Joseph Larmarange

Comparing modelled HIV incidence estimates with empirical HIV incidence observations in high-burden HIV African epidemic settings: systematic review and meta-regression

Joseph LARMARANGE — 2026-02-10T17:15:53Z

Authors

Oliver Stevens, Michelle Moffa, Joanne H. Hunt, Kyle Patel, Tihitna Aytenfisu, Adam Akullian, Rebecca L Anderson, Peter Bock, Amelia C Crampin, Sian Floyd, Simon Gregson, Richard J Hayes, Collins Iwuji, Ivan Kasamba, Daniel Kwaro, Joseph Larmarange, Shahin Lockman, Denna Michael, Louisa Moorhouse, Joseph Mugisha, Elphas Okango, Maya L Petersen, Victor Ssempijja, Emma Slaymaker, Frank Tanser, Cari van Schalkwyk, M. Kate Grabowski, Jeffrey W. Imai-Eaton

Abstract

Background

HIV incidence in sub-Saharan Africa has declined substantially since 2000 according to epidemic estimates published by UNAIDS. These estimates, derived by fitting mathematical models to national surveillance data, guide HIV programmes and epidemic response strategies. We assessed whether the level and age distribution of HIV incidence from modelled estimates were consistent with empirical HIV incidence observations, and whether incidence levels and trends were systematically different between study types, populations, and age groups.

Methods

We conducted an updated systematic review of adult HIV incidence data from sub-Saharan Africa published July 2019-February 2024 by searching Scopus, PubMed, Embase, and OVID databases, and combined with earlier systematic review data. We matched empirical incidence measurements between 1990-2023 to UNAIDS HIV incidence estimates by study area, sex, age group, and year. We used Bayesian mixed-effect Poisson regression to estimate (1) incidence rate ratios (IRR) between empirical observations and matched modelled incidence estimates adjusted for sex, year and study type/population; and (2) time trends in age-specific incidence from population-based cohort studies and household surveys.

Results

3560 HIV empirical incidence measurements were included from 179 studies conducted in 21 countries, comprising 23,000 new infections and 3.1 million person-years. Incidence observations from nationally-representative household surveys (IRR 1.07 95%CI 0.68, 1.67) and population-representative study populations (IRR 0.98 95%CI 0.51, 1.89) were not significantly different from matched modelled estimates, and declined at the same rate as modelled estimates (annual aRR 0.99 95%CI 0.98, 1.01). Studies among pregnant women (IRR 2.60 95%CI 1.58, 4.28), control arms of clinical trials (IRR 3.01 95%CI 1.90, 4.77) and key populations (FSW IRR: 6.46 95%CI 4.18, 10.00; MSM 44.02 95%CI 27.35, 70.87) had significantly higher incidence than modelled total population incidence estimates. Across population cohorts in Eastern and Southern Africa, HIV incidence among adults aged 15-49 declined by 75-90% between 2010-2023, and declined 7% (95%CI 4-10%) faster per year among young adults 15-24 compared to age 25+ years. Modelled incidence declined similarly to cohort data, but did not reflect the aging of the epidemic.

Conclusion

Observed incidence in population-representative studies in sub-Saharan Africa has declined steeply. Mathematical models that infer incidence from cross-sectional HIV surveillance data estimated the same incidence level and decline over time as population-representative studies. Studies with non-representative inclusion criteria had significantly higher incidence, including those among pregnant women and most HIV prevention/vaccine efficacy trials. The age pattern of incidence in modelled estimates should be reconsidered to capture the aging of the epidemic indicated by cohort studies.

