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

Population-level viremia predicts HIV incidence at the community level across the Universal Testing and Treatment Trials in eastern and southern Africa

Joseph LARMARANGE — 2023-07-20T11:00:49Z

Population-level viremia predicts HIV incidence at the community level across the Universal Testing and Treatment Trials in eastern and southern Africa

Joseph Larmarange , Pamela Bachanas , Timothy Skalland , Laura Balzer , Collins Iwuji , Sian Floyd , Lisa Mills , Deenan Pillay , Diane Havlir , Moses Kamya , Helen Ayles , Kathleen Wirth , François Dabis , Richard Hayes , Maya Petersen

PLOS Global Public Health, 2023, 3 (7), pp.e0002157. ⟨10.1371/journal.pgph.0002157⟩

Article dans une revue

hal-04166971

Authors

Joseph Larmarange, Pamela Bachanas, Timothy Skalland, Laura B. Balzer, Collins Iwuji, Sian Floyd, Lisa A. Mills, Deenan Pillay, Diane Havlir, Moses R. Kamya, Helen Ayles, Kathleen Wirth, François Dabis, Richard Hayes, Maya Petersen, for the UT³C consortium

Abstract

Universal HIV testing and treatment (UTT) strategies aim to optimize population-level benefits of antiretroviral treatment. Between 2012 and 2018, four large community randomized trials were conducted in eastern and southern Africa. While their results were broadly consistent showing decreased population-level viremia reduces HIV incidence, it remains unclear how much HIV incidence can be reduced by increasing suppression among people living with HIV (PLHIV).

We conducted a pooled analysis across the four UTT trials. Leveraging data from 105 communities in five countries, we evaluated the linear relationship between i) population-level viremia (prevalence of non-suppression–defined as plasma HIV RNA >500 or >400 copies/mL–among all adults, irrespective of HIV status) and HIV incidence; and ii) prevalence of non-suppression among PLHIV and HIV incidence, using parametric g-computation.

HIV prevalence, measured in 257 929 persons, varied from 2 to 41% across the communities; prevalence of non-suppression among PLHIV, measured in 31 377 persons, from 3 to 70%; population-level viremia, derived from HIV prevalence and non-suppression, from < 1% to 25%; and HIV incidence, measured over 345 844 person-years (PY), from 0.03/100PY to 3.46/100PY.

Decreases in population-level viremia were strongly associated with decreased HIV incidence in all trials (between 0.45/100PY and 1.88/100PY decline in HIV incidence per 10 percentage points decline in viremia). Decreases in non-suppression among PLHIV were also associated with decreased HIV incidence in all trials (between 0.06/100PY and 0.17/100PY decline in HIV incidence per 10 percentage points decline in non-suppression).

Our results support both the utility of population-level viremia as a predictor of incidence, and thus a tool for targeting prevention interventions, and the ability of UTT approaches to reduce HIV incidence by increasing viral suppression. Implementation of universal HIV testing approaches, coupled with interventions to leverage linkage to treatment, adapted to local contexts, can reduce HIV acquisition at population level.

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

Long-term survival among people living with HIV in rural South Africa: results from 6 years of observation in the ANRS 12249 treatment as prevention trial

Joseph LARMARANGE — 2021-07-19T09:00:00Z

Long-term survival among people living with HIV in rural South Africa: results from 6 years of observation in the ANRS 12249 treatment as prevention trial

Kathy Baisley , Joanna Orne-Gliemann , Joseph Larmarange , Mélanie Plazy , Dami Collier , Jaco Dreyer , T Mngomezulu , Kobus Herbst , W Hanekom , François Dabis , Mark Siedner , Collins Iwuji

11th IAS Conference on HIV Science (IAS 2021), Jul 2021, Berlin, Germany

Poster de conférence

hal-04121468

Authors

C. Iwuji, K. Baisley, J. orne-Gliemann, J. Larmarange, M. Plazy, D. Collier, J. Dreyer, T. Mngomezulu, K. Herbst, W. Hanekom, F. Dabis, M. Siedner

