Joseph Larmarange

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

Joseph LARMARANGE — 2026-01-30T17:14:26Z

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

Authors

Arlette Simo Fotso, Christian Koukobo, Romain Silhol, Arsène Kouassi Kra, Marie-Claude Boily, Anthony Vautier, Joseph Larmarange on behalf of the ATLAS team

Abstract

Background

Awareness of HIV status is crucial for accessing HIV care and prevention but remains suboptimal in West Africa. The ATLAS initiative, launched in Côte d'Ivoire, Mali, and Senegal, addressed this gap by distributing approximately 380,000 HIV self-testing (HIVST) kits from 2019 to 2021, primarily to key populations and their social networks. This study assessed levels and correlates of Knowledge, Attitudes, and Practices (KAP) related to HIVST in the Bas-Sassandra region of Côte d'Ivoire following ATLAS's introduction.

Method

A cross-sectional population-based survey was conducted in the Bas-Sassandra region in 2021 among individuals aged 15–49. A total of 6,271 people (3,203 men and 3,068 women) were interviewed. They were selected using a three-stage stratified sampling approach in the Bas-Sassandra region. Bivariate statistics and multivariable logistic regressions were used to assess KAP levels and the associated factors.

Results

Although few participants reported having heard about HIVST (11%) or having used it (3%), most of them reported that if it were freely available, they would be interested/very interested in using it for themselves (76%), as well as for their sexual partners (75%). Education and wealth were positively associated with knowledge and positive attitudes towards HIVST among both men and women, whereas age was positively correlated to knowledge and use of HIVST among men only. The number of sexual partners over the last 12 months was positively associated with knowledge of HIVST and willingness to use HIVST for themselves or their sexual partners among both sexes. We also found that high HIV-related knowledge and low levels of negative attitude were positively associated with positive attitudes towards HIVST, while exposure to the media appeared to be correlated to knowledge of HIVST.

Conclusion

The high level of positive attitudes towards HIVST calls for a scaling up of access to HIVST in the region. Specific attention to groups with the worst KAP, such as the less educated, the poor or those with more HIV-related negative attitude, could enhance the success of such initiatives.

Pilot Implementation of HIV Self-Testing Delivery in Private Pharmacies Combined With a Respondent-Driven Sampling Method to Improve HIV Testing for Men Who Have Sex With Men and Transgender Women in Phnom Penh (ANRS 0100s): Protocol for a Prospective Mixed Method Feasibility Study

Joseph LARMARANGE — 2025-06-27T09:45:00Z

Pilot Implementation of HIV Self-Testing Delivery in Private Pharmacies Combined With a Respondent-Driven Sampling Method to Improve HIV Testing for Men Who Have Sex With Men and Transgender Women in Phnom Penh (ANRS 0100s): Protocol for a Prospective Mixed Method Feasibility Study

Chhavarath Dary , Olivier Ségéral , Joseph Larmarange , Emilie Mosnier , Mohamed Ben Mechlia , Vichea Ouk , Bruno Spire , Vonthanak Saphonn

JMIR Research Protocols, 2025, 14, pp.e65351. ⟨10.2196/65351⟩

Article dans une revue

inserm-05471400

Authors

Chhavarath Dary, Olivier Ségéral, Joseph Larmarange, Emilie Mosnier, Mohamed Ben Mechlia, Vichea Ouk, Bruno Spire, Vonthanak Saphonn

Abstract

Background: Regular testing is recognized as a key strategy for HIV control. The 2023 Integrated Biological and Behavioral Survey (IBBS) in Cambodia revealed that nearly one-third of men who have sex with men (MSM) and one-fourth of transgender women (TGW) were never tested for HIV or not for more than 12 months. The majority of MSM and TGW were tested at community-based organizations (CBOs) facilities and by CBO outreach workers, while private facilities are poorly used for HIV testing (6% for MSM and 9% for TGW). Private pharmacies could be able to deliver HIV self-testing kits giving the advantage of confidentiality, anonymity, and time savings, in particular for those reluctant to visit CBOs. The recruitment of participants using a respondent-driven sampling method could provide the opportunity to reach MSM and TGW outside the network of CBOs.

Objective: This pilot study aims to evaluate the feasibility of free HIV self-testing delivery by a private pharmacy combined with a respondent-driven sampling method to improve HIV testing among MSM and TGW in Phnom Penh, Cambodia.