FLUID · Développement d'une cohorte longitudinale sur la fluidité sexuelle chez les jeunes adultes au Canada, en France et au Royaume-Uni

Joseph LARMARANGE — 2025-02-28T14:20:09Z

Responsable scientifique

Pierre-Julien Coulaud (CERPOP)

Partenaires

Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP UMR1295, Université de Toulouse, Inserm) https://cerpop.inserm.fr/
Ceped (UMR 196, Université Paris Cité, IRD,, Université Sorbonne Paris Nord, Inserm) httsp ://www.ceped.org
École de santé publique de l'Université de Montréal (ESPUM) https://espum.umontreal.ca/
Robert Gordon University https://www.rgu.ac.uk/

Financement

ANRS | MIE

Résumé

La génération actuelle de jeunes (18-30 ans) arrive à un âge où la façon dont la sexualité est perçue et vécue change profondément. Des recherches ont montré que les jeunes connaissent des changements d'orientation sexuelle au cours du temps (aussi appelés fluidité sexuelle), notamment des changements d'attirances, d'identités et/ou de comportements sexuels. De nouvelles données démontrent aussi que la fluidité sexuelle est un déterminant essentiel des inégalités en matière de santé sexuelle, de santé mentale, de consommation de substances et de maladies chroniques. De plus, des études suggèrent que des facteurs contextuels (par exemple, les normes de genre, le climat politique) peuvent influencer les expériences de fluidité sexuelle, mettant en avant le besoin de mener des études comparatives entre pays pour mieux appréhender le rôle de ces facteurs. Des approches de recherche innovantes sont ainsi nécessaires pour comprendre comment évolue la sexualité des jeunes dans le contexte actuel.

Pour combler ces lacunes, notre objectif est de développer une nouvelle étude de cohorte longitudinale sur la fluidité sexuelle chez les jeunes au Canada, en France et au Royaume-Uni (RU). Pour cela, une étude pilote permettra d'identifier les mesures et les méthodes adaptées pour évaluer au mieux la diversité et la complexité des modèles et des trajectoires de fluidité sexuelle chez les jeunes. Cette étude offrira la possibilité d'établir des partenariats avec des leaders communautaires et des chercheurs locaux et internationaux qui faciliteront le développement de notre futur programme de recherche sur la fluidité sexuelle.

Mots-Clés

Fluidité sexuelle, orientation sexuelle, normes de genre, santé sexuelle, santé mentale

Zone géographique

Canada, France, Royaume-Uni

Calendrier

2025-2027

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.

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.

Orientation sexuelle et identité de genre : quelles catégories d'enquête en Afrique subsaharienne ?

Joseph LARMARANGE — 2023-09-04T09:04:17Z

Orientation sexuelle et identité de genre : quelles catégories d'enquête en Afrique subsaharienne ?

Joseph Larmarange , Christophe Broqua

Wilfried Rault; Mathieu Trachman. Minorités de genre et de sexualité : objectivation, catégorisations et pratiques d'enquête, Ined Éditions, pp.191-207, 2023, Méthodes et Savoirs, 978-2-7332-8036-2. ⟨10.4000/books.ined.19336⟩

Chapitre d'ouvrage

hal-04194856

Auteurs

Joseph Larmarange & Christophe Broqua

Résumé

À l'inverse de quelques travaux pionniers en sciences humaines et sociales, la question de l'homosexualité masculine est restée inexistante dans les enquêtes quantitatives en Afrique subsaharienne jusqu'au début des années 2000, malgré les épidémies de VIH qui ravageaient le continent.

C'est en 2005 qu'est publiée, pour la première fois, une étude quantitative bio-comportementale (Wade et al., 2005) sur une population d'hommes ayant des rapports sexuels avec des hommes (HSH) en Afrique – en l'occurrence au Sénégal. Le principal résultat concernait la prévalence du VIH : sur les 463 hommes interrogés, 22 % étaient infectés par le VIH, et ce dans un pays, le Sénégal, connu pour sa faible prévalence en population générale (moins de 1 %). Mais l'enquête apportait aussi d'autres informations importantes, notamment au sujet de l'orientation sexuelle : 94 % des répondants déclaraient avoir eu des relations sexuelles avec des femmes au moins une fois au cours de leur vie. Cette proportion élevée d'hommes ayant des pratiques bisexuelles est devenue un élément récurrent des enquêtes sur les HSH en Afrique, et l'un des aspects les plus discutés.

