Reaching key and peripheral populations: a phone-based survey of HIV self-test users in West Africa
Authors
Arsène Kouassi Kra, Arlette Simo Fosto, Kouassi Noël N’guessan, Olivier Geoffroy, Sidibé Younoussa, Odé Kanku Kabemba, Baidy Dieng, Pauline Dama Ndeye, Nicolas Rouveau, Mathieu Maheu-Girou, Boily Marie-Claude, Silhol Romain, Marc d’Elbée, Anthony Vautier and Joseph Larmarange on behalf of the ATLAS team.
Abstract
Background
In West Africa, community-based strategies focussing on key populations (KP) such as female sex workers (FSW) and men having sex with men (MSM) have significantly improved access to HIV testing for KP. However, some of them (like “occasional FSW” or “hidden MSM”) remain difficult to reach, as well as their sexual partners and clients.
HIV self-testing (HIVST) kits can be distributed to primary contacts for personal use and through secondary distribution, where contacts are invited to redistribute kits to their peers, partners, and relatives.
Since 2019, the ATLAS program implements such a strategy in Côte d’Ivoire, Mali, and Senegal, including FSW-based and MSM-based activities within the communities.
Methods
To examine the profiles of actual HIVST users without actively tracking them, we implemented a phone‐based survey. Between March and June 2021, leaflets were distributed in Côte d’Ivoire, Mali and Senegal with the HIV test kits, inviting users to call a free phone number anonymously. Participation was rewarded with $3 USD of phone credit. Each flyer had a unique participation number to indirectly identify the distribution channel (DC), FSW-based or MSM-based.
Results
A total of 1305 participants were recruited among the FSW-DC and 1100 through MSM-DC across countries out of 44’598 HIVST kits distributed.
Of participants, 69% received their self-test kit through primary distribution and 31% received it from a friend (17%), sexual partner (7%), relative (6%) or colleague (1%), which illustrates the feasibility of secondary distribution.
In the FSW-DC, 48% of participants were male, and in the MSM-DC 9% were female, showing the capacity of HIVST to reach sexual partners and clients of KP. Only 50% of male participants in the MSM-DC reported to the interviewer that they ever had sex with a man, suggesting that some “hidden MSM” may also be recruited.
One third of female participants from the FSW-DC and 45% of male participants from the MSM-DC were testing for the first time. The proportions whose last HIV test was done more than a year were respectively 24% and 14%. These proportions are higher than observed in surveys conducted among FSW and MSM in the same countries.
Conclusions
HIVST offers a complementary testing approach to increase diagnosis coverage among KP that face barriers to conventional HIV testing strategies. Secondary distribution of HIVST is feasible and has the potential to reach, beyond KP, vulnerable peripheral groups.