Methods: Both qualitative and quantitative approaches are used in this prospective feasibility study. The protocol was approved by the National Ethics Committee for Health Research in Cambodia (N0 351 NECHR). MSM and TGW aged more than 18 years old will be recruited via a respondent-driven sampling method with seeds recruited at hot spots and on social networks. The seeds will then distribute electronic and paper coupons to their networks physically and via social media, messaging, and calling applications. Each recruited peer will bring the coupon to receive direct and free access to one HIV self-testing kit at partner pharmacies as well as 10 additional coupons to recruit members of their networks. As for quantitative analysis, data from the study website will be imported, appended into a single matrix using Stata version 18SE (StataCorp), and analyzed using descriptive statistics, with a statistical significance level of .05. After 6 months, a qualitative assessment will be conducted among users, providers, and policymakers or key stakeholders to evaluate the acceptability and appropriateness of the strategy and to identify the barriers, facilitators, and recommendations. All transcripts will be analyzed according to the 6-phase reflexive thematic approach by Braun and Clarke. The results will be reported by participant-based and provider-based issues. QSR NVivo V.14 for Windows will be used to manage the data.

Results: The study was funded by Agence nationale de recherches sur le sida, les hépatites, et les maladies infectieuses émergentes (ANRS) in September 2023. Approval of the study protocol was successfully obtained from the NECHR in Cambodia and the Commission Nationale de l'Informatique et des Libertés (CNIL) in France (Autorisation Tacite) in February 2025. Data collection will be conducted between September 2024 and December 2025. The initial results are expected to be published in February 2026.

Conclusions: This public-private partnership intervention could allow the hidden population of MSM and TGW in Phnom Penh to be reached and tested.

Trial Registration: ClinicalTrials.gov NCT05745168; https://clinicaltrials.gov/study/NCT05745168

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

Joseph LARMARANGE — 2024-07-21T15:55:00Z

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

Authors

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

Abstract

Introduction

HIV self-testing (HIVST) is a promising strategy to improve diagnosis coverage among key populations (KP). The ATLAS (Auto Test VIH, Libre d'Accéder à la connaissance de son Statut) programme implemented HIVST in three West African countries, distributing over 380,000 kits up between 2019 and 2021, focussing on community-led distribution by KP to their peers and subsequent secondary distribution to their partners and clients. We aim to evaluate the cost-effectiveness of community-led HIVST in Côte d'Ivoire, Mali and Senegal.

Methods

An HIV transmission dynamics model was adapted and calibrated to country-specific epidemiological data and used to predict the impact of HIVST. We considered the distribution of HIVST among two KP—female sex workers (FSW), and men who have sex with men (MSM)—and their sexual partners and clients. We compared the cost-effectiveness of two scenarios against a counterfactual without HIVST over a 20-year horizon (2019–2039). The ATLAS-only scenario mimicked the 2-year implemented ATLAS programme, whereas the ATLAS-scale-up scenario achieved 95% coverage of HIVST distribution among FSW and MSM by 2025 onwards. The primary outcome is the number of disability-adjusted life-years (DALY) averted. Scenarios were compared using incremental cost-effectiveness ratios (ICERs). Costing was performed using a healthcare provider's perspective. Costs were discounted at 4%, converted to $USD 2022 and estimated using a cost-function to accommodate economies of scale.

Results

The ATLAS-only scenario was highly cost-effective over 20 years, even at low willingness-to-pay thresholds. The median ICERs were $126 ($88–$210) per DALY averted in Côte d'Ivoire, $92 ($88–$210) in Mali and 27$ ($88–$210) in Senegal. Scaling-up the ATLAS programme would also be cost-effective, and substantial epidemiological impacts would be achieved. The ICERs for the scale-up scenario were $199 ($122–$338) per DALY averted in Côte d'Ivoire, $224 ($118–$415) in Mali and $61 ($18–$128) in Senegal.

Conclusions

Both the implemented and the potential scale-up of community-led HIVST programmes in West Africa, where KP are important to overall transmission dynamics, have the potential to be highly cost-effective, as compared to a scenario without HIVST. These findings support the scale-up of community-led HIVST to reach populations that otherwise may not access conventional testing services.