Depuis le milieu des années 2000, parallèlement à une attention internationale croissante accordée aux HSH dans les pays à ressources limitées et une pression politique des bailleurs internationaux pour la prise en compte des populations dites « clés » dans la riposte aux épidémies de VIH, les enquêtes quantitatives sur les HSH se sont développées exponentiellement en Afrique subsaharienne. À partir des années 2010, une partie d'entre elles aussi exploré l'identité de genre et certaines publications ont concerné plus, spécifiquement, les personnes « transgenres ».

Ce chapitre fait le point sur ces dimensions telles qu'elles apparaissent dans la littérature disponible, en examinant les connaissances dont nous disposons sur les différentes populations que recouvre la catégorie HSH. À partir d'une revue de littérature exhaustive, nous recensons les catégories que mettent en évidence les enquêtes quantitatives du point de vue de l'orientation sexuelle (articulant plusieurs dimensions, dont le pôle d'activité sexuelle, l'orientation sexuelle déclarée et l'attirance sexuelle) et de l'identité de genre.

L'objectif est de savoir si les dimensions investiguées sont suffisantes pour la compréhension fine, tant des logiques sociales de la sexualité que des comportements et des identités, et de questionner la façon dont est pensée la diversité des profils au sein de la catégorie HSH. Nous faisons l'hypothèse que les catégories utilisées sont importées des pays du Nord et plaquées sur les pays africains au détriment des catégories et représentations locales, en suivant un agenda international lié à l'épidémie de VIH, qui dicte la définition des catégories à investiguer. Après de nombreuses décennies au cours desquelles s'est construite l'image d'un continent exclusivement hétérosexuel, le développement exponentiel des enquêtes épidémiologiques sur les HSH en Afrique ne témoigne-t-il pas lui aussi d'un travers, certes inverse, en dessinant des formes d'orientation sexuelle et d'identité de genre minoritaires de manière réductrice et schématique ?

Supplément

Tableau détaillé des résultats (doi : 10.5281/zenodo.4569342)

Note

Illustration extraite du film Woubi Chéri (1998)

Estimating health care costs at scale in low- and middle-income countries: Mathematical notations and frameworks for the application of cost functions

Joseph LARMARANGE — 2023-06-19T15:19:05Z

Estimating health care costs at scale in low‐ and middle‐income countries: Mathematical notations and frameworks for the application of cost functions

Marc d'Elbee , Fern Terris-Prestholt , Andrew Briggs , Ulla Kou Griffiths , Joseph Larmarange , Graham Francis Medley , Gabriella Beatriz Gomez

Health Economics, 2023, 32 (10), pp.2216-2233. ⟨10.1002/hec.4722⟩

Article dans une revue

hal-04133193

Authors

Marc d'Elbée, Fern Terris-Prestholt, Andrew Briggs, Ulla Kou Griffiths, Joseph Larmarange, Graham Francis Medley, Gabriella Beatriz Gomez

Abstract

Appropriate costing and economic modeling are major factors for the successful scale-up of health interventions. Various cost functions are currently being used to estimate costs of health interventions at scale in low- and middle-income countries (LMICs) potentially resulting in disparate cost projections. The aim of this study is to gain understanding of current methods used and provide guidance to inform the use of cost functions that is fit for purpose. We reviewed seven databases covering the economic and global health literature to identify studies reporting a quantitative analysis of costs informing the projected scale-up of a health intervention in LMICs between 2003 and 2019. Of the 8725 articles identified, 40 met the inclusion criteria. We classified studies according to the type of cost functions applied—accounting or econometric—and described the intended use of cost projections. Based on these findings, we developed new mathematical notations and cost function frameworks for the analysis of healthcare costs at scale in LMICs setting. These notations estimate variable returns to scale in cost projection methods, which is currently ignored in most studies. The frameworks help to balance simplicity versus accuracy and increase the overall transparency in reporting of methods.

