to initiate ART immediately (intervention) or following national guidelines (control). Methods: Exiting care was defined as ≥3 months late for a clinic appointment, transferring elsewhere, or death. Group-based trajectory modeling was performed to estimate RIC trajectories over 18 months and associated factors in 777 ART-eligible patients. Results: Four RIC trajectory groups were identified: (1) group 1 “remained” in care (reference, n = 554, 71.3%), (2) group 2 exited care then “returned” after [median (interquartile range)] 4 (3–9) months (n = 40, 5.2%), (3) group 3 “exited care rapidly” [after 4 (4–6) months, n = 98, 12.6%], and (4) group 4 “exited care later” [after 11 (9–13) months, n = 85, 10.9%]. Group 2 patients were less likely to have initiated ART within 1 month and more likely to be male, young (<29 years), without a regular partner, and to have a CD4 count >350 cells/mm3. Group 3 patients were more likely to be women without social support, newly diagnosed, young, and less likely to have initiated ART within 1 month. Group 4 patients were more likely to be newly diagnosed and aged 39 years or younger. Conclusions: High CD4 counts at care initiation were not associated with a higher risk of exiting care. Prompt ART initiation and special support for young and newly diagnosed patients with HIV are needed to maximize RIC.
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  • Larmarange Joseph, Diallo Mamadou H, McGrath Nuala, Iwuji Collins, Plazy Mélanie, Thiébaut Rodolphe, Tanser Frank, Bärnighausen Till, Orne-Gliemann Joanna, Pillay Deenan, Dabis François et ANRS 12249 TasP Study Group (2019) « Temporal trends of population viral suppression in the context of Universal Test and Treat: the ANRS 12249 TasP trial in rural South Africa », Journal of the International AIDS Society, 22 (10) (octobre 22), p. e25402. DOI : 10/ggnfnr. https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25402.
    Résumé : Abstract Introduction The universal test-and-treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa. Methods The TasP cluster-randomized trial (2012 to 2016) implemented six-monthly repeat home-based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 ? 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level. Results 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p?
    Mots-clés : antiretroviral therapy, HIV, population health, retention in care, South Africa, sustained viral suppression.
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  • Rolland Matthieu, McGrath Nuala, Tiendrebeogo Thierry, Larmarange Joseph, Pillay Deenan, Dabis François, Orne-Gliemann Joanna et Group for the ANRS 12249 TasP study (2019) « No effect of test and treat on sexual behaviours at population level in rural South Africa », AIDS, 33 (4) (mars 15), p. 709-722. DOI : 10.1097/QAD.0000000000002104. https://journals.lww.com/aidsonline/Abstract/2019/03150/No_effect_of_test_and_treat_on_sexual_behaviours.14.aspx.
    Résumé : Context: Within the community-randomized ANRS 12249 Treatment-as-Prevention trial conducted in rural South Africa, we analysed sexual behaviours stratified by sex over time, comparing immediate antiretroviral therapy irrespective of CD4+ cell count vs. CD4+-guided antiretroviral therapy (start at CD4+ cell count > 350 cells/μl then >500 cells/μl) arms. Methods: As part of the 6-monthly home-based trial rounds, a sexual behaviour individual questionnaire was administered to all residents at least 16 years. We considered seven indicators: sexual intercourse in the past month; at least one regular sexual partner in the past 6 months; at least one casual sexual partner in the past 6 months and more than one sexual partner in the past 6 months; condom use at last sex (CLS) with regular partner, CLS with casual partner, and point prevalence estimate of concurrency. We conducted repeated cross-sectional analyses, stratified by sex. Generalized Estimating Equations models were used, including trial arm, trial time, calendar time and interaction between trial arm and trial time. Results: CLS with regular partner varied between 29–51% and 23–46% for men and women, respectively, with significantly lower odds among women in the control vs. intervention arm by trial end (P < 0.001). CLS with casual partner among men showed a significant interaction between arm and trial round, with no consistent pattern. Women declared more than one partner in the past 6 months in less than 1% of individual questionnaires; among men, rates varied between 5–12%, and odds significantly and continuously declined between calendar rounds 1 and 7 [odds ratio = 4.2 (3.24–5.45)]. Conclusion: Universal Test and Treat was not associated with increased sexual risk behaviours.
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2018



  • Iwuji Collins, Orne-Gliemann Joanna, Larmarange Joseph, Balestre Eric, Thiebaut Rodolphe, Tanser Frank, Okesola Nonhlanhla, Makowa Thembisa, Dreyer Jaco, Herbst Kobus, McGrath Nuala, Bärnighausen Till, Boyer Sylvie, De Oliveira Tulio, Rekacewicz Claire, Bazin Brigitte, Newell Marie-Louise, Pillay Deenan et Dabis François (2018) « Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial », The Lancet HIV, 5 (3) (mars 1), p. e116-e125. DOI : 10.1016/S2352-3018(17)30205-9. http://www.sciencedirect.com/science/article/pii/S2352301817302059.