Potential population-level effects of HIV self-test distribution among key populations in Côte d'Ivoire, Mali, and Senegal : a mathematical modelling analysis

Joseph LARMARANGE — 2024-07-09T11:57:51Z

Authors

Romain Silhol, Mathieu Maheu-Giroux, Nirali Soni, Arlette Simo Fotso, Nicolas Rouveau, Anthony Vautier, Clémence Doumenc-Aïdara, Olivier Geoffroy, Kouassi Noel N'Guessan, Younoussa Sidibé, Odé Kanku Kabemba, Papa Alioune Gueye, Pauline Dama Ndeye, Christinah Mukandavire, Prof Peter Vickerman, Abdelaye Keita, Prof Cheikh Tidiane Ndour, Joseph Larmarange, Prof Marie-Claude Boily on behalf of theATLAS Team

Abstract

Background

During 2019–21, the AutoTest VIH, Libre d'accéder à la connaissance de son Statut (ATLAS) programme distributed around 380 000 HIV self-testing kits to key populations, including female sex workers, men who have sex with men, and their partners, in Côte d'Ivoire, Mali, and Senegal. We aimed to estimate the effects of the ATLAS programme and national scale-up of HIV self-test distribution on HIV diagnosis, HIV treatment coverage, HIV incidence, and HIV-related mortality.

Methods

We adapted a deterministic compartmental model of HIV transmission in Côte d'Ivoire, parameterised and fitted to country-specific demographic, behavioural, HIV epidemiological, and intervention data in Côte d'Ivoire, Mali, and Senegal separately during 1980–2020. We simulated dynamics of new HIV infections, HIV diagnoses, and HIV-related deaths within scenarios with and without HIV self-test distribution among key populations. Models were separately parameterised and fitted to country-specific sets of epidemiological and intervention outcomes (stratified by sex, risk, age group, and HIV status, if available) over time within a Bayesian framework. We estimated the effects on the absolute increase in the proportion of people with HIV diagnosed at the end of 2021 for the ATLAS-only scenario and at the end of 2028 and 2038 for the HIV self-testing scale-up scenario. We estimated cumulative numbers of additional HIV diagnoses and initiations of antiretroviral therapy and the proportion and absolute numbers of new HIV infections and HIV-related deaths averted during 2019–21 and 2019–28 for the ATLAS-only scenario and during 2019–28 and 2019–38 for the HIV self-testing scale-up scenario.

Findings

Our model estimated that ATLAS could have led to 700 (90% uncertainty interval [UI] 500–900) additional HIV diagnoses in Côte d'Ivoire, 500 (300–900) in Mali, and 300 (50–700) in Senegal during 2019–21, a 04 percentage point (90% UI 03–05) increase overall by the end of 2021. During 2019–28, ATLAS was estimated to avert 1900 (90% UI 1300–2700) new HIV infections and 600 (400–800) HIV-related deaths across the three countries, of which 386% (90% UI 318–483) of new infections and 701% (604–773) of HIV-related deaths would be among key populations. ATLAS would avert 15% (08–31) of all HIV-related deaths across the three countries during this period. Scaling up HIV self-testing would avert 162% (90% UI 100–231) of all new HIV infections during 2019–28 in Senegal, 53% (30–89) in Mali, and 16% (10–24) in Côte d'Ivoire. HIV self-testing scale-up among key populations was estimated to increase HIV diagnosis by the end of 2028 to 13 percentage points (90% UI 08–19) in Côte d'Ivoire, 106 percentage points (53–168) in Senegal, and 36 percentage points (20–64) in Mali.

Interpretation

Scaling up HIV self-test distribution among key populations in western Africa could attenuate disparities in access to HIV testing and reduce infections and deaths among key populations and their partners.

Funding

Unitaid, Solthis, the UK Medical Research Council Centre for Global Infectious Disease Analysis, the EU European & Developing Countries Clinical Trials Partnership programme, and the Wellcome Trust.

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

Joseph LARMARANGE — 2024-06-14T13:29:00Z

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

Authors

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

Abstract

HIV self-testing (HIVST) empowers individuals to decide when and where to test and with whom to share their results. From 2019 to 2022, the ATLAS program distributed ∼ 400 000 HIVST kits in Côte d'Ivoire, Mali, and Senegal. It prioritised key populations, including female sex workers and men who have sex with men, and encouraged secondary distribution of HIVST to their partners, peers and clients.

