Joseph Larmarange

A Life course approach to investigate breast cancer and migration in the greater Paris area: the SENOVIE study protocol

Joseph LARMARANGE — 2025-04-03T15:40:18Z

A Life course approach to investigate breast cancer and migration in the greater Paris area: the SENOVIE study protocol

Karna Coulibaly , Clémence Schantz , Luis Teixeira , Annabel Desgrées du Loû , Gaëtan Des Guetz , Hamid Hocini , Laurent Zelek , Joseph Larmarange , Anne Gosselin

BMJ Open, 2025, 15 (4), pp.e095759. ⟨10.1136/bmjopen-2024-095759⟩

Article dans une revue

hal-05019538

Authors

Karna Coulibaly, Clémence Schantz, Luis Teixeira, Annabel Desgrées du Loû, Gaëtan Des Guetz, Hamid Hocini, Laurent Zelek, Joseph Larmarange, Anne Gosselin, for the SENOVIE study group

Abstract

Introduction

Breast cancer is a global public health challenge. It is the most commonly diagnosed cancer and the leading cause of cancer-related death in women. Several inequalities remain among women facing this disease, depending on their country of birth and their sociodemographic characteristics. The SENOVIE study (Therapeutic mobility and breast cancer) aims to understand the life trajectories of women born in France and in sub-Saharan Africa treated for breast cancer in four hospitals in the greater Paris area.

Methods and analysis

The SENOVIE study is a mixed methods study, combining a quantitative and a qualitative approach. A quantitative retrospective life-event survey is conducted in four hospital centres in the greater Paris area, France, to (1) understand how breast cancer (diagnosis, treatment and possibly reconstruction) impacts the life trajectories of women in many spheres (migration, family life, professional life, financial situation, etc); (2) study the access to healthcare by women living with breast cancer and their determinants; and (3) examine how gender relations may shape breast cancer experience. Women born in France and women born in sub-Saharan Africa are recruited: 1000 women, including 500 per group. In the standardised, face-to-face questionnaire, each dimension of interest is collected year by year from birth until the time of the survey. Clinical and laboratory information is documented with a short medical questionnaire filled out by the medical teams. The qualitative survey is conducted specifically with women born in sub-Saharan Africa who came to France for treatment to better understand their trajectories and the specific obstacles they faced. To analyse the quantitative data collected, descriptive analyses will be used to visualise trajectories (sequence analysis), along with longitudinal analysis methods (survival models and duration models).

Ethics and dissemination

The study is conducted in accordance with the Declaration of Helsinki. The French Data Protection Authority (Commission Nationale de l'Informatique et des Libertés, declaration number 2231238) and the Committee for Persons' Protection East I (Comité de Protection des Personnes Est I, national number 2023-A01311-44) approved it. We will disseminate the findings through scientific publications, policy briefs, conferences and workshops.

Trial registration number

The SENOVIE France study is registered on Clinicaltrial.gov (NCT06503393; registration date: 7 September 2024; https://clinicaltrials.gov/study/NCT06503393).

SENOVIE

Joseph LARMARANGE — 2024-07-02T17:15:15Z

Responsable scientifique

Clémence Schantz

Partenaires

Liste complète sur https://www.ceped.org/senovie

France

IRD
Ined
CHU Saint-Louis (Senopôle), Paris
Hôpital Delafontaine, Saint-Denis
Inserm
UPEC
Université Paris Nanterre

Mali

Faculté de Médecine et d'Odontostomatologie de Bamako
Association « Les Combattantes du Cancer », Bamako
INSP, Bamako
Centre de Santé de Référence de la Commune 2, Bamako
Hôpital du Mali, Bamako

Bénin

CNHU, Cotonou
Ministère de la santé, Cotonou
CHU-MEL, Cotonou

Cambodge

Hôpital Calmette, Phnom Penh
Douleurs sans frontière
Université des Beaux-Arts

Financements

Résumé

Le cancer du sein est le cancer le plus fréquent au monde. Dans de nombreux pays des Suds, les ressources thérapeutiques sont faibles, ce qui amène certaines femmes en quête de soins à quitter leur pays. Avec une approche biographique mixte (à la fois qualitative et quantitative), nous retraçons les parcours de vie de ces femmes et cherchons à préciser ce qu'impliquent ces mobilités thérapeutiques en termes de vécus et de ruptures biographiques. Afin d'avoir une vision globale de ces circulations, et afin de saisir les raisons qui amènent certaines femmes à partir, nous menons cette recherche en France (région Ile de France) mais aussi en Afrique de l'Ouest (Mali, Bénin) et Asie du Sud-Est (Cambodge). Avec le souci constant de co-contruire nos connaissances, et en impliquant des chercheures, des soignantes et des associations de femmes, cette recherche souhaite contribuer à la lutte contre les inégalités sociales de santé et à la mise en lumière de ces cancers en Afrique de l'Ouest et en Asie du Sud-Est.

