Joseph Larmarange

La fin du sida est-elle toujours en vue ?

Joseph LARMARANGE — 2025-03-27T10:47:15Z

La fin du sida est-elle toujours en vue ?
Joseph Larmarange Journée Scientifique Sidaction 2025, Sidaction, Mar 2025, Paris, France Communication dans un congrès hal-05008296
Plénière d'ouverture de Journée scientifique Sidaction 2025, le 27 mars 2025 à Paris.

- Communications / Accès aux soins, Dépistage, Financement des programmes, Mesure d'impact, Pepfar, Politiques publiques, Prévention, Santé publique, Santé sexuelle, Science de la mise en œuvre , Traitement antirétroviral (ARV), Treatment as Prevention (TasP), VIH / SIDA

Transforming effective innovations into efficient interventions: contributions from social and implementation sciences

Joseph LARMARANGE — 2023-11-30T17:00:02Z

Transforming effective innovations into efficient interventions: contributions from social and implementation sciences

Joseph Larmarange

40 years of HIV science, Institut Pasteur; ANRS|MIE, Nov 2023, Paris, France

Communication dans un congrès

hal-04316678

Abstract

The history of the fight against AIDS has been marked by the development of major scientific and biomedical innovations: antiretroviral treatments, rapid screening tests, pre-exposure prophylaxis... However, these innovations have often been insufficient on their own to curve the epidemics. It has also been essential to innovate in terms of funding, organisation of services and care, advanced “out-of-hospital” strategies, human rights, taking account of the specific characteristics of the most vulnerable populations, etc.

Effective innovation will be ineffective if it is not adapted to the social, cultural, and legal constraints faced by populations and to the structural, organisational, and economic constraints of healthcare systems. Hence the need for a genuine science of implementation that is necessarily interdisciplinary and intersectoral.

Lutte contre le SIDA : les projets de recherche de l'ANRS à l'international

Joseph LARMARANGE — 2022-11-30T08:54:37Z

À deux jours de la Journée mondiale du SIDA du 1^er décembre, RFI donne la parole à des chercheurs et des acteurs de terrain, mobilisés pour lutter contre la maladie. Le VIH touche environ 38,4 millions de personnes dans le monde, dont plus des deux tiers (25,6 millions) dans la région africaine.

29/11/2022 (09h10 - 09h59 TU) PRIORITE SANTE

Au travers de programmes qui intègrent les patients et les associations, nous verrons comment cette dimension communautaire constitue l'un des piliers des projets conduits à l'international, par l'agence ANRS/Maladies Infectieuses Émergentes, qui coordonne et finance la recherche française sur ces pathologies. L'ANRS avait été, à son origine, en 1988, créée face à l'urgence de l'épidémie à VIH.

Joseph Larmarange, démographe en Santé publique à l'IRD et coprésident du CSS14 : Recherches en santé publique et en sciences de l'homme et de la société au sein de l'ANRS | Maladies infectieuses émergentes
Calice Talom Yomgne, chargé de programme éthique des soins et de la recherche au sein de l'association/collectif REDS, au Cameroun.
Yalikhatou Camara, personnel soignant, projet DIAVINA en Guinée Conakry
Fatoumata Hané, socio-anthropologue de la santé, enseignante chercheure à l'Université Assane Seck de Ziguinchor, au Sénégal et membre du Comité d'évaluation du CSS14 (Recherches en santé publique et en sciences de l'homme et de la société) à l'ANRS | Maladies infectieuses émergentes. Elle a participé au projet de recherche ANRS ETEA-VIH sur la sexualité des adolescents vivant avec le VIH au Sénégal.

Référence

Paré Caroline (2022) « Lutte contre le SIDA: les projets de recherche de l'ANRS à l'international », Priorité santé, Radio France Internatinal. https://www.rfi.fr/fr/podcasts/priorit%C3%A9-sant%C3%A9/20221129-lutte-contre-le-sida-les-projets-de-recherche-de-l-anrs-%C3%A0-l-international.

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

Risks and benefits of oral HIV pre-exposure prophylaxis for people with chronic hepatitis B

Joseph LARMARANGE — 2022-07-11T09:40:04Z

Risks and benefits of oral HIV pre-exposure prophylaxis for people with chronic hepatitis B

Amir M Mohareb , Joseph Larmarange , Arthur Y Kim , Patrick A Coffie , Menan Gérard Kouamé , Anders Boyd , Kenneth A Freedberg , Emily P Hyle

The Lancet HIV, 2022, Lancet HIV, 9 (8), pp.e585-e594. ⟨10.1016/S2352-3018(22)00123-0⟩

Article dans une revue

ird-03879814

Authors

Amir M Mohareb, Joseph Larmarange, Arthur Y Kim, Patrick A Coffie, Menan Gérard Kouamé, Anders Boy, Kenneth A Freedber, Emily P Hyle

Summary

Individuals with chronic hepatitis B virus (HBV) infection who are at substantial risk of HIV acquisition benefit from pre-exposure prophylaxis (PrEP) with tenofovir-based antiviral therapy. Considering that tenofovir potently inhibits HBV, providing PrEP to individuals with HBV effectively results in treatment of their HBV infection. However, some clinicians might be hesitant to initiate PrEP in people with chronic HBV due to unknown risks of HBV reactivation, hepatitis, and acute liver failure during periods of antiviral cessation. Unfortunately, these knowledge gaps affect scale up of PrEP among people with chronic HBV. Emerging data regarding the risks and benefits of antiviral cessation in people with chronic HBV suggest that PrEP can be safely initiated despite the risks of non-adherence or discontinuation. People with chronic HBV who stop PrEP should be closely monitored for HBV reactivation and hepatitis flares after antiviral cessation.