    Résumé : Summary Background Universal antiretroviral therapy (ART), as per the 2015 WHO recommendations, might reduce population HIV incidence. We investigated the effect of universal test and treat on HIV acquisition at population level in a high prevalence rural region of South Africa. Methods We did a phase 4, open-label, cluster randomised trial of 22 communities in rural KwaZulu-Natal, South Africa. We included individuals residing in the communities who were aged 16 years or older. The clusters were composed of aggregated local areas (neighbourhoods) that had been identified in a previous study in the Hlabisa subdistrict. The study statisticians randomly assigned clusters (1:1) with MapInfo Pro (version 11.0) to either the control or intervention communities, stratified on the basis of antenatal HIV prevalence. We offered residents repeated rapid HIV testing during home-based visits every 6 months for about 4 years in four clusters, 3 years in six clusters, and 2 years in 12 clusters (58 cluster-years) and referred HIV-positive participants to trial clinics for ART (fixed-dose combination of tenofovir, emtricitabine, and efavirenz) regardless of CD4 cell count (intervention) or according to national guidelines (initially ≤350 cells per μL and <500 cells per μL from January, 2015; control). Participants and investigators were not masked to treatment allocation. We used dried blood spots once every 6 months provided by participants who were HIV negative at baseline to estimate the primary outcome of HIV incidence with cluster-adjusted Poisson generalised estimated equations in the intention-to-treat population after 58 cluster-years of follow-up. This study is registered with ClinicalTrials.gov, number NCT01509508, and the South African National Clinical Trials Register, number DOH-27-0512-3974. Findings Between March 9, 2012, and June 30, 2016, we contacted 26 518 (93%) of 28 419 eligible individuals. Of 17 808 (67%) individuals with a first negative dried blood spot test, 14 223 (80%) had subsequent dried blood spot tests, of whom 503 seroconverted after follow-up of 22 891 person-years. Estimated HIV incidence was 2·11 per 100 person-years (95% CI 1·84–2·39) in the intervention group and 2·27 per 100 person-years (2·00–2·54) in the control group (adjusted hazard ratio 1·01, 95% CI 0·87–1·17; p=0·89). We documented one case of suicidal attempt in a woman following HIV seroconversion. 128 patients on ART had 189 life-threatening or grade 4 clinical events: 69 (4%) of 1652 in the control group and 59 (4%) of 1367 in the intervention group (p=0·83). Interpretation The absence of a lowering of HIV incidence in universal test and treat clusters most likely resulted from poor linkage to care. Policy change to HIV universal test and treat without innovation to improve health access is unlikely to reduce HIV incidence. Funding ANRS, GiZ, and 3ie.
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  • Larmarange Joseph, Diallo Mamadou Hassimiou, McGrath Nuala, Iwuji Collins, Plazy Mélanie, Thiébaut Rodolphe, Tanser Frank, Bärnighausen Till, Orne-Gliemann Joanna, Pillay Deenan, Dabis François et ANRS 12249 TasP Study Group (2018) « Temporal trends of population viral suppression in the context of Universal Test and Treat: results from the ANRS 12249 TasP trial in rural South Africa » (communication orale TUAC0103), présenté à 22nd International AIDS Conference, Amsterdam. http://programme.aids2018.org/Programme/Session/105.
    Résumé : Background: The universal test-and-treat strategy (UTT) aims to maximize the proportion of all people living with HIV (PLWHIV) on antiretroviral treatment (ART) and virally suppressed in a community, i.e. to reach population viral suppression (PVS). The ANRS 12249 TasP trial did not demonstrate an impact of universal ART on HIV incidence at population level (Lancet HIV 2017). Here, we investigated whether PVS improved during the course of the trial: differentially by arm, according to trial interventions or contextual changes. Methods: The TasP cluster-randomized trial (2012-2016) implemented six-monthly repeated home-based HIV counselling and testing (RHBCT) and referral of PLWHIV to local HIV clinics in 2×11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters vs. regardless of CD4 count in intervention clusters. Test results, clinic visits, ART prescriptions, viral loads, CD4 counts, migrations and deaths were used to produce information on residency status, HIV status and HIV care status for each participant. PVS was computed daily and per cluster among all resident PLWHIV (≥16, including those not in care). We used a mixed linear model to explore the relation between PVS with calendar time, time since cluster opening, trial arm and interaction between arm and time since cluster opening, adjusting on sociodemographic changes at cluster level. Results: 8,646 PLWHIV were observed. Between January 1st, 2013 and January 1st, 2016, PVS increased significantly in both arms (intervention: 29.0% to 46.2%, +17.2, p< 0.001; control: 32.4% to 44.6%, +12.2, p < 0.001), but difference in temporal variation (+5.0%) was not significant (p=0.175). According to adjusted model (figure) this increase was mainly attributable to RHBCT (measured by time since cluster opening). They were also some effect due to contextual changes (measured by calendar time). The effect attributable to universal ART (interaction term) was limited. Conclusions: Although suboptimal, the UTT strategy implemented in TasP trial improved PVS over time. As it was mainly due to RHBCT rather than universal ART, it did not induce differences between arms, explaining the null effect observed on cumulative incidence, the main trial finding. Changes in ART initiation guidelines alone are not enough to significantly increase PVS.
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  • Larmarange Joseph, Diallo Mamadou Hassimiou, McGrath Nuala, Iwuji Collins, Thiébaut Rodolphe, Tanser Frank, Bärnighausen Till, Pillay Deenan, Dabis François, Orne-Gliemann Joanna et ANRS 12249 TasP Study Group (2018) « From individual care trajectories to HIV care cascade at population level in rural KwaZulu-Natal (South Africa): the impact of population dynamics » (communication orale), présenté à Life History Research Society Conference, Paris.