Mots-Clés

Migrations, Cancers, Genre, Afrique, Asie

Zones géographiques (terrains de recherche)

France, Mali, Bénin, Cambodge

Calendrier

2021-2026

Dernières publications

How a quantitative biographical approach can help in understanding the complex intersections of breast cancer, migration and gender ? The case of the SENOVIE France study

Karna Coulibaly , Clémence Schantz , Luis Teixeira , Gaetan Des Guetz , Laurent Zelek , Joseph Larmarange , Anne Gosselin

SLLS Annual Conference 2025, Society for Longitudinal and Lifecourse Studies, Sep 2025, Fribourg (Suisse), Switzerland

Communication dans un congrès

hal-05332921

The contribution of a quantitative biographical approach in studying the social and health trajectories of immigrant and French-born women receiving breast cancer care in the greater Paris area

Karna Coulibaly , Clémence Schantz , Annabel Desgrées du Loû , Anne Gosselin

22nd IMISCOE Annual Conference, IMISCOE, Jul 2025, Auberviliers, Campus Condorcet, France

Communication dans un congrès

hal-05332880

Global therapeutic mobilities and cancer: a scoping review

Clémence Schantz , Sarah Boisson , Léa Prost-Lançon , Emmanuel Bonnet , Aurélien Dancoisne , Myriam Baron , Audrey Bochaton

BMJ Open, 2025, 15 (6), pp.e089780. ⟨10.1136/bmjopen-2024-089780⟩

Article dans une revue

hal-05124533

Knowledge transfer interventions on cancer in Africa and Asia: a scoping review

Julie Robin , Clémence Schantz , Madani Ly , Bakary Abou Traore , Kadiatou Faye , Aurélien Dancoisne , Valéry Ridde

BMC Cancer, 2025, 25 (1), pp.704. ⟨10.1186/s12885-025-14061-8⟩

Article dans une revue

hal-05111610

A Life course approach to investigate breast cancer and migration in the greater Paris area: the SENOVIE study protocol

Karna Coulibaly , Clémence Schantz , Luis Teixeira , Annabel Desgrées du Loû , Gaëtan Des Guetz , Hamid Hocini , Laurent Zelek , Joseph Larmarange , Anne Gosselin

BMJ Open, 2025, 15 (4), pp.e095759. ⟨10.1136/bmjopen-2024-095759⟩

Article dans une revue

hal-05019538

Réfléchir sur les cancers du sein en interdisciplinarité et à la lumière des rapports sociaux de genre : retour réflexif sur le projet SENOVIE

Clémence Schantz , Sarah Boisson , Joseph Larmarange , Luis Teixeira

XXIIe Congrès International des Sociologues de Langue Française, AISLF, Jul 2024, Ottawa, Canada

Communication dans un congrès

hal-04639785

Associations de lutte contre les cancers du sein en Île-de-France : quelles implications auprès des femmes immigrées d'Afrique subsaharienne ?

Clémence Schantz , Marie Bottin , Léa Prost , Louise Ludet , Gaëtan Des Guetz , Luis Teixeira , Myriam Baron , Groupe Senovie

Santé Publique, 2024, 36 (4), pp.47-59. ⟨10.3917/spub.244.0047⟩

Article dans une revue

hal-04730706

The challenge of radiotherapy in the fight against cancer in French-speaking West Africa

Clémence Schantz

The social and political lives of new cancer technologies in the global South, Fondation Brocher, Jun 2024, Geneva, Switzerland

Communication dans un congrès

hal-04612608

Amazons in Mali? Women's experiences of breast cancer and gender (re)negotiation

Clémence Schantz , Abdourahmane Coulibaly , Kadiatou Faye , Drissa Traoré

Social Science & Medicine, 2024, 348, pp.116874. ⟨10.1016/j.socscimed.2024.116874⟩