Abstract

BACKGROUND: Universal test-and-treat trials increased population-level virological suppression across trial sites in sub-Saharan Africa. 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-randomised trial implemented in 22 communities in rural South Africa, from 2012'2016. Households were offered six-monthly home-based HIV testing. Immediate antiretroviral therapy (ART) was offered in trial clinics to all people living with HIV (PLHIV) in the intervention clusters and according to national guidelines in the control clusters. At trial end, individuals attending the intervention clinics were transferred to the public ART programme, with a 'treat-all' strategy adopted in September 2016. Deaths during and two years after trial end were ascertained through annual demographic surveillance. Random effects Poisson regression was used to estimate rate ratios (RR) and 95%CI for the effect of trial arm on mortality among i) all PLHIV regardless of serostatus awareness, ii) PLHIV aware of their status, iii) those not on ART at entry to trial clinics. An interaction term between period and treatment arm was included, to allow the effect of trial arm to differ between periods.

RESULTS: Amongst all PLHIV and those aware of their serostatus, there was no effect of immediate ART on mortality (Table). Among individuals who started ART during the trial, there was evidence that the intervention decreased mortality (aRR=0.69, 95%CI=0.45-1.04, p=0.08), although the effect was primarily during the trial (aRR=0.49, 95%CI=0.28-0.85, p=0.01), but not after the trial ended (aRR=1.15, 95%CI=0.59-2.21, p=0.69).

CONCLUSIONS: The 'treat-all' strategy resulted in a mortality benefit amongst individuals who started ART within the trial but not in all PLHIV over 6 years of follow-up. To achieve maximum benefit of immediate ART in South Africa, barriers to ART uptake and retention in care need to be addressed.

VIH, Hépatites virales, Santé sexuelle

Joseph LARMARANGE — 2020-09-18T08:41:18Z

L'AFRAVIH – Alliance francophone des acteurs de santé contre le VIH et les infections virales chroniques – propose un ouvrage faisant le point des connaissances, des stratégies et des programmes d'actions à conduire dans trois domaines clés de la santé publique, trois défis de dimension mondiale qui concernent l'ensemble des populations et dont l'intrication pose des questions de santé globale : la lutte contre le VIH et contre les hépatites, avec la prise en compte de la santé sexuelle comme élément déterminant de la santé.

Participation

J'y ai coordonné avec Jade Ghosn la section dédiée à la Prévention du VIH et j'y signe ou co-signe trois chapitres.

Larmarange Joseph (2020) « Prévention du VIH - Introduction », in VIH, Hépatites virales, Santé sexuelle, par Christine Katlama, Jade Ghosn, et Gilles Wandeler, Paris : AFRAVIH, EDP sciences, p. 683-686. ISBN : 978-2-7598-2403-8. https://www.livre-afravih.org/.
Larmarange Joseph (2020) « Le Traitement antirétroviral comme moyen de prévention (TasP) », in VIH, Hépatites virales, Santé sexuelle, par Christine Katlama, Jade Ghosn, et Gilles Wandeler, Paris : AFRAVIH, EDP sciences, p. 702-711. ISBN : 978-2-7598-2403-8. https://www.livre-afravih.org/.
Gantner Pierre, Laurent Christian, Larmarange Joseph et Ghosn Jade (2020) « Prophylaxie préexposition (PrEP) », in VIH, Hépatites virales, Santé sexuelle, par Christine Katlama, Jade Ghosn, et Gilles Wandeler, Paris : AFRAVIH, EDP sciences, p. 715-726. ISBN : 978-2-7598-2403-8. https://www.livre-afravih.org/.

L'ouvrage est accessible gratuitement en ligne : https://www.livre-afravih.org/

Population-level Viremia Predicts HIV Incidence across the Universal Test and Treat Studies

Joseph LARMARANGE — 2020-03-19T11:06:07Z

Oral communication virtually presented at CROI 2020 the 9^th of March 2020

Authors

Maya Petersen, Joseph Larmarange, Kathleen Wirth, Timothy Skalland, Helen Ayles, Moses Kamya, Shahin Lockman, Collins Iwuji, François Dabis, Joseph Makhema, Diane Havlir, Sian Floyd, Richard Hayes for the UT3C Consortium

Abstract

Improved understanding of the extent to which increased population-level viral suppression will reduce HIV incidence is needed. Using data from four large Universal Test and Treat Trials, we evaluated the relationship between viremia and incidence and its consistency across epidemic contexts.