Achieving the UNAIDS 90–90-90 targets: a comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce HIV transmission in sub-Saharan Africa

Joseph LARMARANGE — 2022-12-18T12:26:51Z

Achieving the UNAIDS 90–90-90 targets: a comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce HIV transmission in sub-Saharan Africa

K. Sabapathy , L. Balzer , Joseph Larmarange , L. Block , S. Floyd , C. Iwuji , K. Wirth , H. Ayles , S. Fidler , M. Kamya , M. Petersen , D. Havlir , F. Dabis , J. Moore , R. Hayes

BMC Public Health, 2022, 22 (1), pp.2333. ⟨10.1186/s12889-022-14713-5⟩

Article dans une revue

ird-03905396

Authors

K. Sabapathy, L. Balzer, J. Larmarange, L. Block, S. Floyd, C. Iwuji, K. Wirth, H. Ayles, S. Fidler, M. Kamya, M. Petersen, D. Havlir, F. Dabis, J. Moore & R. Hayes

Abstract

Background
Four large community-randomized trials examining universal testing and treatment (UTT) to reduce HIV transmission were conducted between 2012–2018 in Botswana, Kenya, Uganda, Zambia and South Africa. In 2014, the UNAIDS 90–90-90 targets were adopted as a useful metric to monitor coverage. We systematically review the approaches used by the trials to measure intervention delivery, and estimate coverage against the 90–90-90 targets. We aim to provide in-depth understanding of the background contexts and complexities that affect estimation of population-level coverage related to the 90–90-90 targets.

Methods
Estimates were based predominantly on “process” data obtained during delivery of the interventions which included a combination of home-based and community-based services. Cascade coverage data included routine electronic health records, self-reported data, survey data, and active ascertainment of HIV viral load measurements in the field.

Results
The estimated total adult populations of trial intervention communities included in this study ranged from 4,290 (TasP) to 142,250 (Zambian PopART Arm-B). The estimated total numbers of PLHIV ranged from 1,283 (TasP) to 20,541 (Zambian PopART Arm-B). By the end of intervention delivery, the first-90 target (knowledge of HIV status among all PLHIV) was met by all the trials (89.2%-94.0%). Three of the four trials also achieved the second- and third-90 targets, and viral suppression in BCPP and SEARCH exceeded the UNAIDS target of 73%, while viral suppression in the Zambian PopART Arm-A and B communities was within a small margin ( 3%) of the target.

Conclusions
All four UTT trials aimed to implement wide-scale testing and treatment for HIV prevention at population level and showed substantial increases in testing and treatment for HIV in the intervention communities. This study has not uncovered any one estimation approach which is superior, rather that several approaches are available and researchers or policy makers seeking to measure coverage should reflect on background contexts and complexities that affect estimation of population-level coverage in their specific settings.

All four trials surpassed UNAIDS targets for universal testing in their intervention communities ahead of the 2020 milestone. All but one of the trials also achieved the 90–90 targets for treatment and viral suppression. UTT is a realistic option to achieve 95–95-95 by 2030 and fast-track the end of the HIV epidemic.

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

Routine programmatic data show a positive population-level impact of HIV self-testing: the case of Côte d'Ivoire and implications for implementation

Joseph LARMARANGE — 2022-09-29T09:50:45Z

Routine programmatic data show a positive population-level impact of HIV self-testing: the case of Côte d'Ivoire and implications for implementation

Arlette Simo Fotso , Cheryl Johnson , Anthony Vautier , Konan Blaise Kouamé , Papa Moussa Diop , Romain Silhol , Mathieu Maheu-Giroux , Marie-Claude Boily , Nicolas Rouveau , Clémence Doumenc-Aïdara , Rachel Baggaley , Eboi Ehui , Joseph Larmarange

AIDS. Official journal of the international AIDS Society, 2022, Aids, 36 (13), pp.1871-1879. ⟨10.1097/qad.0000000000003328⟩

Article dans une revue

ird-03879798

Authors

Simo Fotso Arlette, Johnson Cheryl, Vautier Anthony, Kouamé Konan Blaise, Diop Papa Moussa, Silhol Romain, Maheu-Giroux Mathieu, Boily Marie-Claude, Rouveau Nicolas, Doumenc-Aïdara Clémence, Baggaley Rachel, Ehui Eboi, and Larmarange Joseph for the ATLAS Team

Abstract

Objectives: We estimate the effects of ATLAS's HIV self-testing (HIVST) kit distribution on conventional HIV testing, diagnoses, and antiretroviral treatment (ART) initiations in Côte d'Ivoire.