Article dans une revue

hal-04593224

Plan de gestion des données du projet SENOVIE France

Anne Gosselin , Karna Coulibaly , Joseph Larmarange , Clémence Schantz

Institut de Recherche pour le Développement (IRD). 2024

Rapport

hal-04563793

Voir la liste complète des publications

Trends in HIV testing, the treatment cascade, and HIV incidence among men who have sex with men in Africa: a systematic review and meta-analysis

Joseph LARMARANGE — 2023-07-20T10:25:10Z

Trends in HIV testing, the treatment cascade, and HIV incidence among men who have sex with men in Africa: a systematic review and meta-analysis

James Stannah , Nirali Soni , Jin Keng Stephen Lam , Katia Giguère , Kate Mitchell , Nadine Kronfli , Joseph Larmarange , Raoul Moh , Marcellin Nouaman , Gérard Menan Kouamé , Marie-Claude Boily , Mathieu Maheu-Giroux

The Lancet HIV, 2023, 10 (8), pp.e528-e542. ⟨10.1016/S2352-3018(23)00111-X⟩

Article dans une revue

hal-04166933

Authors

James Stannah, Nirali Soni, Jin Keng Stephen Lam, Katia Giguère, Kate M Mitchell, Nadine Kronfli, Joseph Larmarange, Raoul Moh, Marcellin Nouaman, Gérard Menan Kouamé, Prof Marie-Claude Boily, Mathieu Maheu-Giroux

Abstract

Background

Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. In Africa, MSM face structural barriers to HIV prevention and treatment that increase their vulnerability to HIV acquisition and transmission, and undermine the HIV response. In this systematic review, we aimed to explore progress towards increases in HIV testing, improving engagement in the HIV treatment cascade, and HIV incidence reductions among MSM in Africa.

Methods

We searched Embase, MEDLINE, Global Health, Scopus, and Web of Science for cross-sectional and longitudinal studies reporting HIV testing, knowledge of status, care, antiretroviral therapy (ART) use, viral suppression, and HIV incidence among MSM in Africa published between Jan 1, 1980, and March 3, 2023. We pooled surveys using Bayesian generalised linear mixed-effects models, used meta-regression to assess time trends, and compared HIV incidence estimates among MSM with those of all men.

Findings

Of 9278 articles identified, we included 152 unique studies published in 2005–23. In 2020, we estimate that 73% (95% credible interval [CrI] 62–87) of MSM had ever tested for HIV. HIV testing in the past 12 months increased over time in central, western, eastern, and southern Africa (odds ratio per year [ORyear] 123, 95% CrI 101–151, n=46) and in 2020 an estimated 82% (70–91) had tested in the past 12 months, but only 51% (30–72) of MSM living with HIV knew their HIV status. Current ART use increased over time in central and western (ORyear 141, 108–193, n=9) and eastern and southern Africa (ORyear 137, 104–184, n=17). We estimated that, in 2020, 73% (47–88) of all MSM living with HIV in Africa were currently on ART. Nevertheless, we did not find strong evidence to suggest that viral suppression increased, with only 69% (38–89) of MSM living with HIV estimated to be virally suppressed in 2020. We found insufficient evidence of a decrease in HIV incidence over time (incidence ratio per year 096, 95% CrI 063–150, n=39), and HIV incidence remained high in 2020 (69 per 100 person-years, 95% CrI 31–276) and substantially higher (27–199 times higher) than among all men.

Interpretation

HIV incidence remains high, and might not be decreasing among MSM in Africa over time, despite some increases in HIV testing and ART use. Achieving the UNAIDS 95-95-95 targets for diagnosis, treatment, and viral suppression equitably for all requires renewed focus on this key population. Combination interventions for MSM are urgently required to reduce disparities in HIV incidence and tackle the social, structural, and behavioural factors that make MSM vulnerable to HIV acquisition.

Funding

US National Institutes of Health, UK Medical Research Council, Canadian Institutes of Health Research, and Fonds de Recherche du Québec–Santé.