We analyzed data from 105 communities in the PopART (21 communities in South Africa and Zambia, 25,000 adults each), BCPP (30 communities in Botswana, 3,600 adults each), ANRS 12249 TasP (22 communities in South Africa, 1,300 adults each) and SEARCH (32 communities in Uganda and Kenya, 5,000 adults each) studies. Communities ranged from rural to urban and varied in the mobility of their populations and their sex ratio ( 30% to 50% male). HIV incidence was measured via repeat testing between 2012-2018. Population viremia – % of all adults (HIV+ or HIV-) with HIV viremia – was estimated at midpoint of follow-up based on HIV prevalence and non-suppression among HIV+, with adjustment for differences between the measurement cohort and underlying population. Community-level regression, adjusted for study, was used to quantify the association between HIV incidence and viremia and to evaluate cross-study heterogeneity.

HIV prevalence (measured in 257,929 total persons, PopART: 37,006; BCPP: 12,570; TasP: 20,978; SEARCH: 187,375), ranged from 2% to 40% by community. Non-suppression among HIV+ (measured in 39,928 persons, PopART: 6,233; BCPP: 2,318; TasP: 6,617; SEARCH: 16,209) ranged from 3% to 70%. HIV incidence (measured over 345,844 person-years, PopART: 39,702; BCPP: 8,551; TasP: 26,832; SEARCH: 270,759) ranged from 0.03 to 3.4 per 100PY. Population-level viremia was strongly associated with HIV incidence; pooling across studies, HIV incidence decreased by 0.07/100PY (95% CI: 0.05,0.10, p<0.001) for each 1% absolute decrease in viremia. Incidence was significantly associated with viremia in each study; however, both strength of the incidence-viremia relationship (slope) and projected incidence at 0% viremia (intercept) differed (Figure).

Lower population-level HIV viremia was associated with lower HIV incidence in all four Universal Test and Treat Studies, conducted in a wide range of epidemic contexts in sub-Saharan Africa. Differences in external infection rate (due to variation in community size, mobility, and sex ratio) may have contributed to heterogeneity between studies.

Reference

Petersen Maya, Larmarange Joseph, Wirth Kathleen E, Skalland Timothy, Ayles Helen, Kamya Moses, Lockman Shahin, Iwuji Collins, Dabis François, Makhema Joseph, Havlir Diane, Floyd Sian, Hayes Richard et UT3C Consortium (2020) « Population-level Viremia Predicts HIV Incidence across the Universal Test and Treat Studies » (communication orale), présenté à Conference on Retroviruses and Opportunitic Infections (CROI), Boston. http://www.croiconference.org/sessions/population-level-viremia-predicts-hiv-incidence-across-universal-test-treat-studies.

What do the Universal Test and Treat trials tell us about the path to HIV epidemic control?

Joseph LARMARANGE — 2020-02-25T09:49:53Z

Authors

Diane Havlir, Shahin Lockman, Helen Ayles, Joseph Larmarange, Gabriel Chamie, Tendani Gaolathe, Collins Iwuji, Sarah Fidler, Moses Kamya, Sian Floyd, Janet Moore, Richard Hayes, Maya Petersen, Francois Dabis on behalf of the (Universal Test and Treat Trials) UT3 Consortium

Abstract

Introduction

Achieving HIV epidemic control globally will require new strategies to accelerate reductions in HIV incidence and mortality. Universal test and treat (UTT) was evaluated in four randomized population‐based trials (BCPP/Ya Tsie, HPTN 071/PopART, SEARCH, ANRS 12249/TasP) conducted in sub‐Saharan Africa (SSA) during expanded antiretroviral treatment (ART) eligibility by World Health Organization guidelines and the UNAIDS 90‐90‐90 campaign.