To preserve the confidential nature of HIVST, use of kits and their results were not systematically tracked. Instead, an anonymous phone survey was carried out in two phases during 2021 to estimate HIVST positivity rates (phase 1) and linkage to confirmatory testing (phase 2). Initially, participants were recruited via leaflets from March to June and completed a sociobehavioural questionnaire. In the second phase (September-October), participants who had reported two lines or who reported a reactive result were recontacted to complete another questionnaire. Of the 2 615 initial participants, 89.7% reported a consistent response between the number of lines on the HIVST and their interpretation of the result (i.e., ‘non-reactive' for 1 line, ‘reactive' for 2 lines).

Overall positivity rate based on self-interpreted HIVST results was 2.5% considering complete responses, and could have ranged from 2.4% to 9.1% depending on the interpretation of incomplete responses. Using the reported number of lines, this rate was estimated at 4.5% (ranging from 4.4% to 7.2%). Positivity rates were significantly lower only among respondents with higher education. No significant difference was observed by age, key population profile, country or history of HIV testing.

The second phase saw 78 out of 126 eligible participants complete the questionnaire. Of the 27 who reported a consistent reactive response in the first phase, 15 (56%, 95%CI: 36 to 74%) underwent confirmatory HIV testing, with 12 (80%) confirmed as HIV-positive, all of whom began antiretroviral treatment.

The confirmation rate of HIVST results was fast, with 53% doing so within a week and 91% within three months of self-testing. Two-thirds (65%) went to a general public facility, and one-third to a facility dedicated to key populations.

The ATLAS HIVST distribution strategy reached people living with HIV in West Africa. Linkage to confirmatory testing following a reactive HIVST remained relatively low in these first years of HIVST implementation. However, if confirmed HIV-positive, almost all initiated treatment. HIVST constitutes a relevant complementary tool to existing screening services.

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

Joseph LARMARANGE — 2024-01-15T10:55:48Z

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

L'auto-dépistage du VIH a non seulement l'avantage d'être une méthode anonyme et rapide, mais a aussi et surtout le potentiel d'atteindre de nouveaux publics éloignés des milieux associatifs et médicaux. En effet, une fois distribués, les autotests peuvent être utilisés par les personnes qui les ont récupérés, mais aussi par leurs proches, partenaires sexuels ou collègues. C'est ce qu'on appelle la distribution secondaire et c'est l'un des grands succès du programme Atlas. Financé par Unitaid et mis en œuvre par Solthis et l'IRD, il promeut et déploie l'auto-dépistage du VIH en Côte d'Ivoire, au Mali et au Sénégal. Ainsi, quelque 400 000 autotests VIH y ont été distribués entre 2019 et 2022 auprès de populations clés, comme les travailleuses du sexe, les hommes ayant des rapports sexuels avec des hommes, et les personnes consommant des drogues.

ATLAS et la dispensation secondaire de kits d'autodépistage du VIH
par Projet ATLAS

https://www.youtube.com/watch?v=TJM...

Afin de connaître les pratiques des utilisatrices et utilisateurs finaux dans les trois pays, une enquête téléphonique anonyme a été réalisée de mars à juin 2021. Les retours sont encourageants : parmi les répondants, 30 % avaient reçu leur autotest via la distribution secondaire et, surtout, 41 % n'avait jamais effectué de dépistage avant d'utiliser l'autotest. Des résultats positifs qui confirment que la stratégie déployée par Atlas est une solution faisable, acceptable et soutenable sur le long terme pour lutter contre l'épidémie de VIH et ainsi poursuivre l'objectif 3 de développement durable de l'ONU.

Can HIV self-testing reach first-time testers? A telephone survey among self-test end users in Côte d'Ivoire, Mali, and Senegal

Joseph LARMARANGE — 2023-09-25T12:20:57Z

Can HIV self-testing reach first-time testers? A telephone survey among self-test end users in Côte d'Ivoire, Mali, and Senegal

Arsene Kra Kouassi , Arlette Simo Fotso , Kouassi Noël N'guessan , Olivier Geoffroy , Sidibé Younoussa , Odé Kanku Kabemba , Papa Alioune Gueye , Pauline Dama Ndeye , Nicolas Rouveau , Marie-Claude Boily , Romain Silhol , Marc d'Elbee , Mathieu Maheu-Giroux , Anthony Vautier , Joseph Larmarange