    Résumé : Introduction The universal test-and-treat strategy (UTT) was developed to maximize the proportion of all HIV-positive individuals on antiretroviral and virally suppressed, assuming that it leads to reduction in HIV incidence. The evolution over time of the cross-sectional population HIV care cascade is determined by longitudinal individual trajectories through the HIV care continuum and the underlying HIV population dynamics. This structural effect could dilute the impact observed at population level of a UTT strategy RT: either add impact on what (incidence) or delete sentence. The purpose of this paper is to quantify the contribution of each component of population change on the population HIV care cascade in the context of UTT. Sample We used prospective individual-level longitudinal data from the ANRS 12249 cluster-randomized trial which was implemented in rural KwaZulu-Natal, South Africa between 2012 and 2016 to test such an approach. Methods HIV tests results and information on clinic visits, ART prescription, viral load and CD4 count, migration and deaths were used to calculate residency status, HIV status and HIV care status for each individual on a daily basis. Position within the HIV care continuum was considered as a score ranging from 0 (undiagnosed) to 4 (virally suppressed). We compared the cascade score of each individual joining or leaving the HIV population with the average score of their cluster at the time of entry or exit. Then, we computed the contribution of each event on the average cascade score and the annualised total contribution of all events, considering 5 components of HIV population change: aging into the cohort, HIV seroconversions, in-migrations, out-migrations, and permanent exits (including deaths). Results While the average cascade score increased over time in all clusters, that increase was limited due to population dynamics, the total contribution of all population entries and exits being negative. Permanent exits and individuals already infected when reaching the age of 16 had a marginal effect. Although migrants had a lower position than the rest of the population, their overall impact on the cross-sectional population cascade remained limited as in- and out-migration compensated each other. Conclusions In a context of high HIV incidence, the continuous flow of newly infected individuals slows down the efforts to increase ART coverage and population viral suppression.
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  • Nishimwe Marie, Protopopescu Camelia, Iwuji Collins, Okesola Nonhlanhla, Spire Bruno, Orne-Gliemann Joanna, McGrath Nuala, Pillay Deenan, Dabis François, Larmarange Joseph et Boyer Sylvie (2018) « Effet du traitement antirétroviral précoce sur la révélation du statut sérologique du VIH et le soutien social dans un programme de dépistage et traitement universel en Afrique du Sud (essai TasP ANRS 12249) » (communication orale S17.05), présenté à 9e Conférence Internationale Francophone sur le VIH et les Hépatites Virales (AFRAVIH 2018), Bordeaux.
    Résumé : Objectif La révélation du statut VIH et le soutien social sont associés à une meilleure observance au traitement antirétroviral (TARV) et à de bons résultats cliniques. Cette analyse a pour but d’évaluer l’effet de l’initiation précoce du TARV sur la révélation du statut VIH et le soutien social dans un essai de dépistage et traitement universel (UTT) conduit en zone rurale en Afrique du Sud. Méthodes Dans cet essai randomisé en clusters (2012-2016), un dépistage universel était proposé à domicile. Les personnes VIH+ orientées vers les cliniques de l’essai pouvaient recevoir le TARV immédiatement dans le bras intervention (I) ou selon les recommandations nationales (CD4≤350 jusqu’au 31/12/2014 puis ≤500) dans le bras contrôle (C). Cette analyse a inclus les patients non traités à la 1ère visite (baseline), ayant des CD4>500 et au moins 2 visites de suivi. Un index de révélation (0-5) et un index de soutien social (0-4) ont été estimés à baseline puis tous les 6 mois : un point a été attribué lorsque le patient déclarait avoir révélé son statut VIH à (ou recevoir du soutien social de) au moins un des membres des groupes suivants : partenaire régulier, famille, amis, voisins, autres. Des modèles de Poisson à effets mixtes ont été utilisés pour étudier, après ajustement sur les facteurs individuels, l’effet sur les 2 index : 1) du temps depuis baseline, du bras de randomisation et de leur terme d’interaction statistique; 2) de l’initiation du TARV (variable dépendante du temps); 3) du terme d’interaction statistique entre initiation du TARV et bras. Résultats Sur 3019 patients suivis dans les cliniques de l’essai, 1597 étaient non traités à baseline, dont 473 ayant des CD4>500 et 182 au moins 2 visites (93 dans le bras I et 89 dans le bras C). Le suivi médian [écart interquartile (EIQ)] était de 13,2[7,0-18,5] mois. À 6 mois, 97% étaient sous TARV dans le bras I et 22% dans le bras C. À baseline, la médiane [EIQ] de l’index de révélation était de 2[1-2] versus 1[1-2] dans les bras I et C (p=0,72) et celle de l’index de soutien social de 1[1-2] versus 2[1-3] (p=0,12). Les valeurs des deux index ont augmenté au cours du temps, avec une hausse significativement plus rapide dans le bras I pour le soutien social (ratio du taux d’incidence (RTI) [IC95%]=1,2[1,0;1,5] par an versus le bras C) et une évolution similaire entre les bras pour l’index de révélation. L’initiation du TARV était positivement associée aux 2 index (RTI [IC95%]=1,5[1,3;1,7]) et 1,3[1,1;1,6], respectivement). Pour la révélation du statut, l’initiation du TARV annulait l’effet du bras, alors que pour le soutien social l’effet de l’initiation du TARV était plus important dans le bras I (RTI [IC95%]=1,5[1,1;2,0]). Conclusion Nos résultats obtenus en milieu rural sud-africain suggèrent que l’initiation précoce du TARV impacterait positivement la révélation du statut VIH et le soutien social. Ces résultats sont encourageants pour les pays qui ont fait le choix de mettre en œuvre des stratégies UTT.
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  • Perriat Delphine, Diallo Mamadou Hassimiou, Dabis François, Pillay Deenan, Orne-Gliemann Joanna, Larmarange Joseph et ANRS 12249 TasP Study Group (2018) « From home-based HIV testing to viral suppression : HIV care trajectories in the context of Universal Test-and-Treat in rural South Africa » (communication orale), présenté à Life History Research Society Conference, Paris.