Discussion

These three‐year studies were conducted in Botswana, Zambia, Uganda, Kenya and South Africa in settings with baseline HIV prevalence from 4% to 30%. Key observations across studies were: (1) Universal testing (implemented via a variety of home and community‐based testing approaches) achieved >90% coverage in all studies. (2) When coupled with robust linkage to HIV care, rapid ART start and patient‐centred care, UTT achieved among the highest reported population levels of viral suppression in SSA. Significant gains in population‐level viral suppression were made in regions with both low and high baseline population viral load; however, viral suppression gains were not uniform across all sub‐populations and were lower among youth. (3) UTT resulted in marked reductions in community HIV incidence when universal testing and robust linkage were present. However, HIV elimination targets were not reached. In BCPP and HPTN 071, annualized HIV incidence was approximately 20% to 30% lower in the intervention (which included universal testing) compared to control arms (no universal testing). In SEARCH (where both arms had universal testing), incidence declined 32% over three years. (4) UTT reduced HIV associated mortality by 23% in the intervention versus control communities in SEARCH, a study in which mortality was comprehensively measured.

Conclusions

These trials provide strong evidence that UTT inclusive of universal testing increases population‐level viral suppression and decreases HIV incidence and mortality faster than the status quo in SSA and should be adapted at a sub‐country level as a public health strategy. However, more is needed, including integration of new prevention interventions into UTT, in order to reach UNAIDS HIV elimination targets.

Reference

Havlir Diane, Lockman Shahin, Ayles Helen, Larmarange Joseph, Chamie Gabriel, Gaolathe Tendani, Iwuji Collins, Fidler Sarah, Kamya Moses, Floyd Sian, Moore Janet, Hayes Richard, Petersen Maya et Dabis Francois (2020) « What do the Universal Test and Treat trials tell us about the path to HIV epidemic control? », Journal of the International AIDS Society, 23 (2) (février 24), p. e25455. DOI : 10.1002/jia2.25455. https://onlinelibrary.wiley.com/doi/abs/10.1002/jia2.25455.

No effect of test and treat on sexual behaviours at population level in rural South Africa

Joseph LARMARANGE — 2019-03-06T00:15:31Z

Authors

Rolland Matthieu, McGrath Nuala, Tiendrebeogo Thierry, Larmarange Joseph, Pillay Deenan, Dabis François, Orne-Gliemann Joanna for the ANRS 12249 TasP study group

Abstract

Context: Within the community-randomized ANRS 12249 Treatment-as-Prevention trial conducted in rural South Africa, we analysed sexual behaviours stratified by sex over time, comparing immediate antiretroviral therapy irrespective of CD4+ cell count vs. CD4+-guided antiretroviral therapy (start at CD4+ cell count > 350 cells/μl then >500 cells/μl) arms.

Methods: As part of the 6-monthly home-based trial rounds, a sexual behaviour individual questionnaire was administered to all residents at least 16 years. We considered seven indicators: sexual intercourse in the past month; at least one regular sexual partner in the past 6 months; at least one casual sexual partner in the past 6 months and more than one sexual partner in the past 6 months; condom use at last sex (CLS) with regular partner, CLS with casual partner, and point prevalence estimate of concurrency. We conducted repeated cross-sectional analyses, stratified by sex. Generalized Estimating Equations models were used, including trial arm, trial time, calendar time and interaction between trial arm and trial time.

Results: CLS with regular partner varied between 29–51% and 23–46% for men and women, respectively, with significantly lower odds among women in the control vs. intervention arm by trial end (P < 0.001). CLS with casual partner among men showed a significant interaction between arm and trial round, with no consistent pattern. Women declared more than one partner in the past 6 months in less than 1% of individual questionnaires; among men, rates varied between 5–12%, and odds significantly and continuously declined between calendar rounds 1 and 7 [odds ratio = 4.2 (3.24–5.45)].

Conclusion: Universal Test and Treat was not associated with increased sexual risk behaviours.

Reference

Rolland Matthieu, McGrath Nuala, Tiendrebeogo Thierry, Larmarange Joseph, Pillay Deenan, Dabis François, Orne-Gliemann Joanna et Group for the ANRS 12249 TasP study (2019) « No effect of test and treat on sexual behaviours at population level in rural South Africa », AIDS, 33 (4) (mars 15), p. 709. DOI : 10.1097/qad.0000000000002104. https://journals.lww.com/aidsonline/Abstract/2019/03150/No_effect_of_test_and_treat_on_sexual_behaviours.14.aspx.