Design: Ecological study using routinely collected HIV testing services program data.

Methods: We used the ATLAS's programmatic data recorded between the third quarter of 2019 and the first quarter of 2021, in addition to data from the President's Emergency Plan for AIDS Relief dashboard. We performed ecological time series regression using linear mixed models. Results are presented per 1000 HIVST kits distributed through ATLAS.

Results: We found a negative but nonsignificant effect of the number of ATLAS' distributed HIVST kits on conventional testing uptake (−190 conventional tests; 95% confidence interval [CI]: −427 to 37). The relationship between the number of HIVST kits and HIV diagnoses was significant and positive (+8 diagnosis; 95% CI: 0 to 15). No effect was observed on ART initiation (−2 ART initiations; 95% CI: −8 to 5).

Conclusions: ATLAS' HIVST kit distribution had a positive impact on HIV diagnoses. Despite the negative signal on conventional testing, even if only 20% of distributed kits are used, HIVST would increase access to testing. The methodology used in this paper offers a promising way to leverage routinely collected programmatic data to estimate the effects of HIVST kit distribution in real-world programs.

24th International AIDS Conference @ Montreal

Joseph LARMARANGE — 2022-08-08T18:58:39Z

Oral communications and poster presented at the 24^th International AIDS Conference 2022 in Montreal.

List of communications

Larmarange Joseph (2022) “Self-Testing, Empowerment and Self-Care: perspectives from lessons learned in implementing HIV self-testing in West Africa” (communication orale (symposium SA019), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Programme/Session/107.

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Larmarange - 2022 - Self-Testing, Empowerment and Self-Care perspecti.pdf 1.8 MiB

Nouaman Marcellin, Coffie Patrick A, Plazy Mélanie, Becquet Valentine, Agoua Aline, Zébago Clémence, Dao Hervé, Larmarange Joseph, Eholié Serge and ANRS 12381 PRINCESSE study group (2022) “Prevalence and incidence of sexually transmitted infections in a cohort of female sex workers in San Pedro, Côte d'Ivoire (ANRS 12381 PRINCESSE)” (poster), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=6713.

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Abstract: BACKGROUND: The ANRS 12381 PRINCESSE study is an interventional single-arm cohort. Participants recruitment started in November 2019. The study aimed to evaluate a comprehensive and community-based care offer among FSWs aged '¥ 18 years in the San Pedro area. METHODS: Care services included quarterly syndromic screening for STIs, as well as vaginal and anal swabs for the screening of chlamydia trachomatis (CT) and neisseria gonorrhoea (NG) by polymerase chain reaction (PCR) at M0, M12 and M24. At the same visits, identification of dysplasias and precancerous lesions of the cervix was performed by visual inspection after applying acetic acid and Lugol's iodine. STIs were managed according to the national algorithm. We describe (i) the characteristics of cervical lesions as well as the prevalence of STIs (syndromic and PCR) and associated symptoms and (ii) the incidence of syndromic STIs during follow-up. RESULTS: In November 2021, 372 FSWs were included. The median age was 29 years, 34% had never been to school, 56% were Ivorian, and the median duration of sex work was 2 years. At inclusion, 4.7% [95% confidence interval: 2.8-7.5] had cervical lesions with 3.5% leukoplakia and 2.2% haemorrhagic cervical junction zone. The prevalence of syndromic STIs was 17.2% [13.0-22.6]; associated clinical signs were vaginal discharge (13.7%), vaginal ulceration (2.1%), lower abdominal pain (4.3%) and cervical inflammation (2.6%). The prevalence of anovaginal CT and NG were 8.7% [6.2- 12.1] and 10.4% [7.6- 13.9], respectively; clinical signs were found in 2.4% of CT-positive and 12.2% of NG-positive FSWs. Most FSWs with syndromic STIs did not have CT or NG infection. During the follow-up, 82 cases of syndromic STIs were observed per 209 person-years, i.e. an incidence of 39.1% [31.1- 49.0]. PCR data at M12 and M24 are being consolidated and will allow estimating the incidence of CT and NG. CONCLUSIONS: A high prevalence and incidence of syndromic STIs were observed among FSWs, highlighting the importance and the interest of a regular follow-up. The results also showed the predominantly asymptomatic nature of STIs discovered by PCR in this at-risk population and, therefore, the importance of coupling syndromic screening and PCR analyses.

