Joseph Larmarange

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

Retention in Care Trajectories of HIV-Positive Individuals Participating in a Universal Test-and-Treat Program in Rural South Africa (ANRS 12249 TasP Trial)

Joseph LARMARANGE — 2019-02-27T15:57:37Z

Authors

Gosset Andréa, Protopopescu Camelia, Larmarange Joseph, Orne-Gliemann Joanna, McGrath Nuala, Pillay Deenan, Dabis François, Iwuji Collins, Boyer Sylvie

Abstract

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.

Reference

Gosset Andréa, Protopopescu Camelia, Larmarange Joseph, Orne-Gliemann Joanna, McGrath Nuala, Pillay Deenan, Dabis François, Iwuji Collins and Boyer Sylvie (2019) “Retention in Care Trajectories of HIV-Positive Inspaniduals 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) (April 1), p. 375. DOI : 10.1097/qai.0000000000001938. https://journals.lww.com/jaids/Fulltext/2019/04010/Retention_in_Care_Trajectories_of_HIV_Positive.2.aspx.

PRINCESSE · PrEP, infections sexuellement transmissibles, contraception, hépatite virale B, santé sexuelle pour les travailleuses du sexe en Côte d'Ivoire

Joseph LARMARANGE — 2018-07-19T10:22:40Z

Responsables scientifiques

Joseph LARMARANGE (Ceped)
Serge EHOLIE (PAC-CI)

Partenariat

Financement

Agence Nationale de Recherche sur le Sida et les hépatites virales (ANRS)

Enregistrement sur clinicaltrials.org

NCT03985085

Résumé

Suite aux résultats du projet exploratoire PrEP-CI (ANRS 12361) portant sur la question de la faisabilité et de la pertinence d'un programme PrEP auprès des travailleuses du sexe (TS) en Côte d'Ivoire, nous avons conçu, conjointement avec les acteurs communautaires ivoiriens, une intervention de santé dénommée PRINCESSE, portant sur une offre de soins globale en santé sexuelle et reproductive à destination des travailleuses du sexe de la région de San Pedro.

L'originalité de cette intervention réside dans la combinaison d'une offre de prophylaxie préexposition VIH (pour les TS VIH-) avec une prise en charge précoce des femmes VIH+, la prise en compte de l'infection au VHB (dépistage, vaccination et traitement), le dépistage et le traitement des infections sexuellement transmissibles et de leurs conséquences, une offre de contraception, un conseil en gestion des menstrues et le repérage des situations de dépendance. La mise en œuvre de ce dispositif sera réalisée en partenariat avec une ONG communautaire (Aprosam), au travers de sa clinique fixe déjà existante et d'une clinique mobile adaptée à un suivi trimestriel directement sur les sites prostitutionnels.

Objectif principal

Développer, documenter et analyser une offre de soins communautaire combinant dépistage, prévention combinée dont prophylaxie préexposition (PrEP), traitement immédiat du VIH, prise en charge de l'hépatite B et santé sexuelle et reproductive (SSR) afin de réduire l'exposition au VIH des travailleuses du sexe (TS) et de leurs partenaires en Côte d'Ivoire.

Objectifs secondaires

Analyser l'accès aux soins et la rétention, et plus généralement le parcours de soins des participantes, dans un suivi trimestriel des TS (infectées ou non par le VIH)
Mesurer l'évolution au cours du temps de l'état de santé des participantes via des indicateurs cliniques, comportementaux et sociaux
Évaluer l'initiation, les usages et l'observance à la PrEP
Comparer la prise en charge VIH dans le dispositif PRINCESSE avec la prise en charge en routine existante
Mesurer le dépistage, la vaccination et le traitement de l'hépatite B dans le cadre d'une prise en charge décentralisée intégrée à une offre de PrEP VIH ainsi que les interactions éventuelles entre PrEP VIH et infection au VHB
Documenter les conséquences (positives ou négatives) non prévues du dispositif PRINCESSE sur le quotidien des participantes en particulier et sur le marché du travail du sexe en général

Méthodologie

Le dispositif PRINCESSE est une cohorte interventionnelle mono-bras de 500 travailleuses du sexe à San Pedro (400 VIH- et 100 VIH+).

Quatre dispositifs de collecte de données sont intégrés à la cohorte : (i) données cliniques et de pharmacovigilance, (ii) questionnaires socio-comportementaux, (iii) données biologiques et (iv) entretiens approfondis avec les participantes.