Comment aborder la fin du sida ?

Joseph LARMARANGE — 2018-11-30T08:37:06Z

Intervention dans le cadre d'une journée d'études Les temporalités du sida : Collecter, conserver et exposer l'histoire sociale du VIH-sida organisée par le Musée des civilisations de l'Europe et de la Méditerranée (Mucem) à Marseille le 30 novembre 2018. Vidéo Référence
Larmarange Joseph (2018) « Comment aborder la fin du sida ? » (communication orale), présenté à Les temporalités du sida : Collecter, conserver et exposer l'histoire sociale du VIH-sida (MUCEM), Marseille. (…)

- Communications / VIH / SIDA, Prévention, Traitement antirétroviral (ARV), Dépistage, Treatment as Prevention (TasP), Autotests VIH

Temporal trends of population viral suppression in the context of Universal Test and Treat: results from the ANRS 12249 TasP trial in rural South Africa

Joseph LARMARANGE — 2018-07-30T10:02:03Z

Oral communication presented at the 22^nd International AIDS Conference in Amsterdam the 24^th of July, 2018, in a abstract session entitled Forging new pathways towards HIV elimination.

Authors

Joseph Larmarange, Mamadou Hassimiou Diallo, Nuala McGrath, Collins Iwuji, Mélanie Plazy, Rodolphe Thiébaut, Frank Tanser, Till Bärninghausen, Joanna Orne-Gliemann, Deenan Pillay, François Dabis for the ANRS 12249 TasP Study Group

Abstract

Background: The universal test-and-treat strategy (UTT) aims to maximize the proportion of all people living with HIV (PLWHIV) on antiretroviral treatment (ART) and virally suppressed in a community, i.e. to reach population viral suppression (PVS). The ANRS 12249 TasP trial did not demonstrate an impact of universal ART on HIV incidence at population level (Lancet HIV 2017). Here, we investigated whether PVS improved during the course of the trial: differentially by arm, according to trial interventions or contextual changes.

Methods: The TasP cluster-randomized trial (2012-2016) implemented six-monthly repeated home-based HIV counselling and testing (RHBCT) and referral of PLWHIV to local HIV clinics in 2×11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters vs. regardless of CD4 count in intervention clusters.
Test results, clinic visits, ART prescriptions, viral loads, CD4 counts, migrations and deaths were used to produce information on residency status, HIV status and HIV care status for each participant. PVS was computed daily and per cluster among all resident PLWHIV (≥16, including those not in care). We used a mixed linear model to explore the relation between PVS with calendar time, time since cluster opening, trial arm and interaction between arm and time since cluster opening, adjusting on sociodemographic changes at cluster level.

Results: 8,646 PLWHIV were observed. Between January 1^st, 2013 and January 1^st, 2016, PVS increased significantly in both arms (intervention: 29.0% to 46.2%, +17.2, p< 0.001; control: 32.4% to 44.6%, +12.2, p < 0.001), but difference in temporal variation (+5.0%) was not significant (p=0.175).
According to adjusted model (figure) this increase was mainly attributable to RHBCT (measured by time since cluster opening). They were also some effect due to contextual changes (measured by calendar time). The effect attributable to universal ART (interaction term) was limited.

Conclusions: Although suboptimal, the UTT strategy implemented in TasP trial improved PVS over time. As it was mainly due to RHBCT rather than universal ART, it did not induce differences between arms, explaining the null effect observed on cumulative incidence, the main trial finding. Changes in ART initiation guidelines alone are not enough to significantly increase PVS.

Video

Medias

Reference

Larmarange Joseph, Diallo Mamadou Hassimiou, 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 (2018) « Temporal trends of population viral suppression in the context of Universal Test and Treat: results from the ANRS 12249 TasP trial in rural South Africa » (communication orale TUAC0103), présenté à 22nd International AIDS Conference, Amsterdam. http://programme.aids2018.org/Programme/Session/105.