    Résumé : Background : In order for people living with HIV to achieve an undetectable viral load, and thus live longer and healthier, they need access to a continuum of services. There are numerous reports of “leaks” at all steps of the HIV care cascade. We described the timing and sequencing of individual HIV care statuses from care referral to viral suppression, by identifying groups of individuals with similar trajectories and factors associated. Sample : We used prospective individual-level longitudinal data from the ANRS 12249 TasP cluster-randomized trial, which investigated the impact of universal antiretroviral treatment (ART) on HIV incidence in rural South Africa (2012-2016). We included trial participants >16 years, identified HIV+, not in care at referral and followed-up for ≥18 months. Method : The care status of all study participants was classified for each calendar day as : not in care, in care but not on ART, on ART but not virally suppressed, virally suppressed. We used state sequence data analysis to identify homogeneous care trajectories groups. A multinomial logistic regression was used to identify the profile of each group in terms of individual and cluster characteristics. Results : 1,816 participants were included. Median age was 34 years [IQR 27-45], 74% were female. We identified four care trajectories groups : (i) participants who mostly did not enter care (55%), (ii) participants with inconstant care, visiting a clinic occasionally but leaving care thereafter (median time to exit care : 10 m. [5.2-13]) (12%), (iii) participants who took extensive time at each step of the care continuum (median time between referral and ART : 8.0 m. [6.4-9.7]) (12%) and (iv) participants who rapidly progressed towards continuous care (median time between referral and ART : 1.2 m. [0.6-2.7]) (21%). Participants younger than 50 years, newly diagnosed at referral, living further than a kilometre from a trial clinic, and living in a cluster were immediate ART was not offered, were more likely to present with incomplete, inconstant and slow care trajectories. Conclusions : A longitudinal and person-specific approach to the study of HIV care patterns contributed to highlight the heterogeneity in care trajectories, in terms of speed and care utilization behaviours. Differentiated and personalised care and support should be scaled-up, especially between diagnosis and ART initiation, which constitutes the main bottleneck of HIV programs in this South African rural study area.
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2017


  • Gosset Andréa, Protopopescu Camelia, Okesola Nonhlanhla, Spire Bruno, Larmarange Joseph, Orne-Gliemann Joanna, McGrath Nuala, Pillay Deenan, Dabis François, Iwuji Collins et Boyer Sylvie (2017) « Care trajectories among people living with HIV and followed within a universal test and treat programme in rural South Africa (ANRS 12249 TasP trial) » (poster WEPED1454), présenté à 9th IAS Conference on HIV Science (IAS 2017), Paris. http://programme.ias2017.org/Abstract/Abstract/3791.
    Résumé : Background: Retention in care is essential to optimize antiretroviral treatment (ART) impact on viral suppression and ensure the success of the universal test and treat (UTT) strategy. We aimed to identify care trajectories and associated factors among ART-eligible patients within the UTT cluster-randomized TasP trial. Methods: Following home-based HIV testing, HIV-positive individuals were referred to TasP clinics and offered immediate ART (intervention arm) or according to national guidelines (control arm). This analysis included all patients ART-eligible at their first clinic visit ≥18 months before the trial end. Monthly clinical follow-up was offered in TasP clinics. A patient was considered exiting care if ≥3 months late for the last appointment, transferred-out or dead. Care trajectories, assessed over 18 months of follow-up, and their associated factors were identified using a group-based trajectory model (Nagin, 2005, Harvard University Press).   Results: Among the 787 ART-eligible patients who attended TasP clinics, four trajectory groups were identified: 70.5% remained in care throughout the entire follow-up period (group 1), 13.6% exited care rapidly (median 4 [IQR 4-6] months after first visit) (group 2), 10.6% exited care latter (11 [9-13] months) (group 3) and 5.2% exited care then returned after 4 [3-9] months (group 4) (Figure 1). The risk of exiting care (groups 2&3) was higher in newly diagnosed patients and those <29 years. The “returning group” members (group 4) were more likely male, with CD4 >350 cells/mm3 at first visit, living in high HIV prevalence clusters (>34%) with the lower nurse-patient ratio, and less likely to have initiated ART. Conclusions: Although most patients remained in care over the 18-month period, a significant proportion exited care at different follow-up times. Particular attention should be paid to men, young and newly diagnosed patients, and those with CD4>350 in order to improve retention in care and maximize the effect of UTT strategies. (Figure)
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  • Larmarange Joseph, Diallo Mamadou Hassimiou, Iwuji Collins, Orne-Gliemann Joanna, McGrath Nuala, Plazy Mélanie, Tanser Frank, Thiebaut Rodolphe, Pillay Deenan et Dabis François (2017) « Cascade of Care of HIV Seroconverters in the Context of Universal "Test and Treat" » (communication orale et poster 1018), présenté à Conference on Retroviruses and Opportunistic Infections (CROI) 2017, Seattle. http://www.croiconference.org/sessions/cascade-care-hiv-seroconverters-context-universal-%E2%80%9Ctest-and-treat%E2%80%9D-0.