Nouaman et al. - 2022 - Prevalence and incidence of sexually transmitted i.pdf 832 KiB

Plazy Mélanie, Nouaman Marcellin, Becquet Valentine, Agoua Aline, Zébago Clémence, Dao Hervé, Coffie Patrick A, Eholié Serge, Larmarange Joseph and ANRS 12381 PRINCESSE study group (2022) “Delays to PrEP initiation among female sex workers in Côte d'Ivoire (ANRS 12381 PRINCESSE project)” (poster), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=6824.

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Abstract: BACKGROUND: To describe the delays to initiation of oral pre-exposure prophylaxis (PrEP) among female sex workers (FSW) in Côte d''Ivoire. METHODS: The ANRS 12381 PRINCESSE project is a single-arm interventional cohort aiming to evaluate the implementation of a comprehensive and community-based care offer among FSW aged '¥18 years in the San Pedro region since end-2019, through a mobile clinic operating on 10 prostitution sites (visited every two weeks). PrEP is offered to all HIV-positive FSW after verifying the creatinine level (results valid for one month). We described the time between FSW's interest for PrEP and PrEP initiation (or end of follow-up) among HIV- and hepatitis B virus-negative (HBsAg-) FSW included until end-October 2021. The probability of PrEP initiation since PrEP interest is described through a Kaplan-Meier curve censored on end-November 2021 (an analysis censored at the date of the last visit was also conducted). RESULTS: Of the 362 FSW included in the PRINCESSE cohort, 302 were HIV-/AgHBs-, and for 296 of them, PrEP was presented by medical staff (95.2% at inclusion). In total, 292 FSW expressed PrEP interest, and 192 (65.8%) initiated PrEP: 18 on the same day (the biological test having been performed during a previous visit), 148 during the next visit (median time since interest: 3 weeks [Inter-Quartile Range: 2-6]) and 26 during a subsequent visit (median time: 20 weeks [9-36]). The probability of PrEP initiation after PrEP interest was 39.0% at 1 month and 56.6% at 3 months (censoring on the date of the last visit, these proportions were 50.7% and 74.6%, respectively). Among the 100 FSW who did not initiate PrEP despite expressing interest, 68 were never seen again in the project; 4 declared that they were no longer interested in PrEP (median time since interest: 12 weeks [10-19]), 1 was tested HIV+ (delay of 2 weeks), and 27 were seen >1 month later (their biological tests were no longer valid). CONCLUSIONS: Despite strong PrEP interest among FSW, PrEP initiation remained suboptimal. Barriers to PrEP initiation should be more explored and considered to find appropriate solutions to make PrEP effective among this specific key population.

Plazy et al. - 2022 - Delays to PrEP initiation among female sex workers.pdf 484.6 KiB

Silhol Romain, Maheu-Giroux Mathieu, Soni Nirali, Simo Fotso Arlette, Rouveau Nicolas, Vautier Anthony, Doumenc-Aïdara Clémence, N'Guessan Kouakou, Mukandavire Christinah, Vickerman Peter, Keita Abdelaye, Ndour Cheikh Tidiane, Larmarange Joseph, Boily Marie Claude and ATLAS Team (2022) “Identifying population-specific HIV diagnosis gaps in Western Africa and assessing their impact on new infections: a modelling analysis for Côte d'Ivoire, Mali and Senegal” (poster), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=4243.

