Joseph Larmarange

Estimating HIV self-testing positivity rate and linkage to confirmatory testing and care: a telephone survey in Côte d'Ivoire, Mali and Senegal

Joseph LARMARANGE — 2023-06-13T10:30:00Z

Oral communication presented the 13^th of June, 2023, at AIDS Impact conference in Stockholm, Sweden.

Estimating HIV self-testing positivity rate and linkage to confirmatory testing and care: a telephone survey in Côte d'Ivoire, Mali and Senegal

Arsene Kra Kouassi , Arlette Simo Fotso , Nicolas Rouveau , Mathieu Maheu-Giroux , Marie-Claude Boily , Romain Silhol , Marc d'Elbée , Anthony Vautier , Joseph Larmarange

AIDS Impact Conference, Jun 2023, Stockhlom, Sweden

Communication dans un congrès

hal-04120705

Authors

Arsène Kra Kouassi, Arlette Simo Fotso, Nicolas Rouveau, Mathieu Maheu-Giroux, Marie-Claude Boily, Romain Silhol, Marc d'Elbée, Anthony Vautier, Joseph Larmarange

Abstract

Background

HIV self-testing (HIVST) empowers individuals and allow them to decide when/where to test and with whom to share their result.

Between 2019 and 2022, the ATLAS program distributed 400 000 HIVST kits in a mixed epidemic context (Côte d'Ivoire, Mali and Senegal), prioritizing key populations, including female sex workers (FSW) and men who have sex with men (MSM), and encouraged secondary distribution of HIVST to their partners, peers and FSW clients.

To preserve its confidential nature, distributed HIVST kits were not systematically tracked. An anonymous phone survey was implemented among its users to estimate test positivity rates and linkage to confirmatory testing and care.

Methods

We conducted a two-step survey. Between March and June 2021, participants were recruited using dedicated leaflets distributed with HIVST kits, inviting users to call a free phone number anonymously (participation was rewarded USD $3.40) and to complete a sociobehavioural questionnaire (phase 1), including the self-reported number of visible lines on their HIVST kits and their interpretation of results.

In September and October 2021, participants who reported a reactive HIVST result in phase 1 and agreed to be re-contacted were recalled to complete a short questionnaire (phase 2) on linkage to confirmatory testing and care.

Results

During phase 1, 2 615 participants were recruited: 2 346 (89.7%) reported a consistent HIVST result (2 visible lines and result interpreted as reactive; one line and interpreted as non-reactive; or no/one line and interpreted as invalid), 48 (1.8%) reported an inconsistent result and 221 (8.5%) did not know (DK) how to interpret their result or refused to answer.

HIVST positivity rates ranged from 2.4% to 4.5%, depending on different assumptions (self-interpreted result or reported number of lines, inclusion or exclusion of DK and refusals). Among men who received an HIVST through activities targeting MSM, positivity rates ranged from 3.2% to 4.8%, and from 2.2% to 4.2% for women reached through activities targeting FSW.

Among 126 phase 1 participants eligible for phase 2, 120 agreed to be re-contacted, and 78 fully completed the phase 2 questionnaire. Among the 27 who reported a consistent reactive result in the phase 1 questionnaire, 15 (56%, 95%CI: 36-74%) linked to confirmatory test, including 12 (80%) confirmed HIV-positive, which all started treatment (100%). Linkage was lower among those who reported an inconsistent result in phase 1(37%, 95%CI: 24-52%).

Among those confirming reactive self-tests, 53% did it in less than one week following self-testing, and 91% in less than three months. Two-thirds (65%) went to a general public facility and one-third to a facility dedicated to key populations.

Conclusion

Our HIVST distribution strategy successfully reached people living with HIV in West Africa. Linkage to confirmatory testing remained sub-optimal in these first years of HIVST implementation. However, if confirmed HIV-positive, almost all initiated treatment. The majority of those who linked to confirmatory testing went to a general facility, suggesting that HIVST has the potential to reach more discrete populations. HIVST constitutes a complementary tool to existing screening services.

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

Les travailleuses du sexe en Afrique de l'Ouest, une population impliquée dans la dynamique de l'épidémie : des études observationnelles à PRINCESSE

Joseph LARMARANGE — 2019-11-26T08:30:00Z

Communication présentée dans le cadre du Séminaire ANRS Recherches sur le VIH/sida et les hépatites virales, quels nouveaux enjeux ? le 26 novembre 2019 à Paris.

Présentation


Présentation « des études observationnelles à PRINCESSE »: PDF - 1.8 Mio

Référence

Larmarange Joseph (2019) « Les travailleuses du sexe en Afrique de l'Ouest, une population impliquée dans la dynamique de l'épidémie : des études observationnelles à PRINCESSE » (communication orale), présenté à Séminaire ANRS : Recherches sur le VIH/sida et les hépatites virales, quels nouveaux enjeux ?, Paris.

Temporal trends of population viral suppression in the context of Universal Test and Treat: the ANRS 12249 TasP trial in rural South Africa

Joseph LARMARANGE — 2019-10-28T09:56:48Z

This paper was published in the Journal of the International AIDS Society in October 2019.