Décrire les épidémies, Comprendre les populations : une démographie du VIH en Afrique subsaharienne

Joseph LARMARANGE — 2022-10-14T06:38:12Z

Habilitation à Diriger des Recherches soutenue le 12 octobre 2012 par Joseph Larmarange à l'Université Paris Cité.
Décrire les épidémies, Comprendre les populations : une démographie du VIH en Afrique subsaharienne
Joseph Larmarange Démographie. Université Paris Cité, 2022 HDR tel-03814024

- Publications / Afrique subsaharienne, ATLAS, CAP-CoV-Soignants-BF, DOD-CI (ANRS 12287 / 12323), ELIHoS (ANRS 12139), PrEP CI (ANRS 12361), Prévalences du VIH (ANRS 12114), prevR, PRINCESSE, TasP (ANRS 12249), Afrique du Sud, Burkina Faso, Côte d'Ivoire, Mali, Sénégal, Accès aux soins, Analyse de séquences, Approches biographiques, Approches communautaires, Autotests VIH, Cartographie, Cascade des soins, Comparaison de cohortes, Comportements sexuels, Démographie, Dépistage, EDS (Enquêtes Démographiques et de Santé), Enquêtes par téléphone, Enseignement académique, Lien vers les soins, Épidémiologie, Essais cliniques, Estimateurs à noyau (kernel density estimation), Femmes enceintes, Financement des programmes, Hépatites virales, Homo / Bisexualités, Identités sexuelles, Incidence du VIH, Interpolation spatiale, IST (Infections Sexuellement Transmissibles), Itinéraires thérapeutiques, Masculinités, Ménages, Mesure d'impact, Mesure des indicateurs, Méthodologie, Migrations, Observatoire de population, Partenaires sexuel(le)s, PrEP, Prévalence du VIH, Prévention, Prise en charge, Recherche interventionnelle, Recherche participative/communautaire, Recrutement « boules de neige », Représentations / Perceptions, Représentativité et Biais, Santé publique, Santé sexuelle, Structure des populations, Structures de santé, Surveillance sentinelle, Téléphones mobiles, Temporalités, Traitement antirétroviral (ARV), Travail du sexe, Treatment as Prevention (TasP), Universal Test & Treat (UTT), Usageres de drogue, VIH / SIDA

24th International AIDS Conference @ Montreal

Joseph LARMARANGE — 2022-08-08T18:58:39Z

Oral communications and poster presented at the 24^th International AIDS Conference 2022 in Montreal.

List of communications

Larmarange Joseph (2022) “Self-Testing, Empowerment and Self-Care: perspectives from lessons learned in implementing HIV self-testing in West Africa” (communication orale (symposium SA019), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Programme/Session/107.

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Larmarange - 2022 - Self-Testing, Empowerment and Self-Care perspecti.pdf 1.8 MiB

Nouaman Marcellin, Coffie Patrick A, Plazy Mélanie, Becquet Valentine, Agoua Aline, Zébago Clémence, Dao Hervé, Larmarange Joseph, Eholié Serge and ANRS 12381 PRINCESSE study group (2022) “Prevalence and incidence of sexually transmitted infections in a cohort of female sex workers in San Pedro, Côte d'Ivoire (ANRS 12381 PRINCESSE)” (poster), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=6713.

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Abstract: BACKGROUND: The ANRS 12381 PRINCESSE study is an interventional single-arm cohort. Participants recruitment started in November 2019. The study aimed to evaluate a comprehensive and community-based care offer among FSWs aged '¥ 18 years in the San Pedro area. METHODS: Care services included quarterly syndromic screening for STIs, as well as vaginal and anal swabs for the screening of chlamydia trachomatis (CT) and neisseria gonorrhoea (NG) by polymerase chain reaction (PCR) at M0, M12 and M24. At the same visits, identification of dysplasias and precancerous lesions of the cervix was performed by visual inspection after applying acetic acid and Lugol's iodine. STIs were managed according to the national algorithm. We describe (i) the characteristics of cervical lesions as well as the prevalence of STIs (syndromic and PCR) and associated symptoms and (ii) the incidence of syndromic STIs during follow-up. RESULTS: In November 2021, 372 FSWs were included. The median age was 29 years, 34% had never been to school, 56% were Ivorian, and the median duration of sex work was 2 years. At inclusion, 4.7% [95% confidence interval: 2.8-7.5] had cervical lesions with 3.5% leukoplakia and 2.2% haemorrhagic cervical junction zone. The prevalence of syndromic STIs was 17.2% [13.0-22.6]; associated clinical signs were vaginal discharge (13.7%), vaginal ulceration (2.1%), lower abdominal pain (4.3%) and cervical inflammation (2.6%). The prevalence of anovaginal CT and NG were 8.7% [6.2- 12.1] and 10.4% [7.6- 13.9], respectively; clinical signs were found in 2.4% of CT-positive and 12.2% of NG-positive FSWs. Most FSWs with syndromic STIs did not have CT or NG infection. During the follow-up, 82 cases of syndromic STIs were observed per 209 person-years, i.e. an incidence of 39.1% [31.1- 49.0]. PCR data at M12 and M24 are being consolidated and will allow estimating the incidence of CT and NG. CONCLUSIONS: A high prevalence and incidence of syndromic STIs were observed among FSWs, highlighting the importance and the interest of a regular follow-up. The results also showed the predominantly asymptomatic nature of STIs discovered by PCR in this at-risk population and, therefore, the importance of coupling syndromic screening and PCR analyses.