    Résumé : The ANRS 12249 TasP cluster-randomized trial aimed at evaluating the impact of a Universal Test and Treat (UTT) approach on population-based HIV incidence in rural KwaZulu Natal, South Africa. Previous results showed low rates of early linkage to HIV care and treatment and did not identify any incidence reduction. To optimize the impact of UTT, time to ART initiation and viral suppression must be shorten significantly, in particular among newly infected individuals. We describe here the longitudinal cascade of care for those seroconverting during the course of the TasP trial. Every six months between March 2012 and June 2016, resident members aged ≥16 years old were offered rapid HIV testing at home and asked independently to provide dried blood spot (DBS) samples. Those testing positive or who self-reported their positive status were referred to local trial clinics for ART initiation, regardless of their CD4 count (intervention) or according to national guidelines (control). Cases of HIV seroconversion were identified using multiple sources: repeat DBS, repeat rapid tests, HIV+ self-reports and clinic visits. Date of seroconversion was estimated using a random point approach. The HIV care status, for each day following seroconversion (M0), was computed using additional data collected on CD4 count, ART prescription, viral load and migration out of the trial area. Follow-up was right-censored by dates of death or trial closure if alive. We observed 565 individuals acquiring HIV (244 in intervention arm; 321 in control arm). Among them, one year after seroconversion (M12), 22% out-migrated from the trial area. 57% were diagnosed (aware of their HIV status), 27% were actively in HIV care, 12% were on ART, and were 10% virally suppressed. The cascade was comparable in both trial arms, except for ART coverage, higher in the intervention arm (15%) than in the control arm (9%). The observed cascade of care was suboptimal in seroconverters despite the introduction of UTT services and a trial environment. This poor outcome was aggravated in this rural setting by out-migration considered here as loss to the cascade. Newly HIV-infected individuals need time to (re)test, initiate ART and reach viral suppression. This is one of the plausible explanations of the lack of effect of the UTT strategy on HIV incidence in our setting. For a UTT approach to be effective, innovative strategies to identify seroconverters and support them to engage in ART care promptly are required.
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  • Nishimwe Marie, Protopopescu Camelia, Iwuji Collins, Okesola Nonhlanhla, Spire Bruno, Orne-Gliemann Joanna, McGrath Nuala, Pillay Deenan, Dabis François, Larmarange Joseph et Boyer Sylvie (2017) « The impact of early ART initiation on HIV disclosure and social support among people living with HIV and followed within a universal test and treat programme in rural South Africa (ANRS 12249 TasP trial) » (communication orale), présenté à AIDS Impact 13th International Conference, Cape Town. http://www.aidsimpact.com/abstracts/-KohAV6cKhSNCJEku24i.
    Résumé : Aim HIV status disclosure and social support have been associated with increased antiretroviral treatment (ART) adherence and better clinical outcomes. We aimed to investigate the impact of early ART initiation on HIV status disclosure and social support among patients in care within the universal test and treat (UTT) cluster-randomized TasP trial conducted in rural South Africa between 2012 and 2016. Method/Issue Following home-based HIV testing, HIV-positive individuals were referred to trial clinics and offered ART regardless of CD4 in intervention arm or according to national guidelines (CD4≤350 cells/mm3 until December 2014, then ≤500 cells/mm3) in control arm. This analysis included patients not ART-treated at baseline (i.e. first clinic visit) and with CD4>500 cells/mm3 who attended at least two clinic visits. HIV disclosure and social support indexes (0-5) were estimated every 6 months: one point was attributed when HIV status was disclosed to - or when the patient reported social support from - at least one member of the following groups: regular partner, family, friends, neighbours, others. We used Poisson mixed effects models, adjusted on individual factors, exploring (i) the impact of time since baseline clinic visit, trial arm and interaction between arm and time; (ii) the impact of ART initiation (time-dependent); and (iii) interaction between arm and ART initiation. Results/Comments Of 3019 patients entering in care in trial clinics, 1597 were not on ART at baseline, 477 had CD4>500 cells/mm3 and 182 had at least two visits (93 in intervention, 89 in control arm). The 182 participants had a median [interquartile range (IQR)] follow-up duration of 13.2 [7.0-18.5] months. After 6 months, 22% had initiated ART in control arm versus 97% in intervention arm, while after 12 months they were 29% and 98% respectively. At baseline, median [IQR] HIV disclosure index was 2 [1;2] versus 1 [1;2] in intervention and control arms, respectively (p=0.361) and median [IQR] social support index was 1 [0;2] versus 2 [1;3] (p=0.053). Both outcomes significantly improved over time. The social support increased significantly faster in intervention arm (Incidence Rate Ratio (IRR) [95% Confidence Interval (CI)]=1.25 [1.04;1.49] per year for the interaction). HIV disclosure was higher in intervention arm (IRR (95% CI)=1.23 [1.10;1.38]), with a similar increase over time between arms. When introducing ART initiation, treatment appeared positively associated with both outcomes (IRR [95% CI]=1.39 [1.17;1.65] for HIV disclosure and 1.36 [1.13;1.63] for social support). For HIV disclosure, differences in ART initiation between arms explained the higher disclosure observed in intervention arm, the effect of arm not being significant anymore. Initiating ART was also associated to increased social support, and this effect was stronger in intervention arm (IRR [95% CI] =1.51 [1.13;2.01] for the interaction). Discussion Our findings suggest that, besides clinical benefits, early ART initiation at high CD4 cell count may also positively influence HIV disclosure and social support. For this second outcome, a longer time of follow-up may however be required to observe this benefit. These findings are encouraging for countries that made the choice of implementing UTT strategies.
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  • Orne-Gliemann Joanna, Rolland Matthieu, Tiendrebeogo Thierry, Larmarange Joseph, Pillay Deenan, Dabis François, McGrath Nuala et ANRS 12249 TasP Study Group (2017) « Is there an effect of universal ART on sexual behaviours in rural KwaZulu-Natal, South Africa? ANRS 12249 treatment-as-prevention (TasP) trial » (poster WEPEC0968), présenté à 9th IAS Conference on HIV Science (IAS 2017), Paris. http://programme.ias2017.org/Abstract/Abstract/2390.
