At the 11th IAS Conference on HIV Science (IAS 2021), the ATLAS Project is presenting 1 oral communication and two posters (see below).
d'Elbée Marc, Traore Métogara Mohamed, Badiane Kéba, Vautier Anthony, Simo Fotso Arlette, Kanku Kabemba Odé, Rouveau Nicolas, Godfrey-Faussett Peter, Maheu-Giroux Mathieu, Boily Marie-Claude, Medley Graham Francis, Larmarange Joseph and Terris-Prestholt Fern (2021) “Costs and costs-at-scale of provision of HIV self-testing kits by civil society organisations to key populations and their sexual partners in Côte d'Ivoire, Senegal and Mali” (poster PED500), presented at the 11th IAS Conference on HIV Science, Berlin. https://theprogramme.ias2021.org/Abstract/Abstract/476.Abstract: BACKGROUND: Despite significant progress on the proportion of individuals who know their HIV status in 2020, Côte d'Ivoire (76%), Senegal (78%), and Mali (48%) remain far below the 90-90-90 targets. Key populations including female sex workers (FSW), men who have sex with men (MSM), and people who use drugs (PWUD) are the most vulnerable groups with HIV prevalence at 5%-30%. HIV self-testing (HIVST) was introduced in West Africa in 2019 as a new testing modality through the ATLAS project coordinated by the international partner organisation Solthis (IPO). METHODS: We estimated the costs of implementing HIVST through twenty-three civil society organisations (CSO)-led models in Côte d'Ivoire (N=7), Senegal (N=11), and Mali (N=5). We modelled costs for programme transition (2021) and early scale-up (2022-2023). RESULTS: Between July-2019 and September-2020, a total of 51,028, 14,472 and 34,353 HIVST kits were distributed in Côte d'Ivoire, Senegal, and Mali, respectively. Across countries, 64%-80% of HIVST kits were distributed to FSW, 20%-31% to MSM, and 5%-8% to PWUD. Cost per HIVST kit distributed ranged from $12-$15 (FSW), $14-$27 (MSM), to $15-$143 (PWUD), driven by personnel costs at various intervention levels (53%-78% of total costs), and HIVST kit costs (2%-15%). Predicted costs at scale-up ranged from $5-$13 (FSW), $5-$24 (MSM), to $13-$53 (PWUD), and were mainly explained by the spreading of IPO costs over higher HIVST distribution volumes. CONCLUSIONS: In all countries, CSO-led HIVST kit provision to key populations showed relatively high costs related to the progressive integration of the programme to CSO activities and contextual challenges (e.g. country security issues). In the transition to scale-up and further integration of the HIVST programme into CSO activities, this model can become less costly. This is particularly relevant as it remains today the most promising strategy for reaching key populations and their sexual partners not accessing HIV testing.
Ky-Zerbo Odette, Desclaux Alice, Kouadio Brou Alexis, Rouveau Nicolas, Vautier Anthony, Sow Souleymane, Camara Cheick Sidi, Boye Sokhna, Pourette Dolorès, Younoussa Sidibé, Maheu-Giroux Mathieu, Larmarange Joseph and for the ATLAS Team (2021) “Introducing HIV self-testing (HIVST) among key populations in West Africa: a baseline qualitative analysis of key stakeholders' attitudes and perceptions in Côte d'Ivoire, Mali, and Senegal” (poster PEC320), presented at the 11th IAS Conference on HIV Science, Berlin. https://theprogramme.ias2021.org/Abstract/Abstract/972.Abstract: BACKGROUND: HIV self-testing (HIVST) is a way to improve HIV status knowledge and access to HIV testing. Since 2019, the ATLAS project has introduced, promoted, and delivered HIVST in Côte d'Ivoire, Mali, and Senegal, in particular among female sex workers (FSW), men who have sex with men (MSM), people who use drugs (PWUD), these key populations being particularly vulnerable to HIV and stigmatized in West Africa. Stakeholders involved in HIV testing activities targeting key populations are essential for the deployment of HIVST. Here, we analyze their perceptions of the introduction of HIVST in their countries. METHODS: A qualitative survey was conducted from September to November 2019 within three months of HIVST distribution initiation. Individual interviews were conducted with 60 stakeholders (Côte d'Ivoire, 19; Mali, 20; Senegal, 21). Semi-structured interviews were recorded, translated when necessary, and transcribed. Data were coded using Dedoose"© software for thematic analyses. RESULTS: In the three countries, stakeholders express enthusiasm and willingness to introduce HIVST for several reasons. HIVST is considered able to reduce stigma, preserve anonymity and confidentiality, especially for MSM and PWUD; reach key populations that do not access testing via usual strategies and HIV+ key populations; remove spatial barriers; save time for providers and users, notably for FSW; and empower users with autonomy and responsibility. HIVST is noninvasive and easy to use. Secondary distribution of HIVST seems appropriate for reaching partners of MSM, with confidentiality. However, stakeholders expressed doubts about key populations' ability, particularly PWUD, to correctly use HIVST kits, ensure quality secondary distribution, accept a reactive test result, and use confirmation testing and care services. They also mentioned that FSW might have difficulties redistributing HIVST to their clients and partners. CONCLUSIONS: HIVST is considered an attractive strategy to improve access to HIV testing for key populations. The doubts about users' capacities could be a matter of reflective communication with stakeholders before HIVST implementation in other western African countries.
Larmarange Joseph (2021) “From Key Populations to beyond : using HIV self-testing to increasingly reach vulnerable groups in West-Africa” (communication orale), presented at the 11th IAS Conference on HIV Science, Berlin. https://theprogramme.ias2021.org/Programme/Session/163.