Nouaman et al. - 2022 - Prevalence and incidence of sexually transmitted i.pdf 832 KiB

Plazy Mélanie, Nouaman Marcellin, Becquet Valentine, Agoua Aline, Zébago Clémence, Dao Hervé, Coffie Patrick A, Eholié Serge, Larmarange Joseph and ANRS 12381 PRINCESSE study group (2022) “Delays to PrEP initiation among female sex workers in Côte d'Ivoire (ANRS 12381 PRINCESSE project)” (poster), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=6824.

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Abstract: BACKGROUND: To describe the delays to initiation of oral pre-exposure prophylaxis (PrEP) among female sex workers (FSW) in Côte d''Ivoire. METHODS: The ANRS 12381 PRINCESSE project is a single-arm interventional cohort aiming to evaluate the implementation of a comprehensive and community-based care offer among FSW aged '¥18 years in the San Pedro region since end-2019, through a mobile clinic operating on 10 prostitution sites (visited every two weeks). PrEP is offered to all HIV-positive FSW after verifying the creatinine level (results valid for one month). We described the time between FSW's interest for PrEP and PrEP initiation (or end of follow-up) among HIV- and hepatitis B virus-negative (HBsAg-) FSW included until end-October 2021. The probability of PrEP initiation since PrEP interest is described through a Kaplan-Meier curve censored on end-November 2021 (an analysis censored at the date of the last visit was also conducted). RESULTS: Of the 362 FSW included in the PRINCESSE cohort, 302 were HIV-/AgHBs-, and for 296 of them, PrEP was presented by medical staff (95.2% at inclusion). In total, 292 FSW expressed PrEP interest, and 192 (65.8%) initiated PrEP: 18 on the same day (the biological test having been performed during a previous visit), 148 during the next visit (median time since interest: 3 weeks [Inter-Quartile Range: 2-6]) and 26 during a subsequent visit (median time: 20 weeks [9-36]). The probability of PrEP initiation after PrEP interest was 39.0% at 1 month and 56.6% at 3 months (censoring on the date of the last visit, these proportions were 50.7% and 74.6%, respectively). Among the 100 FSW who did not initiate PrEP despite expressing interest, 68 were never seen again in the project; 4 declared that they were no longer interested in PrEP (median time since interest: 12 weeks [10-19]), 1 was tested HIV+ (delay of 2 weeks), and 27 were seen >1 month later (their biological tests were no longer valid). CONCLUSIONS: Despite strong PrEP interest among FSW, PrEP initiation remained suboptimal. Barriers to PrEP initiation should be more explored and considered to find appropriate solutions to make PrEP effective among this specific key population.

Plazy et al. - 2022 - Delays to PrEP initiation among female sex workers.pdf 484.6 KiB

Silhol Romain, Maheu-Giroux Mathieu, Soni Nirali, Simo Fotso Arlette, Rouveau Nicolas, Vautier Anthony, Doumenc-Aïdara Clémence, N'Guessan Kouakou, Mukandavire Christinah, Vickerman Peter, Keita Abdelaye, Ndour Cheikh Tidiane, Larmarange Joseph, Boily Marie Claude and ATLAS Team (2022) “Identifying population-specific HIV diagnosis gaps in Western Africa and assessing their impact on new infections: a modelling analysis for Côte d'Ivoire, Mali and Senegal” (poster), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=4243.

