Joseph Larmarange

Retrait du Pepfar : jusqu'à 56000 décès supplémentaires en Afrique de l'Ouest

Joseph LARMARANGE — 2025-04-30T15:02:44Z

Article de Fredérique Prabonnaud publié le 21 avril 2025 dans transveral, un magazine de Sidaction. Cet article présente des résultats préliminaires du projet Modélisation de l'impact épidémiologique potentiel du retrait du PEPFAR en Côte d'Ivoire, au Mali et au Sénégal.
L'arrêt comme la suspension du programme américain PEPFAR entraînera des conséquences sur l'épidémie de VIH en Afrique de l'Ouest : c'est la conclusion d'une modélisation dont les résultats préliminaires ont été présentés (…)

- Divers / Modélisation de l'impact d'un retrait du Pepfar, Côte d'Ivoire, Mali, Sénégal, Financement des programmes, Mesure d'impact, Pepfar, Politiques publiques, VIH / SIDA

Modéliser l'impact d'un retrait du PEPFAR en Afrique de l'Ouest (ANRS 0792) · Résultats préliminaires

Joseph LARMARANGE — 2025-04-07T10:14:23Z

Modéliser l'impact d'un retrait du PEPFAR en Afrique de l'Ouest (ANRS 0792) · Résultats préliminaires

Romain Silhol , Marie-Claude Boily , Joseph Larmarange , Anatole Mian , Raoul Moh , Serge Niangoran

Journées scientifiques 2025 de l'ANRS|MIE, ANRS|MIE, Apr 2025, Paris, France

Communication dans un congrès

hal-05022978

Auteurs

Romain Silhol, Marie-Claude Boily, Joseph Larmarange, Anatole Mian, Raoul Moh, Serge Niangoran

Modélisation de l'impact épidémiologique potentiel du retrait du PEPFAR en Côte d'Ivoire, au Mali et au Sénégal

Joseph LARMARANGE — 2025-03-20T13:03:45Z

Responsables scientifiques

LARMARANGE Joseph, Ceped
NIANGORAN Serge, PAC-CI
SILHOL Romain, Imperial College London

Partenaires

Imperial College London https://www.imperial.ac.uk/
PAC-CI (programme ANRS de Côte d'Ivoire) https://web.pac-ci.org/
Université Mac Gill https://www.mcgill.ca/

Membres du projet

BOILY Marie-Claude, Imperial College London
LARMARANGE Joseph, IRD / Ceped
MAHEU-GIROUX Mathieu, McGill University
MIAN Anatole, PAC-CI
MOH Raoul, PAC-CI
NIANGORAN Serge, PAC-CI
SILHOL Romain, Imperial College London

Financement

ANRS|MIE

Résumé

La décision de la nouvelle administration américaine d'interrompre le financement du plan présidentiel d'urgence pour la lutte contre le Sida (PEPFAR), officiellement pour une durée minimale de 90 jours à partir du 20 Janvier 2025, pourrait avoir des effets dévastateurs sur les populations vivant en Afrique de l'Ouest. En effet, ces fonds apportaient une aide vitale, non seulement en finançant plus de la moitié de l'accès au diagnostic et traitement antirétroviral contre le VIH auprès des populations vivant avec le VIH (PVVIH), mais supportait également de nombreux programmes de prévention de l'infection VIH, notamment parmi les populations clés (i.e., les plus touchées par le VIH), comme les travailleuses du sexe (TS) et les hommes ayant des rapports sexuels avec d'autres hommes (HSH). Ces financements américains, conjugués aux efforts nationaux des pays d'Afrique de l'Ouest et de la communauté internationale, ont permis de diminuer de moitié le nombre de nouvelles infections et décès dus au VIH entre 2010 et 2023 dans la région.