    Résumé : Background: There are concerns that the implementation of Universal Test and Treat (UTT) could increase populationlevel sexual risk behaviours. We analysed the effect of universal ART vs CD4-guided ART (start at CD4≥350 then ≥500) on sexual behaviours over time, in the context of the cluster-randomised TasP trial. Methods: As part of the 6-monthly home-based survey rounds conducted in 11x2 clusters, a sexual behaviour questionnaire was administered to all residents ≥16 years. We used GEE modelling stratified by gender, to compare reported condom use at last sex (CLS), and multi-partnership (≥2 sexual partners) among those sexually-active in the previous six months across trial arms. We tested whether the sexual behaviours changed over time differently in each arm by inclusion of an interaction term between survey round and arm, using the Quasi-likelihood Independence Criterion (QIC) statistic to compare models. Results: The analysis included 43,106 reports of partnerships (22,974 control, 20,132 intervention) across 7 survey rounds (SR), between 03/2012 and 06/2016. There were no consistent or substantive changes in CLS over time neither by gender nor by arm (fig 1a, 1b); inclusion of an interaction term improved the model fit, reflecting small differences between arms in CLS over time. Less than 1.5% of women reported multiple partnerships at any SR, too few for modelling (fig 1d). The proportion of men reporting multiple partnerships decreased significantly during the study (aOR 0.79, 95% CI 0.75, 0.83), p< 0.001), similarly for each arm (interaction not significant), with overall a small, but significant higher proportion reported in the universal ART arm (13.7%) vs CD4-guided ART (12.1%) (OR=1.15, 95% CI (1.03, 1.27), p=0.02 (fig 1c). [Figure 1] Conclusions: There is no evidence of increased unprotected sex with universal ART in this South African population. Continued monitoring of population-level sexual behaviour indicators, in particular multiple partnerships, is needed as the UTT strategy is rolled out.
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  • Plazy Mélanie, Diallo A, Iwuji Collins, Orne-Gliemann Joanna, Okesola Nonhlanhla, Hlabisa T, Pillay Deenan, Dabis François, Larmarange Joseph et ANRS 12249 TasP Study Group (2017) « Enhancing referral to increase linkage to HIV care in rural South Africa: example from the ANRS 12249 TasP trial » (poster TUPED1308), présenté à 9th IAS Conference on HIV Science (IAS 2017), Paris. http://programme.ias2017.org/Abstract/Abstract/2405.
    Résumé : Background: Timely linkage to care following an HIV diagnosis is critical for people living with HIV to initiate antiretroviral treatment as early as possible and thus decrease the risks of HIV-related morbidity, mortality and HIV transmission. Linkage to HIV care is however often challenging and innovative strategies are required to help people accessing HIV care. We aimed at evaluating the effect of phone calls and home visits following an initial referral on time to linkage to care in the context of a Universal HIV Testing and Treatment (UTT) trial in rural KwaZulu-Natal, South Africa. Methods: The ANRS 12249 TasP trial was conducted from March 2012 to June 2016 with the aim to evaluate the effect of UTT on HIV incidence. Individuals ≥16 years were offered home-based HIV testing; those identified HIV-positive were referred to nearby TasP trial clinics to receive care and treatment. Starting April 2013, an enhancement strategy combining phone calls and home visits was implemented to re-refer people who did not link to care within three months of first referral. Effect of this strategy on time to linkage to care was studied as a time-varying variable among individuals not in care at first referral using a Cox regression model censored for death, migration and end of study observation. Results: Among the 7,643 individuals identified HIV-positive at home and referred to TasP clinics, 2,254 (72% female) were not in care at referral and did not link to care within three months of first referral. Among them, 451 (20%) individuals were contacted through phone calls or home visits before migration or death. Probability of linkage to care was significantly higher mong individuals re-referred to care compared to those not re-referred (Hazard Ratio 2.25; 95% Confidence Interval 1.83-2.78); significant positive effects were also observed for both genders and all age categories (< 30; 30-39; 40-49; ≥50 years old) after stratification. Conclusions: Phone calls and home visits aiming at re-referring people to HIV care appear effective in improving linkage to care. Patient-centered strategies should be part of UTT programs in order to achieve the 90-90-90 UNAIDS targets.
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2016



  • Dah Ter Tiero Elias, Orne-Gliemann Joanna, Guiard Schmid Jean-Baptiste, Becquet Renaud et Larmarange Joseph (2016) « Les hommes qui ont des rapports sexuels avec d’autres hommes (HSH) et l’infection à VIH à Ouagadougou, Burkina Faso : connaissances, attitudes, pratiques et enquête de séroprévalence », Revue d'Épidémiologie et de Santé Publique, 64 (4) (septembre), p. 295-300. DOI : 10.1016/j.respe.2016.02.008. http://www.sciencedirect.com/science/article/pii/S0398762016302826.