Early HIV treatment and survival over six years of observation in the ANRS 12249 Treatment as Prevention Trial

Joseph LARMARANGE — 2022-02-26T17:58:40Z

Early HIV treatment and survival over six years of observation in the ANRS 12249 Treatment as Prevention Trial

Kathy Baisley , Joanna Orne‐gliemann , Joseph Larmarange , Mélanie Plazy , Dami Collier , Jaco Dreyer , Thobeka Mngomezulu , Kobus Herbst , Willem Hanekom , François Dabis , Mark J Siedner , Collins Iwuji

HIV Medicine, 2022, 23 (8), pp.922-928. ⟨10.1111/hiv.13263⟩

Article dans une revue

hal-03610156

Authors

Kathy Baisley, Joanna Orne-Gliemann, Joseph Larmarange, Mélanie Plazy, Dami Collier, Jaco Dreyer, Thobeka Mngomezulu, Kobus Herbst, Willem Hanekom, Francois Dabis, Mark J. Siedner, Collins Iwuji

Abstract

Objectives

Population-based universal test and treat (UTT) trials have shown an impact on population-level virological suppression. We followed the ANRS 12249 TasP trial population for 6 years to determine whether the intervention had longer-term survival benefits.

Methods

The TasP trial was a cluster-randomized trial in South Africa from 2012 to 2016. All households were offered 6-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered through trial clinics to all people living with HIV (PLHIV) in intervention clusters and according to national guidelines in control clusters. After the trial, individuals attending the trial clinics were transferred to the public ART programme. Deaths were ascertained through annual demographic surveillance. Random-effects Poisson regression was used to estimate the effect of trial arm on mortality among (i) all PLHIV; (ii) PLHIV aware of their status and not on ART at trial entry; and (iii) PHLIV who started ART during the trial.

Results

Mortality rates among PLHIV were 9.3/1000 and 10.4/1000 person-years in the control and intervention arms, respectively. There was no evidence that the intervention decreased mortality among all PLHIV [adjusted rate ratio (aRR) = 1.10, 95% confidence interval (CI) = 0.85–1.43, p = 0.46] or among PLHIV who were aware of their status but not on ART. Among individuals who initiated ART, the intervention decreased mortality during the trial (aRR = 0.49, 95% CI = 0.28–0.85, p = 0.01), but not after the trial ended.

Conclusions

The ‘treat all' strategy reduced mortality among individuals who started ART but not among all PLHIV. To achieve maximum benefit of immediate ART, barriers to ART uptake and retention in care need to be addressed.

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.

Early ART Initiation Improves HIV Status Disclosure and Social Support in People Living with HIV, Linked to Care Within a Universal Test and Treat Program in Rural South Africa (ANRS 12249 TasP Trial)

Joseph LARMARANGE — 2020-11-23T16:47:41Z

Authors

Marion Fiorentino, Marie Nishimwe, Camelia Protopopescu, Collins Iwuji, Nonhlanhla Okesola, Bruno Spire, Joanna Orne-Gliemann, Nuala McGrath, Deenan Pillay, François Dabis, Joseph Larmarange, Sylvie Boyer & for the ANRS 12249 TaSP Study Group

Abstract

We investigated the effect of early antiretroviral treatment (ART) initiation on HIV status disclosure and social support in a cluster-randomized, treatment-as-prevention (TasP) trial in rural South Africa. Individuals identified HIV-positive after home-based testing were referred to trial clinics where they were invited to initiate ART immediately irrespective of CD4 count (intervention arm) or following national guidelines (control arm). We used Poisson mixed effects models to assess the independent effects of (a) time since baseline clinical visit, (b) trial arm, and (c) ART initiation on HIV disclosure (n = 182) and social support (n = 152) among participants with a CD4 count > 500 cells/mm³ at baseline. Disclosure and social support significantly improved over follow-up in both arms. Disclosure was higher (incidence rate ratio [95% confidence interval]: 1.24 [1.04; 1.48]), and social support increased faster (1.22 [1.02; 1.46]) in the intervention arm than in the control arm. ART initiation improved both disclosure and social support (1.50 [1.28; 1.75] and 1.34 [1.12; 1.61], respectively), a stronger effect being seen in the intervention arm for social support (1.50 [1.12; 2.01]). Besides clinical benefits, early ART initiation may also improve psychosocial outcomes. This should further encourage countries to implement universal test-and-treat strategies.

Reference

Fiorentino Marion, Nishimwe Marie, Protopopescu Camelia, Iwuji Collins, Okesola Nonhlanhla, Spire Bruno, Orne-Gliemann Joanna, McGrath Nuala, Pillay Deenan, Dabis François, Larmarange Joseph, Boyer Sylvie et for the ANRS 12249 TaSP Study Group (2021) « Early ART Initiation Improves HIV Status Disclosure and Social Support in People Living with HIV, Linked to Care Within a Universal Test and Treat Program in Rural South Africa (ANRS 12249 TasP Trial) », AIDS and Behavior, 25 (4) (avril), p. 1306-1322. DOI : 10.1007/s10461-020-03101-y. https://doi.org/10.1007/s10461-020-03101-y.

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.