Quatre collectes additionnelles sont prévues en dehors de la cohorte elle-même : (i) la capture des registres d'activités en stratégie avancée des paires éducatrices ; (ii) la capture des dossiers médicaux des patientes VIH+ ne participant pas à la cohorte PRINCESSE et vues en routine par l'ONG partenaires ; (iii) des entretiens approfondis avec des informateurs-trices clés dans la communauté des TS ; (iv) des entretiens approfondis avec les acteurs du suivi PRINCESSE (paires-éducatrices et soignants).

Nombre de participantes

500 participantes (100 VIH+ et 400 VIH-)

Critères de jugement

Taux de complétion des visites trimestrielles.
Proportion avec au moins une IST à M0, M12 et M24
Survenue d'une grossesse non désirée
Initiation de la PrEP
Observance à la PrEP
Rétention dans les soins VIH à M18
Survenue d'un échec virologique
Taux de vaccination VHB
Évolution au cours du temps de la charge virale VHB et du niveau de Fibrose (mesurée par l'algorithme FIB-4)
Augmentation des transaminases (flares) après l'arrêt de la PrEP
Évaluation qualitative des évènements sociaux indésirables survenus dans le quotidien des participantes et des non participantes

Intervention

Mise en œuvre d'une offre de soins globale en santé sexuelle et reproductive à destination des travailleuses (TS) du sexe en Côte d'Ivoire, combinant une offre de PrEP VIH (pour les TS VIH-) avec une prise en charge précoce des femmes VIH+, la prise en compte de l'infection par le VHB (dépistage, vaccination et traitement), le dépistage et le traitement des infections sexuellement transmissibles (IST) et de leurs conséquences, une offre de contraception, un dépistage trimestriel des grossesses, un conseil en gestion des menstrues et le repérage des situations de dépendance.
Cette offre de santé sera disponible à la fois dans des cliniques mobiles organisées pour un suivi trimestriel (10 sites d'interventions, chaque site étant visité toutes les deux semaines) et dans la clinique fixe de l'ONG communautaire partenaire, au choix de chaque participante.

Enregistrement

ClinicalTrials.gov Identifier : NCT03985085

Mots-Clés

VIH/Sida, Hépatites virales, PrEP, Santé sexuelle et reproductive, Dépistage, Prévention, Traitement, Travail du Sexe, Cliniques mobiles.

Zone géographique

Côte d'Ivoire

Calendrier

2018-2021

Publications

Évaluation des infections sexuellement transmissibles dans une stratégie avancée d'offre combinée de santé sexuelle dont la prophylaxie préexposition chez des travailleuses du sexe en Côte d'Ivoire

N'zébo Marcellin Nouaman

Médecine humaine et pathologie. Université de Bordeaux, 2025. Français. ⟨NNT : 2025BORD0173⟩

Thèse

tel-05324982

Perceptions regarding long-acting pre-exposure prevention (PrEP) among female sex workers and men having sex with men in San Pedro and Abidjan, Côte d'Ivoire

Evelyne Kissi , Joseph Larmarange , Rose-Marcelle Dedocoton , Mélanie Plazy , Marcellin Nouaman , Patrick Coffie , Serge Eholié , Valentine Becquet

IAS 2025, the 13th IAS Conference on HIV Science, Jul 2025, Kigali, Rwanda.

Poster de conférence

hal-05163769

Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Joseph Larmarange , Mélanie Plazy , Marcellin Nouaman , Evelyne Kissi , Rose-Marcelle Dedocoton , Patrick Coffie , Serge Eholié , Valentine Becquet

IAS 2025, the 13th IAS Conference on HIV Science, International AIDS Society, Jul 2025, Kigali, Rwanda

Communication dans un congrès

hal-05163730

Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d'Ivoire: complex trajectories and early adopters

Joseph Larmarange , Mélanie Plazy , Marcellin Nouaman , Evelyne Kissi , Rose-Marcelle Dedocoton , Patrick Coffie , Serge Eholié , Valentine Becquet

16th AIDSImpact Conference, AIDSImpact, May 2025, Casablanca, Morocco

Communication dans un congrès

hal-05090841

Perception de la Prophylaxie préexposition à longue durée d'action chez les travailleuses du sexe et les HSH à San Pedro et Abidjan, Côte d'Ivoire

Evelyne Kissi , Joseph Larmarange , Rose-Marcelle Dedocoton , Mélanie Plazy , Marcellin Nouaman , Patrick Coffie , Serge Eholié , Valentine Becquet

16th AIDSImpact Conference, AIDSImpact, May 2025, Casablanca, Maroc

Communication dans un congrès

hal-05090784

Sex work in Bolivia during the Covid-19 crisis: intersectional impact and adaptative strategies

Juliana Castro Avila , Harold Mendoza , Nicolas Lorente , Marion Di Ciaccio , Edgar Valdez , Daniela Rojas Castro , Valentine Becquet