    Résumé : Position du problème À l’instar de plusieurs pays africains, la question des rapports sexuels entre hommes au Burkina Faso reste taboue et est parfois cause d’exclusion sociale. Cette population qui est vulnérable face au VIH sida est méconnue, car n’ayant pas souvent fait l’objet d’exploration scientifique. Objectif L’objectif de notre étude était de caractériser les connaissances, attitudes, pratiques sexuelles et d’estimer la séroprévalence du VIH parmi les HSH à Ouagadougou. Méthodes Une étude transversale à visée descriptive et analytique a été conduite auprès de HSH résidant à Ouagadougou recrutés par la technique de « boule de neige », âgés d’au moins 18 ans et acceptant de participer à l’étude. Les données ont été recueillies par un questionnaire administré en face-à-face par deux enquêteurs formés. Le test de dépistage du VIH a été systématiquement proposé aux enquêtés. Résultats Au total, 142 HSH ont été recrutés durant la période d’étude. L’échantillon était constitué à majorité d’élèves ou d’étudiants (60,8 %), de célibataires (91 %) avec un âge compris entre 18 et 30 ans (96,5 %). Le score médian de connaissance vis-à-vis du VIH était de 8/10. La séroprévalence du VIH était estimée à 8,9 % (4,5–15,4). Conclusion Notre étude confirme la vulnérabilité des HSH de Ouagadougou vis-à-vis du VIH vu la séroprévalence élevée de l’infection par le VIH. Des interventions ciblées de prévention, de prise en charge et de recherche scientifique s’imposent aux autorités afin de pérenniser les acquis nationaux de la lutte contre le VIH sida. AbstractBackground Like many African countries, the issue of sex between men in Burkina Faso remains taboo and sometimes result in social exclusion. This population which is vulnerable to HIV/AIDS is unknown, due to lack of scientific researches. Aim Our study aimed to characterize knowledge, attitudes and sexual practices and to estimate HIV seroprevalence among men having sex with men (MSM) living in Ouagadougou. Methods A cross-sectional study was conducted in order to describe and analyze MSM living in Ouagadougou. They were recruited by snowball sampling, aged at least 18 years, and accepted to participate at the study. Data were collected by qualified interviewers through administered questionnaire face to face. HIV test was systematically proposed. Results A total of 142 MSM were recruited during the study period. The sample was mostly composed of students or pupils (60.8%), single men (91%), with age range 18–30 years (96.5%). The HIV knowledge median score was 8/10. HIV seroprevalence was 8.9% (4.5–15.4). Conclusion Our study confirms the vulnerability of MSM living in Ouagadougou about HIV/AIDS given the high rate of HIV seroprevalence. Targeted interventions for prevention, care and scientific research are challenges for the authorities to sustain the achievements of the national fight against HIV and AIDS.
    Mots-clés : attitudes, Attitudes et pratiques, Burkina Faso, Connaissances, ésHSH, HIV prevalence, knowledge, MSM, Orientation sexuelle, ouagadougou, practices, Séroprévalence du VIH, sexual orientation.
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  • Iwuji Collins, Orne-Gliemann Joanna, Larmarange Joseph, Okesola Nonhlanhla, Tanser Frank, Thiebaut Rodolphe, Rekacewicz Claire, Newell Marie-Louise, Dabis Francois et Group ANRS 12249 TasP trial (2016) « Uptake of Home-Based HIV Testing, Linkage to Care, and Community Attitudes about ART in Rural KwaZulu-Natal, South Africa: Descriptive Results from the First Phase of the ANRS 12249 TasP Cluster-Randomised Trial », PLOS Med, 13 (8) (août 9), p. e1002107. DOI : 10.1371/journal.pmed.1002107. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002107.
    Résumé : Collins Iwuji and colleagues report implementation indicators and early health outcomes from the first phase of a cluster-randomized trial of immediate antiretroviral therapy to all HIV-positive individuals in rural KwaZulu-Natal, South Africa.
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  • Orne-Gliemann Joanna, Zuma Thembelhile, Larmarange Joseph et ANRS 12249 TasP Study Group (2016) « Home-based HIV testing and linkage to care : lessons learned from the ANRS 12249 TasP trial » (communication orale (MOSA4402), présenté à 21st International AIDS Conference (AIDS 2016), Durban. http://programme.aids2016.org/Programme/Session/126.

2015



  • Orne-Gliemann Joanna, Larmarange Joseph, Boyer Sylvie, Iwuji Collins, McGrath Nuala, Bärnighausen Till, Zuma Thembelhile, Dray-Spira Rosemary, Spire Bruno, Rochat Tamsen, Lert France, Imrie John et ANRS 12249 TasP Study Group (2015) « Addressing social issues in a universal HIV test and treat intervention trial (ANRS 12249 TasP) in South Africa: methods for appraisal », BMC Public Health, 15 (1) (mars 1), p. 209. DOI : 10.1186/s12889-015-1344-y. http://www.biomedcentral.com/1471-2458/15/209/abstract.
    Mots-clés : Antiretroviral treatment, Behaviour, Community, Cost, HIV care, HIV infections, HIV testing, Social, South Africa.
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2014

2013



  • Iwuji Collins, Orne-Gliemann Joanna, Tanser Frank, Boyer Sylvie, Lessells Richard J, Lert France, Imrie John, Bärnighausen Till, Rekacewicz Claire, Bazin Brigitte, Newell Marie-Louise, Dabis François et ANRS 12249 TasP study group (2013) « Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence: the ANRS 12249 TasP (Treatment as Prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa: study protocol for a cluster randomised controlled trial », Trials, 14 (1) (juillet 23), p. 230. DOI : 10.1186/1745-6215-14-230. http://www.trialsjournal.com/content/14/1/230.