Authors

Joseph Larmarange, Mamadou H Diallo, Nuala McGrath, Collins Iwuji, Mélanie Plazy, Rodolphe Thiébaut, Frank Tanser, Till Bärnighausen, Joanna Orne‐Gliemann, Deenan Pillay, François Dabis for the ANRS 12249 TasP Study Group

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 < 0.001). That increase was similar in both arms (p = 0.514). In the final adjusted model, PVS increase was most associated with increased RHBCT and the implementation of local trial clinics (measured by time since cluster opening). Contextual changes (measured by calendar time) also contributed slightly. The effect of universal ART (trial arm) was positive but limited.

Conclusions

PVS was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative HIV incidence between arms. The PVS gains due to changes in ART‐initiation guidelines alone are relatively small compared to gains obtained by strategies to maximize testing and linkage to care. The achievement of the 90‐90‐90 targets will not be met if the operational and implementational challenges limiting access to care and treatment, often context‐specific, are not properly addressed. Clinical trial number: NCT01509508 (clinicalTrials.gov)/DOH‐27‐0512‐3974 (South African National Clinical Trials Register).

Reference

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 : 10.1002/jia2.25402. https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25402.

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

Joseph LARMARANGE — 2018-07-30T10:02:03Z

Oral communication presented at the 22^nd International AIDS Conference in Amsterdam the 24^th of July, 2018, in a abstract session entitled Forging new pathways towards HIV elimination.

Authors

Joseph Larmarange, Mamadou Hassimiou Diallo, Nuala McGrath, Collins Iwuji, Mélanie Plazy, Rodolphe Thiébaut, Frank Tanser, Till Bärninghausen, Joanna Orne-Gliemann, Deenan Pillay, François Dabis for the ANRS 12249 TasP Study Group

Abstract

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 1^st, 2013 and January 1^st, 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.

Video

Medias

Reference

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.

ATLAS · AutoTest VIH, Libre d'Accéder à la connaissance de son Statut VIH

Joseph LARMARANGE — 2018-07-19T09:59:48Z

Site web du projet

https://atlas.solthis.org/

Coordination scientifique

Joseph Larmarange

Partenaraires (volet recherche)

Financement

Unitaid

Résumé

Le projet ATLAS vise à réduire les nouvelles infections et la mortalité liée au VIH en améliorant l'accès à l'autotest VIH. Il sera mis en œuvre par l'ONG Solthis dans 3 pays d'Afrique de l'Ouest (Côte d'Ivoire, Mali, Sénégal) pour une durée de 3,5 ans.

Devant la spécificité de l'épidémie en Afrique de l'Ouest (prévalence modérée au sein de la population générale mais importante au sein de certains groupes), il est nécessaire de mettre en place des politiques de dépistage ciblées pour toucher ces populations spécifiques, dans un contexte socioculturel freinant le recours au dépistage.

L'autotest VIH est recommandé par l'OMS, car il apporte discrétion, acceptabilité, et empowerment à ceux qui l'utilisent. C'est une approche innovante pour améliorer le diagnostic des personnes vivant avec le VIH. L'autotest n'a pas vocation à remplacer les stratégies de dépistage existantes mais à les compléter pour parvenir à toucher les populations difficiles à atteindre et qui ne se dépistent pas aujourd'hui.

Le projet ATLAS sera géré par un consortium Solthis-IRD, dont Solthis est le chef de file. Solthis assurera la mise en oeuvre des activités (500 000 auto-tests distribués en trois ans) en partenariat avec les conseils/programme nationaux de lutte contre le sida de chacun des trois pays (Côte d'Ivoire, Mali, Sénégal) et les ONGs locales déjà en charge de la réponse à l'épidémie.

L'IRD est en charge de la mise en œuvre des activités d'évaluation et de recherche opérationnelle du projet. Plusieurs enquêtes, intégrées au projet, sont prévues entre 2018 et 2021, incluant une enquête téléphonique sur les trois pays, deux enquêtes qualitatives, une enquête économique et un travail de modélisation épidémiologique et économique. L'équipe scientifique est composée de plus d'une quinzaine de chercheurs internationaux, francophones et anglophones.

Zone géographique

Côte d'Ivoire, Mali et Sénégal

Calendrier

2018-2021

Dernières Pubications

Knowledge, attitudes and practices relating to HIV self-testing following its introduction in the Bas-Sassandra region of Côte d'Ivoire: the case of the ATLAS project

Arlette Simo Fotso , Christian Koukobo , Romain Silhol , Arsene Kra Kouassi , Marie-Claude Boily , Anthony Vautier , Joseph Larmarange

PLoS ONE, 2026, 21 (1), pp.e0314947. ⟨10.1371/journal.pone.0314947⟩

Article dans une revue

hal-05486495

Knowledge, attitudes and practices relating to HIV self-testing following its introduction in the Bas-Sassandra region of Côte d'Ivoire: the case of the ATLAS project