16th AIDSImpact Conference, AIDSImpact, May 2025, Casablanca, Morocco

Communication dans un congrès

hal-05460133

Leçons apprises du projet ANRS 12381 PRINCESSE en Côte d'Ivoire

Joseph Larmarange , Aline Agoua , Hervé Dao , Mama Kate , Mélanie Plazy , Clémence Zébago , Evelyne Kissi , Marcellin Nouaman , Chef d'État Major , Valentine Becquet , Serge Eholié , Hector Juliard , Rose-Marcelle Dedocoton , Patrick Coffie

2025

Vidéo

hal-05090854

Syndromic and biological screening for sexually transmitted infections in female sex workers in Côte d'Ivoire: the ANRS 12381 PRINCESSE cohort study

Marcellin N'zebo Nouaman , Patrick Ahuatchi Coffie , Aline Agoua , Clémence Zébago , Hervé Dao , Evelyne Kissi , Séverin Lenaud , Mian Anatole , Valentine Becquet , Mélanie Plazy , François Dabis , Serge Eholie , Joseph Larmarange

Frontiers in Public Health, 2025, 13, ⟨10.3389/fpubh.2025.1535122⟩

Article dans une revue

hal-04990223

VIH : des solutions préventives à longue durée prometteuses

Louise Hurel , Christian Laurent , Joseph Larmarange , Karna Coulibaly

2024

Article de blog scientifique

hal-04815258

Documentation des tables analytiques de la cohorte 2019-2023 du projet PRINCESSE (Côte d'Ivoire)

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

Institut de Recherche pour le Développement (IRD). 2024

Rapport

hal-04715381

Voir la liste complète des publications

Modélisation à l'échelle du district sanitaire de l'incidence VIH et de la cascade de soins pour optimiser les politiques de contrôle en Côte d'Ivoire

Joseph LARMARANGE — 2018-01-19T14:53:49Z

Responsables scientifiques

Joseph LARMARANGE
Eric OUATTARA (PAC-CI)

Partenariat

PAC-CI (site ANRS de Côte d'Ivoire)
Inserm U219, Bordeaux
Laboratoire MESuRS, CNAM Paris
Imperial College London
Institut Pierre Louis d'épidémiologie et de santé publique (UMRS 1136), Paris

Financement

Agence Nationale de Recherche sur le Sida et les hépatites virales (ANRS)

Résumé

Objectif de la recherche : Les politiques actuelles de dépistage en Côte d'Ivoire se basant sur les « Hotspot » de prévalence, peine à atteindre les personnes les plus à risque de transmission. Estimer l'incidence, meilleur reflet de la dynamique du VIH au niveau des districts sanitaires sera essentiel pour optimiser les politiques de dépistage et de prévention en Côte d'Ivoire. L'objectif de ce contrat d'initiation est d'évaluer la faisabilité de l'estimation de l'incidence du VIH et la cascade des soins au niveau des districts sanitaires à partir de modèles et données existantes en Côte d'Ivoire. Les objectifs spécifiques sont : (i) identifier les sources de données nécessaires pour estimer l'incidence du VIH et la cascade de soins au niveau des districts sanitaires ; (ii) Explorer et voir dans quelle mesure l'on pourrait adapter deux modèles existants pour estimer l'incidence du VIH au niveau des districts sanitaires en Côte d'voire.

Situation du sujet : Les limites aux politiques de dépistage sont : (i) une offre limitée de dépistage « passive » ou « active » : 90% des pays d'Afrique subsaharienne ont adoptés les recommandations de dépistage dans les centres prénataux mais seul 40% l'appliquent ; (ii) des difficultés à atteindre les personnes à risques comme les adolescents : entre 2005 et 2012, les décès liés au VIH chez eux ont augmenté de 50% ; (iii) des lacunes dans la cascade se soin : plus de 40% des personnes dépistées positifs ne sont pas pris en charge pour l'initiation du traitement ARV. Ce nombre devrait diminuer avec l'adoption du traitement ARV précoce. En dehors des limites liées à l'offre, les freins aux dépistages liés au contexte social ou aux caractéristiques des personnes doivent être pris en compte dans contexte de la Cote d'Ivoire ou la prévalence du VIH est de 3.2% et l'incidence élevée dans les régions du sud-ouest et d'Abidjan. Les modèles « statistiques » de rétro-calculs et les modèles « mathématiques » de transmission sont essentiels pour l'estimation de l'incidence mais estime rarement l'incidence infranationale à cause du manque données fiables.

Méthodes : coordonnés par un groupe de travail multidisciplinaire : 1) Recueil des données : (i) revue de la littérature ; (ii) rencontre des autorités et partenaires du VIH ; (iii) Analyse et rédaction d'un document de synthèse. 2) Explorer l'adaptation de deux modèles existants : Workshop pour discuter de l'adaptation des modèles et/ou du développement d'un nouveau modèle.