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Abstract: BACKGROUND: Progress towards HIV elimination in Western Africa may be hindered by diagnosis gaps among people living with HIV (PLHIV), especially among key populations (KP) such as female sex workers (FSW), their clients, and men who have sex with men (MSM). We aimed to identify largest gaps in diagnosis by risk group in Mali, Côte d'Ivoire, and Senegal, and project their contribution to new HIV infections. METHODS: Deterministic models of HIV transmission/diagnosis/treatment that incorporate HIV transmission among KP were parameterized following comprehensive country-specific reviews of demographic, behavioural, HIV and intervention data. The model was calibrated to country- and group-specific empirical outcomes such as HIV incidence/prevalence, the fractions of PLHIV ever tested, diagnosed, and on treatment. We estimated the distribution of undiagnosed PLHIV by risk group in 2020 and the population-attributable-fractions (tPAFs) (i.e. fraction of new primary and secondary HIV infections 2020-2029 originating from risk groups of undiagnosed PLHIV). RESULTS: From 46% (95% UI: 38-58) to 69% (59-79) of undiagnosed PLHIV in 2020 were males, with the lowest proportion in Mali and the highest proportion in Senegal, where 41% (28-59) of undiagnosed PLHIV were MSM. Undiagnosed men are estimated to contribute most new HIV infections occurring over 2020-2029 (Table). Undiagnosed FSW and their clients contribute substantial proportions of new HIV infections in Mali, with tPAF=20% (10-36) and tPAF=43% (26-56), respectively, while undiagnosed MSM in Senegal are estimated to contribute half of new infections. A lower proportion of new HIV infections are transmitted by undiagnosed KP in Côte d'Ivoire (tPAF=21%(10-38)). CONCLUSIONS: Current HIV testing services and approaches are leaving members of KP behind. Increasing the availability of confidential HIV testing modalities in addition to traditional tests may substantially reduce gaps in HIV diagnosis and accelerate the decrease of new HIV infections in Western Africa since half of them could be transmitted by undiagnosed KP.

Silhol et al. - 2022 - Identifying population-specific HIV diagnosis gaps.pdf 288.9 KiB

Simo Fotso Arlette, Johnson Cheryl, Vautier Anthony, Kouamé Konan Blaise, Diop Papa Moussa, Silhol Romain, Maheu-Giroux Mathieu, Boily Marie-Claude, Rouveau Nicolas, Doumenc-Aïdara Clémence, Baggaley Rachel, Ehui Eboi, Larmarange Joseph and ATLAS Team (2022) “Estimating the impact of HIV self-testing on HIV testing services, diagnoses, and treatment initiation at the population-level with routine data: the example of the ATLAS program in Côte d'Ivoire” (poster), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=5409.

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Abstract: BACKGROUND: HIV self-testing (HIVST) is a critical testing approach particularly for reaching those at HIV risk who are hesitant or unable to access existing services. While the discreet and flexible nature of HIVST is appealing to users, these features can limit the ability for programmes to monitor and estimate the population-level impacts of HIVST implementation. This study triangulates publicly available routine programme data from Côte d'Ivoire in order estimate the effects of HIVST distribution on access to testing, conventional testing (self-testing excluded), HIV diagnoses, and antiretroviral treatment (ART) initiations. METHODS: We used quarterly programmatic data (Q3-2019 to Q1-2021) from ATLAS, a project that aims to promote and implement network-based HIVST distribution in West Africa, in addition to routine HIV testing services program data obtained from the PEPFAR dashboard. We performed ecological time series regression using linear mixed-models. RESULTS: Between Q3-2019 and Q1-2021, 99,353 HIVST kits were distributed by ATLAS in 78 health districts included in the analysis. The results (Table 1) show a negative but non-significant effect of the number of ATLAS HIVST on the volume of conventional tests (-190), suggesting the possibility of a slight substitution effect. Despite this, the the beneficial effect on access to testing is significant: for each 1000 HIVST distributed via ATLAS, 390 to 590 additional HIV tests were performed if 60% to 80% of HIVST are used . The effect of HIVST on HIV diagnosis was significant and positive, with 8 additional diagnoses per 1,000 HIVST distributed. No effect of HIVST was observed on ART initiations. CONCLUSIONS: Our study provides a standard methodology for estimating the population-level impact of HIVST that can be used across countries. It shows that HIVST distribution was associated with increased access to HIV testing and diagnosis in Côte d'Ivoire. Wide-scale adoption of this method will improve HIVST data quality and inform evidence-based programming.