Arlette Simo Fotso , Christian Koukobo , Romain Silhol , Arsène Kouassi Kra , Marie-Claude Boily , Anthony Vautier , Joseph Larmarange

2024

Pré-publication, Document de travail

hal-04804558

Cost‐effectiveness analysis of community‐led HIV self‐testing among key populations in Côte d'Ivoire, Mali, and Senegal

Ingrid Jiayin Lu , Romain Silhol , Marc d'Elbée , Marie-Claude Boily , Nirali Soni , Odette Ky-Zerbo , Anthony Vautier , Arlette Simo Fotso , Kéba Badiane , Metogara Traoré , Fern Terris-Prestholt , Joseph Larmarange , Mathieu Maheu-Giroux

Journal of the International AIDS Society, 2024, 27 (7), pp.1-12. ⟨10.1002/jia2.26334⟩

Article dans une revue

hal-04660337

The impact of past HIV interventions and diagnosis gaps on new HIV acquisitions, transmissions, and HIV-related deaths in Côte d'Ivoire, Mali, and Senegal

AIDS. Official journal of the international AIDS Society, 2024, ⟨10.1097/QAD.0000000000003974⟩

Article dans une revue

hal-04632874

HIV self-testing positivity rate and linkage to confirmatory testing and care: a telephone survey in Côte d'Ivoire, Mali, and Senegal

Arsene Kra Kouassi , Arlette Simo Fotso , Nicolas Rouveau , Mathieu Maheu-Giroux , Marie-Claude Boily , Romain Silhol , Marc d'Elbée , Anthony Vautier , Joseph Larmarange

Peer Community Journal, 2024, 4, pp.e56. ⟨10.24072/pcjournal.428⟩

Article dans une revue

hal-04612456

Apport des autotests VIH dans l'accès au dépistage en Afrique de l'Ouest : l'expérience du projet ATLAS

Arsene Kra Kouassi

Médecine humaine et pathologie. Université Paris Cité, 2024. Français. ⟨NNT : 2024UNIP5007⟩

Thèse

tel-04780261

Apport des autotests VIH dans l'accès au dépistage en Afrique de l'Ouest : l'expérience du projet ATLAS

Arsene Kra Kouassi

Santé publique et épidémiologie. Universite Paris Cité, 2024. Français. ⟨NNT : ⟩

Thèse

tel-04491990

Organisation of testing services, structural barriers and facilitators of routine HIV self-testing during sexually transmitted infection consultations: a qualitative study of patients and providers in Abidjan, Côte d'Ivoire

Sokhna Boye , Alexis Kouadio , Amélé Florence Kouvahe , Anthony Vautier , Odette Ky-Zerbo , Nicolas Rouveau , Mathieu Maheu-Giroux , Romain Silhol , Arlette Simo Fotso , Joseph Larmarange , Dolorès Pourette , Souleymane Sow

BMC Infectious Diseases, 2024, 22 (S1), pp.975. ⟨10.1186/s12879-023-08625-x⟩

Article dans une revue

hal-04480842

L'auto-dépistage : une solution pour lutter contre le VIH en Afrique de l'Ouest

Louise Hurel , Joseph Larmarange , Arsene Kra Kouassi

2024

Article de blog scientifique

hal-04394350

Voir la liste complète des publications

From individual care trajectories to HIV care cascade at population level in rural KwaZulu-Natal (South Africa): the impact of population dynamics

Joseph LARMARANGE — 2018-06-06T14:57:15Z

Oral communication presented May 31 2018 at Life History Research Society Conference in Paris.

Authors

Joseph Larmarange, Mamadou Hassimiou Diallo, Nuala McGrath, Collins Iwuji, Rodolphe Thiébaut, Frank Tanser, Till Bärninghausen, Deenan Pillay, François Dabis, Joanna Orne-Gliemann for the ANRS 12249 TasP Study Group

Abstract

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.

Reference

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 inspanidual 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.

From home-based HIV testing to viral suppression: HIV care trajectories in the context of Universal Test-and-Treat in rural South Africa

Joseph LARMARANGE — 2018-06-06T14:55:16Z

Oral communication presented May 31 2018 at Life History Research Society Conference in Paris.

Authors

Delphine Perriat, Mamadou Hassimiou Diallo, François Dabis, Deenan Pillay, Joanna Orne-Gliemann, Joseph Larmarange for the ANRS 12249 TasP Study Group

Abstract

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.

Keywords: State sequence data analysis, HIV care, South Africa

Reference

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.

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

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)

Joseph LARMARANGE — 2018-01-07T18:10:26Z

Oral communication presented at the AIDS Impact 13^th International Conference in Cape Town the 13 November 2017.

Authors

Marie Nishimwe, Camélia Protopopescu, Collins Iwuji, Nonhlanhla Okesola, Bruno Spire, Joanna Orne-Gliemann, Nuala McGrath, Deenan Pillay, François Dabis, Joseph Larmarange, Sylvie Boyer

Abstract

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.

Reference

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.

Joseph Larmarange

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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)

Authors

Abstract

Reference