BMC Infectious Diseases, 2023, 22 (S1), pp.972. ⟨10.1186/s12879-023-08626-w⟩

Article dans une revue

hal-04216954

Authors

Arsène Kouassi Kra, Arlette Simo Fotso, Kouassi Noël N'guessan, Olivier Geoffroy, Sidibé Younoussa, Odé Kanku Kabemba, Papa Alioune Gueye, Pauline Dama Ndeye, Nicolas Rouveau, Marie-Claude Boily, Romain Silhol, Marc d'Elbée, Mathieu Maheu-Giroux, Anthony Vautier & Joseph Larmarange on behalf of the ATLAS team

Abstract

Background

Coverage of HIV testing remains sub-optimal in West Africa. Between 2019 and 2022, the ATLAS program distributed 400 000 oral HIV self-tests (HIVST) in Côte d'Ivoire, Mali, and Senegal, prioritising female sex workers (FSW) and men having sex with men (MSM), and relying on secondary redistribution of HIVST to partners, peers and clients to reach individuals not tested through conventional testing. This study assesses the proportion of first-time testers among HIVST users and the associated factors.

Methods

A phone-based survey was implemented among HIVST users recruited using dedicated leaflets inviting them to anonymously call a free phone number. We collected socio-demographics, sexual behaviours, HIV testing history, HIVST use, and satisfaction with HIVST. We reported the proportion of first-time testers and computed associated factors using logistic regression.

Results

Between March and June 2021, 2 615 participants were recruited for 50 940 distributed HIVST (participation rate: 5.1%). Among participants, 30% received their HIVST kit through secondary distribution (from a friend, sexual partner, family member, or colleague).

The proportion who had never tested for HIV before HIVST (first-time testers) was 41%. The main factors associated with being a first-time tester were sex, age group, education level, condom use, and secondary distribution. A higher proportion was observed among those aged 24 years or less (55% vs 32% for 25–34, aOR: 0.37 [95%CI: 0.30–0.44], and 26% for 35 years or more, aOR: 0.28 [0.21–0.37]); those less educated (48% for none/primary education vs 45% for secondary education, aOR: 0.60 [0.47–0.77], and 29% for higher education, aOR: 0.33 [0.25–0.44]). A lower proportion was observed among women (37% vs 43%, aOR: 0.49 [0.40–0.60]); those reporting always using a condom over the last year (36% vs 51% for those reporting never using them, aOR: 2.02 [1.59–2.56]); and those who received their HISVST kit through primary distribution (39% vs 46% for secondary distribution, aOR: 1.32 [1.08–1.60]).

Conclusion

ATLAS HIVST strategy, including secondary distribution, successfully reached a significant proportion of first-time testers. HIVST has the potential to reach underserved populations and contribute to the expansion of HIV testing services in West Africa.

Assessing the potential population-level impacts of HIV self-testing distribution among key populations in Cote d'Ivoire, Mali, and Senegal: a mathematical modelling analysis

Joseph LARMARANGE — 2023-08-28T14:53:40Z

Authors

Romain Silhol, Mathieu Maheu-Giroux, Nirali Soni, Arlette Simo Fotso, Nicolas Rouveau, Anthony Vautier, Clémence Doumenc-Aidara, Olivier Geoffroy, Kouassi Noel N'Guessan, Younoussa Sidibe, Ode Kanku Kabemba, Papa Alioune Gueye, Christinah Mukandavire, Peter Vickerman, Abdelaye Keita, Cheikh Tidiane Ndour, Eboi Ehui, Joseph Larmarange, Marie-Claude Boily for the ATLAS Team

Abstract

Background: A third of people living with HIV (PLHIV) in Western Africa had an undiagnosed infection in 2020. In 2019-2021, the ATLAS programme has distributed a total of 380 000 HIV self-testing (HIVST) kits to key populations (KP) including female sex workers (FSW) and men who have sex with men (MSM), and their partners in Cote d'Ivoire, Mali and Senegal. We predicted the potential impact of ATLAS and of national HIVST scale-up strategies among KP.

Methods: A deterministic model of HIV transmission was calibrated to country-specific empirical HIV and intervention data over time. We simulated scenarios reflecting 1) the actual ATLAS HIVST distribution only over 2019-2021 ( 2% of all tests done in countries), and 2) ATLAS followed by a scale-up of HIVST distribution to KP (total of 570 000 kits distributed each year). Impacts on HIV diagnosis, new HIV infections and deaths were derived using counterfactual scenarios without HIVST.