Simo Fotso et al. - 2022 - Estimating the impact of HIV self-testing on HIV t.pdf 541.2 KiB

Stannah James, Flores Anato Jorge Luis, Mitchell Kate M, Larmarange Joseph, Maheu-Giroux Mathieu and Boily Marie‐Claude (2022) “Improving our understanding of how structural determinants impact HIV epidemics: a scoping review of dynamic models to guide future research” (poster), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=6564.

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Abstract: BACKGROUND: Dynamic models of HIV transmission have proven valuable tools for informing HIV prevention strategies. Including structural determinants in models is crucial to estimate their population-level impacts on HIV transmission and inform efforts towards HIV elimination. However, this is challenging due to a lack of coherent conceptual frameworks, limited understanding of their specific causal pathways, and few empirical estimates of their impacts on downstream mediators. METHODS: With the overarching aim to improve models, we conducted a scoping review of studies that used dynamic HIV transmission models to evaluate the impact of structural determinants. From included studies, we extracted information on the types of structural determinants and methods used to model their impacts on HIV transmission. We appraised studies on how they conceptualized structural exposures and represented their causal relationships over time within models. RESULTS: We identified 9 dynamic transmission modelling studies that incorporated structural determinants of HIV, including violence (N=3), incarceration (N=2), stigma (N=2), housing instability (N=2), migration (N=1), and education (N=1). Only one study modelled multiple determinants simultaneously. In most models, structural determinants were conceptualized using current, recent, non-recent and/or lifetime exposure categories. Modelled structural determinants largely impacted HIV transmission through mediated effects on one or more proximate risk factors, including sharing injection equipment, condom use, number of partners, and access to treatment. However, causal pathways were simplistic, with few mediators and/or lack of clear empirical justification. To measure impact, most studies simply assumed the elimination of structural determinants in counterfactual comparison scenarios. Few models included long-term and/or delayed effects of past, recurrent, or acute exposure, potentially overestimating impacts of determinants. CONCLUSIONS: Despite the importance of structural determinants for HIV prevention, methods for including them in dynamic HIV transmission models remain insufficient. Few studies have attempted to incorporate structural determinants in HIV models, and methods vary considerably. To improve inferences, models should adopt precise exposure definitions, deconstruct and estimate their complex causal pathways, and translate them into their mechanistic components. The need for development of coherent frameworks to conceptualize the synergistic interplay between strengthened empirical data analysis and the inclusion of structural determinants in dynamic models is pressing.

Stannah et al. - 2022 - Improving our understanding of how structural dete.pdf 538.6 KiB

Replay

La PrEP seule ne suffit pas : elle doit être accompagnée d'une offre de soins globale

Joseph LARMARANGE — 2022-05-19T09:49:15Z

Cette note de politique, préparée par PAC-CI, repose sur des résultats du projet PrEP-CI ANRS 12361.

La PrEP seule ne suffit pas : elle doit être accompagnée d'une offre de soins globale

Alexandra Bitty-Anderson , Annick Guié , Eulalie Kanga , Marcellin Nouaman , Joseph Larmarange

Note de politique PAC-CI #3, Programme PAC-CI. 2022

Rapport

ird-03882265

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

Joseph LARMARANGE — 2021-12-06T09:50:35Z

Protocol paper of the ANRS 12381 PRINCESSE project.

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

Valentine Becquet , Marcellin Nouaman , Mélanie Plazy , Aline Agoua , Clémence Zébago , Hervé Dao , Alice Montoyo , Aude Jary , Patrick A. Coffie , Serge Eholié , Joseph Larmarange

BMC Public Health, 2021, 21 (1), pp.2214. ⟨10.1186/s12889-021-12235-0⟩

Article dans une revue

hal-03467822

Authors

Valentine Becquet, Marcellin Nouaman, Mélanie Plazy, Aline Agoua, Clémence Zébago, Hervé Dao, Alice Montoyo, Aude Jary, Patrick A. Coffie, Serge Eholié, Joseph Larmarange & and the ANRS 12381 PRINCESSE team

Abstract

Background

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.

Methods

PRINCESSE is an open, single-arm interventional cohort of 500 FSWs in San Pedro (Côte d'Ivoire) and its surroundings. Recruitment started on November 26^th, 2019 and is ongoing; the cohort is planned to last at least 30 months. The healthcare package (including HIV, hepatitis B, and sexually transmitted infection management, pregnancy screening, and contraception) is available both at mobile clinics organized for a quarterly follow-up (10 intervention sites, each site being visited every two weeks) and at a fixed clinic.