Résultats attendus et perspectives : Etape préliminaire pour développer un modèle d'estimation de l'incidence du VIH et la cascade des soins par district sanitaire pour évaluer l'efficacité de stratégies de prévention et de dépistages basée sur l'incidence afin d'optimiser la politique de contrôle du VIH en Côte d'Ivoire.

Mots-Clés

Modélisation, VIH/SIDA, Incidence par district sanitaire, cascade de soins

Zone géographique

Côte d'Ivoire

Calendrier

2018-2019

Does a universal test and treat strategy impact ART adherence in rural South Africa? ANRS 12249 TasP cluster-randomized trial

Joseph LARMARANGE — 2015-07-22T08:43:13Z

Oral communication presented the 20^th July 2015 at the 8^th IAS Conference on HIV Pathogeneis, Treatment & Prevention in Vancouver.

Authors

C. Iwuji^1,2, R. Dray-Spira³, A. Calmy⁴, J. Larmarange^1,5, J. Orne-Gliemann⁶, F. Dabis⁶, D. Pillay^1,7, K. Porter⁸

¹Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa, ²University College London, Research Department of Infection and Population Health, London, United Kingdom, ³INSERM-UPMC Univ Paris 06, UMR_S 1136, Paris, France, ⁴Unité VIH/Sida, Hôpitaux Universitaires, Geneva, Switzerland, ⁵CEPED (UMR 196 U. Paris Descartes IRD), Paris, France, ⁶Univ. Bordeaux, ISPED, Centre INSERM U 897, Epidemiologie-Biostatistique, Bordeaux, France, ⁷University College London, Infection and Immunity, London, United Kingdom, ⁸MRC Clinical Trials Unit at UCL, London, United Kingdom

Abstract

Background: HIV treatment guidelines are recommending ART at increasingly higher CD4 counts for maximizing individual and population benefits. However, the expansion of ART use may be at the expense of optimal adherence. We report on adherence and virological suppression when initiating ART at different CD4 thresholds within the Treatment as Prevention (ANRS 12249) trial of universal home-based testing and immediate ART initiation in rural KwaZulu-Natal.

Methods: Using data of a cluster-randomised trial of immediate ART vs. initiation according to current national guidelines (CD4≤350cells/mm³), we compared adherence levels (≥95% vs. < 95%) measured using a visual analogue scale (VAS) and pill count (PC) and virological suppression at 6 months
(< 400 c/mL) according to CD4 count at ART initiation through logistic regression models, adjusting for possible confounders (age, sex, marital status, education and employment).

Results: During March 2012-May 2014, 601 participants who were not on ART entered care in trial clinics; 382 initiated ART; 254 have completed ≥6 months on ART, 227 of whom had 6 months HIV RNA data and were included in analyses. 169 were women; median (IQR) age and CD4 at ART initiation were 35 years (28, 46) and 313cells/mm³ (206, 513). Adherence ≥95% at 6 months was high (88% and 83% by PC and VAS, respectively) with no evidence that this was associated with CD4 at initiation (aOR=0.97 per 100 cells/mm³ higher, 95%-CI: 0.83-1.12, p=0.65 for VAS; aOR 1.13 per 100cells/mm³ higher, 0.98-1.31, p=0.09 for PC). Male sex was independently associated with < 95% adherence (2.58, 1.24-5.35, p= 0.01; ref. females). 83% (183/227) of those who started ART achieved HIV suppression by 6 months with no association with CD4 at initiation (1.13 per 100cells/mm³ higher, 0.96-1.33, p=0.40). Compared to those with ≥95% adherence by VAS, individuals with < 95% adherence were somewhat less likely to suppress (0.44, 0.19-1.03, p=0.06).

Conclusions: We found no evidence that, among people newly entering HIV care, higher CD4 at ART initiation was associated with reduced adherence or poorer virological suppression, at least in the short-term. In this rural South African setting, motivation to adhere to ART may be independent of the presence of symptomatic HIV disease.

Reference

Iwuji Collins, Dray-Spira Rosemary, Calmy Alexandra, Larmarange Joseph, Orne-Gliemann Joanna, Dabis François, Pillay Deenan and Porter Kholoud (2015) “Does a universal test and treat strategy impact ART adherence in rural South Africa? ANRS 12249 TasP cluster-randomized trial” (communication orale n°MOAC0104), presented at the 8th IAS Conference on HIV Pathogeneis, Treatment & Prevention, Vancouver. DOI : 10.7448/IAS.18.5.20340.

Un compte-rendu en français est disponible sur VIH.org.