Findings: ATLAS was predicted to substantially increase HIV diagnosis among KP by the end of 2021, especially among MSM in Mali (94.3 percentage point [pp] increase), and a 1.0pp increase overall. ATLAS might have averted a median of 706 new HIV infections among KP over 2019-2028 in the 3 countries combined, especially among MSM, and 1794 new HIV infections (0.4-3.3% of all new HIV infections across countries) and 591 HIV-related deaths overall. HIVST scale-up increased HIV diagnosis at the end of 2028 by around 8pp among FSW and 33pp among MSM in every country. Overall increases ranged from 1.0pp (Cote d'Ivoire) to 11.0pp (Senegal). HIVST scale-up may avert 3-5% of new HIV infections among FSW, 3-10% among FSW clients, and 20-28% among MSM across countries (and 2-16% overall), and avert 13-18% of HIV-related deaths among MSM over 2019-2028.

Interpretation: Scaling-up HIVST distribution among KP in Western Africa may substantially attenuate disparities in access to HIV testing and help reduce HIV infections and deaths among KP and their partners.

Knowledge, attitude and practices towards HIV testing following the introduction of self-testing: The case of the ATLAS project in Côte d'Ivoire

Joseph LARMARANGE — 2023-06-15T13:00:00Z

Poster presented at AIDS Impact conference in Stockholm, Sweden, 12-14 June 2023.

Knowledge, attitude and practices towards HIV testing following the introduction of self-testing: The case of the ATLAS project in Côte d'Ivoire

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

AIDS Impact Conference, Jun 2023, Stockholm, Sweden

Poster de conférence

hal-04120627

Authors

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

Abstract

Background

HIV testing is a central element of the strategy to end AIDS epidemic, as status awareness is the entry point to HIV care. In West Africa, only 68% of people living with HIV (PLHIV) were aware of their HIV status in 2019. To address the testing gap, the ATLAS project distributed a total of 400000 self-tests (HIVST) in three West African countries between 2019 and 2022, including 200 000 kits in Côte d'Ivoire. The aim of this study is to assess levels and correlates of knowledge, attitude and practice towards HIV conventional testing (tests other than HIVST) and self-testing after the introduction of HIVST in Cote d'Ivoire.

Method

We conducted the population-based cross-sectional in the Bas-Sassandra District of Côte d'Ivoire, 24 months after HIVST was introduced in the region by ATLAS. ATLAS Household Survey (AHS) used a three-stage stratified sampling approach – 3 of the strata are the 3 departments with ATLAS activities and 1 includes departments with almost none, each further stratified on urban and rural settings. Face-to-
face interviews were conducted in a representative a sample of the population aged 15-49. One main objective of the survey was to assess the effect of the ATLAS initiative on HIV testing.

Weighed proportions and chi-square tests were used to assess knowledge of, attitude towards and practice of HIV conventional and self testing, comparing male and female on the one hand and departments with and without ATLAS HIVST distribution activities on the other hand. Logistic regressions were used to identified factors associated with knowledge of, attitude towards and practice of HIV conventional and self testing (ongoing analysis).

Preliminary results

A total of 6274 people with median age of 29 were interviewed and completed the questionnaire (3205 males and 3069 females). Most participants were in couple (44% males and 59% females) and have attended school (63% males and 45% females).

Despite most participants knowing about HIV-AIDS (97 % Males and 96% females), very few reported having heard about HIVST (11% males and 10% females). However, most participants showed a positive attitude toward HIVST and reported that they would be interested/very interested to use it if freely available for themselves (75% males and 71% females), as well as for their sexual partners. About 18% of females and 10% of males reported having performed at least 1 conventional test in the last 12 months, while 3% of participants had already used a HIVST in the past.

Conclusion

Although knowledge and use of HIVST remain relatively low in the region, participants show a positive attitude toward HIVST, and express willingness to use it if freely available. Next results will tell how the observed results differ between participants living in department with ATLAS HIVST distribution and others, and how significant are the differences. It will also provide an overview of associated factors. This will provide policy makers with tools for potential actions in order to improve HIV testing and advance progress towards UNAIDS targets to achieve 95 % of PLHIV who know their status by 2025.

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.

Joseph Larmarange

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