Four waves of data collection were implemented: (i) clinical and safety data; (ii) socio-behavioral questionnaires; (iii) biological data; and (iv) in-depth interviews with female participants. Four additional waves of data collection are scheduled outside the cohort itself: (i) the medical and activity records of Aprosam for the PRINCESSE participants; (ii) the medical records of HIV+ FSW patients not participating in the PRINCESSE cohort, and routinely examined by Aprosam; (iii) in-depth interviews with key informants in the FSW community; and (iv) in-depth interviews with PRINCESSE follow-up actors.

Discussion

The PRINCESSE project is one of the first interventions offering HIV oral PrEP as part of a more global sexual healthcare package targeting both HIV- and HIV+ women. Second, STIs and viral hepatitis B care were offered to all participants, regardless of their willingness to use PrEP. Another innovation is the implementation of mobile clinics for chronic/quarterly care. In terms of research, PRINCESSE is a comprehensive, interdisciplinary project combining clinical, biological, epidemiological, and social specific objectives and outcomes to document the operational challenges of a multidisease program in real-life conditions.

Trial registration

The PRINCESSE project was registered on the Clinicaltrial.gov website (NCT03985085) on June 13, 2019.

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

Joseph LARMARANGE — 2021-05-19T08:58:05Z

Published in Frontiers in Public Health the 19^th of May 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

Sokhna Boye , Seydou Bouaré , Odette Ky-Zerbo , Nicolas Rouveau , Arlette Simo Fotso , Marc d'Elbee , Romain Silhol , Mathieu Maheu-Giroux , Anthony Vautier , Guillaume Breton , Abdelaye Keita , Anne Bekelynck , Alice Desclaux , Joseph Larmarange , Dolorès Pourette

Frontiers in Public Health, 2021, 9, pp.653543. ⟨10.3389/fpubh.2021.653543⟩

Article dans une revue

hal-03790975

Authors

Sokhna Boye, Seydou Bouaré, Odette Ky-Zerbo, Nicolas Rouveau, Arlette Simo Fotso, Marc d'Elbée, Romain Silhol, Mathieu Maheu-Giroux, Anthony Vautier, Guillaume Breton, Abdelaye Keita, Anne Bekelynck, Alice Desclaux, Joseph Larmarange and Dolorès Pourette on behalf of the ATLAS team

Abstract

Context: 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). The AutoTest-VIH, Libre d'accéder à la connaissance de son Statut (ATLAS) program was launched in West Africa with the objective of distributing nearly half a million HIV self-tests from 2019 to 2021 in Côte d'Ivoire, Mali, and Senegal. The ATLAS program integrates several research activities. This article presents the preliminary results of the qualitative study of the ATLAS program in Mali. This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests to PLHIV so that they can offer the tests to their sexual partners.

Methods: This qualitative study was conducted in 2019 in an HIV care clinic in Bamako. It consisted of (i) individual interviews with eight health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) seven observations of peer educator-led PLHIV group discussions. The interviews with health professionals and the observations notes have been subject to content analysis.

Results: 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 HIVST 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.

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.

Comment déployer la PrEP ?

Joseph LARMARANGE — 2020-11-09T13:12:37Z

Mini-Lecture ML 1.1 présentée dans le cadre de la session PrEP de l'AFRAVIH 2020

Référence

Larmarange Joseph (2020) “Comment déployer la PrEP ?” (communication orale ML1.1), presented at the AFRAVIH, Dakar. http://www.afravih2020.org/.

Practices and Obstacles to Provider-Initiated HIV Testing and Counseling (PITC) Among Healthcare Providers in Côte d'Ivoire

Joseph LARMARANGE — 2020-08-24T16:37:20Z

Authors

Maxime Inghels, Arsène Kra Kouassi, Serge Niangoran, Anne Bekelynck, Séverine Carillon, Lazare Sika, Christine Danel, Mariatou Kone, Annabel Desgrees du Lou, Joseph Larmarange & for the ANRS 12323 DOD-CI Study Group

Abstract

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.

Reference

Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Danel Christine, Kone Mariatou, Desgrees du Lou Annabel, Larmarange Joseph and 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 (May 24). DOI : 10.1007/s10461-020-02923-0. https://doi.org/10.1007/s10461-020-02923-0.