Afin d'alerter l'opinion et les pouvoirs politiques et scientifiques, il est urgent de

Comprendre l'impact épidémiologique (nouvelles infections, décès) de l'interruption et ou/arrêt de ce support afin de plaider pour une reprise de l'aide américaine et/ou d'un support européen additionnel ;
Identifier les activités de prévention et de traitement du VIH dont le maintien doit être considéré comme une priorité afin de minimiser l'impact du retrait PEPFAR ;
Évaluer quelles populations pourraient être les plus affectées par ce retrait, en s'appuyant sur des données stratifiées par population clé, transmises par des programmes nationaux de lutte nationale contre le sida, ainsi que les organisations non-gouvernementales implémentant ces politiques sur le terrain.

Pour ce projet, nous proposons d'adapter et utiliser le modèle épidémiologique développé dans le projet ATLAS pour simuler le cours de l'épidémie VIH pour la période 1980-2040 (prenant d'abord pour hypothèse contrefactuelle un maintien des activités PEPFAR au cours du temps), comparé à des scenarios de diminution des niveaux de prévention, diagnostic et traitement du VIH au cours de 2025-2040, au sein de chaque pays. Ce modèle a été récemment calibré pour représenter les dynamiques de transmission et contrôle du VIH au cours du temps en Côte d'Ivoire, au Mali et au Sénégal séparément, afin de prédire les dynamiques futures les plus plausibles.

Mots-Clés

Lutte contre le VIH, Pepfar, politiques publiques, modélisations épidémiologiques

Pays

Côte d'Ivoire, Mali, Sénégal

Calendrier

2025

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.

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

Joseph LARMARANGE — 2024-07-02T17:54:28Z

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

Authors

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

Abstract

Objectives

To estimate the epidemiological impact of past HIV interventions and the magnitude and contribution of undiagnosed HIV among different risk groups on new HIV acquisitions in Côte d'Ivoire, Mali and Senegal.

Design

HIV transmission dynamic models among the overall population and key populations [female sex workers (FSW), their clients, and MSM].

Methods

Models were independently parameterized and calibrated for each set of country-specific demographic, behavioural, and epidemiological data. We estimated the fraction of new HIV infections over 2012–2021 averted by condom use and antiretroviral therapy (ART) uptake among key population and nonkey population, the direct and indirect contribution of specific groups to new infections [transmission population-attributable fraction (tPAF)] over 2012–2021 due to prevention gaps, and the distribution of undiagnosed PWH by risk group in January 2022 and their tPAF over 2022–2031.

Results

Condom use and ART may have averted 81–88% of new HIV infections over 2012–2021 across countries, mostly because of condom use by key population. The tPAF of all key populations combined over 2012–2021 varied between 27% (Côte d'Ivoire) and 79% (Senegal). Male key population (clients of FSW and MSM) contributed most to new infections (>60% in Mali and Senegal) owing to their higher HIV prevalence and larger prevention gaps. In 2022, men represented 56% of all PWH with an undiagnosed infection in Côte d'Ivoire (male key population = 15%), 46% in Mali (male key population = 23%), and 69% in Senegal (male key population = 55%). If HIV testing and ART initiation rates remain at current levels, 20% of new HIV infections could be due to undiagnosed key population PWH in Côte d'Ivoire over 2022–2031, 53% in Mali, and 65% in Senegal.

Conclusion

Substantial HIV diagnosis gaps remain in Western Africa, especially among male key population. Addressing these gaps is key to impacting the HIV epidemics in the region and achieving the goal of ending AIDS by 2030.

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.

Joseph Larmarange

Retrait du Pepfar : jusqu'à 56000 décès supplémentaires en Afrique de l'Ouest

Modéliser l'impact d'un retrait du PEPFAR en Afrique de l'Ouest (ANRS 0792) · Résultats préliminaires

Modéliser l'impact d'un retrait du PEPFAR en Afrique de l'Ouest (ANRS 0792) · Résultats préliminaires

Auteurs

Modélisation de l'impact épidémiologique potentiel du retrait du PEPFAR en Côte d'Ivoire, au Mali et au Sénégal

Responsables scientifiques

Partenaires

Membres du projet

Financement

Résumé

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

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

Authors

Abstract

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

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

Authors

Abstract

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

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

Authors

Abstract

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

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

Authors

Abstract

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

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

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

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

Authors

Abstract

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

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

Authors

Abstract