    Résumé : BACKGROUND: Antiretroviral therapy (ART) suppresses HIV viral load in all body compartments and so limits the risk of HIV transmission. It has been suggested that ART not only contributes to preventing transmission at individual but potentially also at population level. This trial aims to evaluate the effect of ART initiated immediately after identification/diagnosis of HIV-infected individuals, regardless of CD4 count, on HIV incidence in the surrounding population. The primary outcome of the overall trial will be HIV incidence over two years. Secondary outcomes will include i) socio-behavioural outcomes (acceptability of repeat HIV counselling and testing, treatment acceptance and linkage to care, sexual partnerships and quality of life); ii) clinical outcomes (mortality and morbidity, retention into care, adherence to ART, virologic failure and acquired HIV drug resistance), iii) cost-effectiveness of the intervention. The first phase will specifically focus on the trial's secondary outcomes. METHODS/DESIGN: A cluster-randomised trial in 34 (2 × 17) clusters within a rural area of northern KwaZulu-Natal (South Africa), covering a total population of 34,000 inhabitants aged 16 years and above, of whom an estimated 27,200 would be HIV-uninfected at start of the trial. The first phase of the trial will include ten (2 × 5) clusters. Consecutive rounds of home-based HIV testing will be carried out. HIV-infected participants will be followed in dedicated trial clinics: in intervention clusters, they will be offered immediate ART initiation regardless of CD4 count and clinical stage; in control clusters they will be offered ART according to national treatment eligibility guidelines (CD4 <350 cells/μL, World Health Organisation stage 3 or 4 disease or multidrug-resistant/extensively drug-resistant tuberculosis). Following proof of acceptability and feasibility from the first phase, the trial will be rolled out to further clusters. DISCUSSION: We aim to provide proof-of-principle evidence regarding the effectiveness of Treatment-as-Prevention in reducing HIV incidence at the population level. Data collected from the participants at home and in the clinics will inform understanding of socio-behavioural, economic and clinical impacts of the intervention as well as feasibility and generalizability. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974.
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  • Orne-Gliemann Joanna, Balestre Eric, Tchendjou Patrice, Miric Marija, Darak Shrinivas, Butsashvili Maia, Perez-Then Eddy, Eboko Fred, Plazy Melanie, Kulkarni Sanjeevani, Desgrées du Loû Annabel, Dabis François et for the Prenahtest ANRS 12127 Study Group (2013) « Increasing HIV testing among male partners », AIDS, 27 (7) (avril), p. 1167-1177. DOI : 10.1097/QAD.0b013e32835f1d8c. http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00002030-201304240-00014.

2011


  • Orne-Gliemann Joanna, Tchendjou Patrice, Miric Marija, Gadgil Mukta, Butsashvili Maia, Eboko Fred, Perez-Then Eddy, Darak Shrinivas, Kulkarni Sanjeevani, Kamkamidze Georges, Balestre Eric, Desgrées du Loû Annabel et Dabis François (2011) « Conseil prénatal pour le VIH orienté vers le couple dans quatre pays à faible et moyenne prévalences : acceptabilité et faisabilité », in Les femmes à l'épreuve du VIH dans les pays du Sud : genre et accès universel à la prise en charge, éd. par Alice Desclaux, Philippe Msellati, et Khoudia Sow, Paris : ANRS, p. 105-120. (Sciences Sociales et Sida). http://www.anrs.fr/Ressources-et-publications/Publications/Publications-ANRS/Les-femmes-a-l-epreuve-du-VIH-dans-les-pays-du-Sud.-Genre-et-acces-universel-a-la-prise-en-charge.

2010



  • Orne-Gliemann Joanna, Tchendjou Patrice, Miric Marija, Gadgil Mukta, Butsashvili Maia, Eboko Fred, Perez-Then Eddy, Darak Shrinivas, Kulkarni Sanjeevani, Kamkamidze Georges, Balestre Eric, Desgrées du Loû Annabel et Dabis François (2010) « Couple-oriented prenatal HIV counseling for HIV primary prevention : an acceptability study », Bmc Public Health, 10, p. 197. DOI : 10.1186/1471-2458-10-197. http://www.hal.inserm.fr/inserm-00521960/en/.
    Résumé : Background: A large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, we assessed the acceptability of couple-oriented post-test HIV counseling (COC) and men's involvement within prenatal care services, among pregnant women, male partners and health care workers in Cameroon, Dominican Republic, Georgia and India. Methods: Quantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men and health care workers; monitoring of the COC intervention and exit interviews with COC participants. Results: In-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care (ANC) services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve ANC and HIV prevention services. COC was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counseling and testing and overall in reproductive health services. Conclusions: One of the keys to men's involvement within prenatal HIV counseling and testing is the better understanding of couple relationships, attitudes and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counseling, which aims at integrated PMTCT and primary prevention of HIV.
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2009


  • Orne-Gliemann Joanna (2009) « Quelle place pour les hommes dans les programmes de prévention de la transmission mère-enfant du VIH ? Revue de la littérature et étude de cas dans les Pays en Développement », Autrepart, 4 (52). http://www.cairn.info/revue-autrepart-2009-4-p-113.htm.
    Résumé : La prévention de la transmission mère-enfant du VIH est une priorité de santé publique à l’échelle mondiale. Cette intervention biomédicale soulève des enjeux socioculturels liés à l’infection par le VIH et aux relations de couple. Mais la prise en compte des hommes dans cette prévention de la transmission du VIH à l’enfant est encore largement insuffisante. Ce papier présente tout d’abord une revue de la littérature sur l’implication des hommes dans la prévention de la transmission mère-enfant du VIH dans les pays à ressources limitées puis les résultats d’une enquête transversale et qualitative conduite dans le cadre d’un essai d’intervention dans quatre pays à ressources limitées.Les hommes jouent un rôle non négligeable sur l’acceptabilité et l’utilisation des services de prévention de la transmission mère-enfant du VIH. Néanmoins, la place accordée dans ces services aux hommes et prise par les hommes est faible. Ce manque d’implication s’explique notamment par la base conceptuelle et structurelle de la prévention de la transmission mère-enfant du VIH focalisée sur la mère et l’enfant, par le manque de communication au sein du couple et par les constructions sociales du rôle de l’homme dans la sphère reproductive. Il est plus que jamais nécessaire de documenter et de mettre en place une approche de la prévention de la transmission mère-enfant du VIH, et à fortiori de la prise en charge globale du VIH/SIDA, qui soit orientée vers le couple.
    Mots-clés : couple, hommes, prévention de la transmission mère-enfant du VIH, VIH, ⛔ No DOI found.
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