Joseph Larmarange

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

Joseph LARMARANGE — 2024-02-27T17:28:12Z

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

Authors

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 for ATLAS team

Abstract

Background

Consultations for sexually transmitted infection (STI) provide an opportunity to offer HIV testing to both patients and their partners. This study describes the organisation of HIV self-testing (HIVST) distribution during STI consultations in Abidjan (Côte d'Ivoire) and analyse the perceived barriers and facilitators associated with the use and redistribution of HIVST kits by STI patients.

Materials and methods

A qualitative study was conducted between March and August 2021 to investigate three services providing HIVST: an antenatal care clinic (ANC), a general health centre that also provided STI consultations, and a dedicated STI clinic. Data were collected through observations of medical consultations with STI patients (N = 98) and interviews with both health professionals involved in HIVST distribution (N = 18) and STI patients who received HIVST kits for their partners (N = 20).

Results

In the ANC clinic, HIV testing was routinely offered during the first prenatal visit. HIVST was commonly offered to women who had been diagnosed with an STI for their partner's use (27/29 observations). In the general health centre, two parallel pathways coexisted: before the consultation, a risk assessment tool was used to offer HIV testing to eligible patients and, after the consultation, patients who had been diagnosed with an STI were referred to a care assistant for HIVST. Due to this HIV testing patient flow, few offers of HIV testing and HIVST were made in this setting (3/16). At the dedicated STI clinic, an HIVST video was played in the waiting room. According to the health professionals interviewed, this video helped reduce the time required to offer HIVST after the consultation. Task-shifting was implemented there: patients were referred to a nurse for HIV testing, and HIVST was commonly offered to STI patients for their partners' use (28/53). When an HIVST was offered, it was generally accepted (54/58). Both health professionals and patients perceived HIVST positively despite experiencing a few difficulties with respect to offering HIVST to partners and structural barriers associated with the organisation of services.

Conclusion

The organisation of patient flow and task-shifting influenced HIV testing and offers of HIVST kits. Proposing HIVST is more systematic when HIV testing is routinely offered to all patients. Successful integration requires improving the organisation of services, including task-shifting.

A community-based healthcare package combining testing and prevention tools, including pre-exposure prophylaxis (PrEP), immediate HIV treatment, management of hepatitis B virus, and sexual and reproductive health (SRH), targeting female sex workers (FSWs) in Côte d'Ivoire: the ANRS 12381 PRINCESSE project

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

Protocol paper of the ANRS 12381 PRINCESSE project.

A community-based healthcare package combining testing and prevention tools, including pre-exposure prophylaxis (PrEP), immediate HIV treatment, management of hepatitis B virus, and sexual and reproductive health (SRH), targeting female sex workers (FSWs) in Côte d'Ivoire: the ANRS 12381 PRINCESSE project

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

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

Article dans une revue

hal-03467822

Authors

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

Abstract

Background

Pre-exposure prophylaxis (PrEP) is recommended by the WHO for HIV prevention among female sex workers (FSWs). A study conducted in 2016–2017 in Côte d'Ivoire showed that if PrEP is acceptable, FSWs also have many uncovered sexual health needs. Based on this evidence, the ANRS 12381 PRINCESSE project was developed in collaboration with a community-based organization. The main objective is to develop, document, and analyze a comprehensive sexual and reproductive healthcare package among FSWs in Côte d'Ivoire.

Methods

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

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

Discussion

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

Trial registration

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

Sexual health needs of female sex workers reached by two NGOs in Côte d'Ivoire: considerations for the future implementation of PrEP

Joseph LARMARANGE — 2019-07-31T12:18:00Z

Oral communication presented at AIDS Impact 2019, July 31, 2019, in London.

Authors

Valentine Becquet, Marcellin Nouaman, Mélanie Plazy, Jean-Marie Masumbuko, Camille Anoma, Soh Kouamé, Christine Danel, Serge Eholié, Joseph Larmarange

Abstract

Aim

In West Africa, most countries have mixed HIV epidemics; new tools such as pre-exposure prophylaxis (PrEP) should target in priority most affected populations, particularly female sex workers (FSWs). This paper describes sexual and reproductive health (SRH) needs of FSWs in Côte d'Ivoire to inform the future implementation of PrEP in this population.

Method/Issue

The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two Ivorian community-based organizations. 1000 FSWs completed a standardized questionnaire assessing women's sociodemographic characteristics, sexual practices and behaviors, use of community health services, a priori acceptability of PrEP. Twenty-two in-depth interviews and eight focus group discussions were conducted at prostitution sites. FSWs were interviewed about risky practices and sexual behaviors, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services.

Results/Comments

The quantitative and qualitative results showed that FSWs were highly exposed to HIV despite their use of condoms with clients. 91% did not use condoms with their regular partner, despite their acknowledged concurrent sexual partnerships. 23% accepted condomless sexual intercourse for a large sum of money, especially when they had had few previous clients. Moreover, FSWs faced many unmet needs regarding SRH beyond HIV prevention and treatment. Inconsistent condom use exposed FSWs to STIs and undesired pregnancies. However, the prevalence of contraceptive use was low (40%) due to fear of contraception causing sterility. FSWs faced obstacles in accessing SRH care and preferred advice from their peers or self-medication.

Discussion

Implementing PrEP among FSWs in West Africa, such as in Côte d'Ivoire, constitutes an opportunity to consider the chronic follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into practicing HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.

Reference

Becquet Valentine, Nouaman Marcellin, Plazy Mélanie, Masumbuko Jean-Marie, Anoma Camille, Kouamé Soh, Danel Christine, Eholié Serge and Larmarange Joseph (2019) “Sexual health needs of female sex workers reached by two NGOs in Côte d'Ivoire: considerations for the future implementation of PrEP” (communication orale), presented at the AIDS Impact, London. http://www.aidsimpact.com/abstracts/-LZFgxedD3IcXCPGWlOB.

Cascade of provider-initiated HIV testing and counselling at specific life events (pregnancy, STIs, marriage plan) in Côte d'Ivoire

Joseph LARMARANGE — 2019-07-30T12:05:00Z

Poster presented at AIDS Impact 2019, July 30, 2019, in London.

Authors

Maxime Inghels, Arsène Kra Kouassi, Serge Niangoran, Anne Bekelynck, Séverine Carillon, Christine Danel, Lazare Sika, Mariatou Kone, Annabel Degrées du Loû, Joseph Larmarange

Abstract

Aim

In Côte d'Ivoire, only 57.8% of women and 37.0% of men have been HIV-tested at least once, which is insufficient to control the epidemic. The objective of this study is to describe at a population level if an HIV test was offered and performed at specific life-events where provider-initiated HIV testing is recommended.

Method/Issue

A cross-sectional telephone survey was conducted in 2017 among a representative sample of 3 867 individuals from the general population in Côte d'Ivoire. For each individual, the occurrence of the following events over the past 5 years was documented: birth of a child, Sexually Transmitted Infections—STIs, marriage. For each of these events, they were asked (i) if they have consulted a health professional, (ii) if they were offered an HIV test during that consultation and (iii) if they accepted it. The factors associated with each of these three steps were analyzed in separate logistic regression models stratified by type of event.

Results/Comments

While 63.7% of women were HIV-tested during their last pregnancy, only 16.9% of men were tested during their partner's last pregnancy and this proportion fell to 13.4% for people with an STI and 14.5% for people who got married. These levels of HIV testing were mainly driven by a lack of medical consultation (except for pregnant women) and a lack of testing proposal (except for pre-marital check-up). Testing acceptability was high.

Discussion

Improving HIV testing coverage in Côte d'Ivoire requires (i) facilitating attendance to health services in case of STIs, marriage plans and pregnancy—for men—and (ii) strengthening routine testing proposal during these occasions.

Reference

Inghels Maxime, Kra Kouassi Arsène, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Danel Christine, Sika Lazare, Koné Mariatou, Desgrées du Loû Annabel and Larmarange Joseph (2019) “Cascade of provider-initiated HIV testing and counselling at specific life events (pregnancy, STIs, marriage plan) in Côte d'Ivoire” (poster), presented at the AIDS Impact, London. http://www.aidsimpact.com/abstracts/-LZpZjJNQzSUV6vuH4Ku.

“We need incentives!” Health care professionals' reluctance to propose systematically HIV testing during general consultation in Cote d'Ivoire

Joseph LARMARANGE — 2019-07-30T11:56:00Z

Poster presented at AIDS Impact 2019, July 30, 2019, in London.

Authors

Séverine Carillon, Anne Bekelynck, Nelly Assoumou, Alexis Kouadio, Christine Danel, Honoré Ouantchi, Mariatou Kone, Joseph Larmarange

Abstract

Aim

To increase access to HIV testing, WHO recommended in 2007 provider-initiated HIV testing using a simplified but still exceptional approach in terms of pre-test counseling and consent. Cote d'Ivoire accepted in 2009 systematic HIV testing proposal in all medical consultations, irrespective of reasons. What are health care professionals (HCPs) perceptions and experiences related to testing proposal?

Method/Issue

An ethnographic multi-site study was conducted in 3 general medical services (urban, semi-urban, rural) in 2 Ivorian health districts: 37 in-depth interviews with HCPs and 200 observed medical consultations (general medicine). A thematic analysis was performed on HCPs' practices and discourses.

Results/Comments

The proportion of patients offered an HIV test was low (around 20%), due to HCPs' reluctance to propose an HIV test in the absence of clinical suspicion. When offered, HIV test was more often prescribed than proposed. The analysis revealed 4 types of explanations in HCPs discourses. (1) Due to stigma associated to HIV, HCPs feared a negative reaction from their patients: refusal, offence, distrust, loss of patients. (2) Time-consuming specificity of HIV testing in terms of counseling, consent and administrative procedure (separate record and dedicated prescription) is perceived by HCPs as not useful and inducing a work overload that should be financially compensated or realized by dedicated providers, as it was before 2009. (3) In the absence of clinical suspicion, they considered that proposing an HIV test during a general consultation is not medically justified and not their priority. (4) Finally, HCPs felt that they are not sufficiently trained.

Discussion

HCPs experiences and perceptions are negatively affected by the legacy of the successive HIV policies implemented since the beginning of the epidemy. Some complex procedures, historically implemented due to confidentiality and stigma issues, could maybe be simplified today. Integrating HIV testing in routine is a challenge considering that these activities were previously implemented with dedicated incentives, training and human resources. In a context of limited resources and mixed epidemic, how to prioritize and reorganize HIV testing in general consultations while motivating HCPs and being efficient in terms of public health?

Reference

Carillon Séverine, Bekelynck Anne, Assoumou Nelly, Kouadio Alexis, Danel Christine, Ouantchi Honoré, Koné Mariatou and Larmarange Joseph (2019) ““We need incentives!” Health care professionals' reluctance to propose systematically HIV testing during general consultation in Cote d'Ivoire” (poster), presented at the AIDS Impact, London. http://www.aidsimpact.com/abstracts/-LZtpxecQfo45SlC9BNU.