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Abstract: BACKGROUND: Progress towards HIV elimination in Western Africa may be hindered by diagnosis gaps among people living with HIV (PLHIV), especially among key populations (KP) such as female sex workers (FSW), their clients, and men who have sex with men (MSM). We aimed to identify largest gaps in diagnosis by risk group in Mali, Côte d'Ivoire, and Senegal, and project their contribution to new HIV infections. METHODS: Deterministic models of HIV transmission/diagnosis/treatment that incorporate HIV transmission among KP were parameterized following comprehensive country-specific reviews of demographic, behavioural, HIV and intervention data. The model was calibrated to country- and group-specific empirical outcomes such as HIV incidence/prevalence, the fractions of PLHIV ever tested, diagnosed, and on treatment. We estimated the distribution of undiagnosed PLHIV by risk group in 2020 and the population-attributable-fractions (tPAFs) (i.e. fraction of new primary and secondary HIV infections 2020-2029 originating from risk groups of undiagnosed PLHIV). RESULTS: From 46% (95% UI: 38-58) to 69% (59-79) of undiagnosed PLHIV in 2020 were males, with the lowest proportion in Mali and the highest proportion in Senegal, where 41% (28-59) of undiagnosed PLHIV were MSM. Undiagnosed men are estimated to contribute most new HIV infections occurring over 2020-2029 (Table). Undiagnosed FSW and their clients contribute substantial proportions of new HIV infections in Mali, with tPAF=20% (10-36) and tPAF=43% (26-56), respectively, while undiagnosed MSM in Senegal are estimated to contribute half of new infections. A lower proportion of new HIV infections are transmitted by undiagnosed KP in Côte d'Ivoire (tPAF=21%(10-38)). CONCLUSIONS: Current HIV testing services and approaches are leaving members of KP behind. Increasing the availability of confidential HIV testing modalities in addition to traditional tests may substantially reduce gaps in HIV diagnosis and accelerate the decrease of new HIV infections in Western Africa since half of them could be transmitted by undiagnosed KP.

Silhol et al. - 2022 - Identifying population-specific HIV diagnosis gaps.pdf 288.9 KiB

Simo Fotso Arlette, Johnson Cheryl, Vautier Anthony, Kouamé Konan Blaise, Diop Papa Moussa, Silhol Romain, Maheu-Giroux Mathieu, Boily Marie-Claude, Rouveau Nicolas, Doumenc-Aïdara Clémence, Baggaley Rachel, Ehui Eboi, Larmarange Joseph and ATLAS Team (2022) “Estimating the impact of HIV self-testing on HIV testing services, diagnoses, and treatment initiation at the population-level with routine data: the example of the ATLAS program in Côte d'Ivoire” (poster), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=5409.

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Abstract: BACKGROUND: HIV self-testing (HIVST) is a critical testing approach particularly for reaching those at HIV risk who are hesitant or unable to access existing services. While the discreet and flexible nature of HIVST is appealing to users, these features can limit the ability for programmes to monitor and estimate the population-level impacts of HIVST implementation. This study triangulates publicly available routine programme data from Côte d'Ivoire in order estimate the effects of HIVST distribution on access to testing, conventional testing (self-testing excluded), HIV diagnoses, and antiretroviral treatment (ART) initiations. METHODS: We used quarterly programmatic data (Q3-2019 to Q1-2021) from ATLAS, a project that aims to promote and implement network-based HIVST distribution in West Africa, in addition to routine HIV testing services program data obtained from the PEPFAR dashboard. We performed ecological time series regression using linear mixed-models. RESULTS: Between Q3-2019 and Q1-2021, 99,353 HIVST kits were distributed by ATLAS in 78 health districts included in the analysis. The results (Table 1) show a negative but non-significant effect of the number of ATLAS HIVST on the volume of conventional tests (-190), suggesting the possibility of a slight substitution effect. Despite this, the the beneficial effect on access to testing is significant: for each 1000 HIVST distributed via ATLAS, 390 to 590 additional HIV tests were performed if 60% to 80% of HIVST are used . The effect of HIVST on HIV diagnosis was significant and positive, with 8 additional diagnoses per 1,000 HIVST distributed. No effect of HIVST was observed on ART initiations. CONCLUSIONS: Our study provides a standard methodology for estimating the population-level impact of HIVST that can be used across countries. It shows that HIVST distribution was associated with increased access to HIV testing and diagnosis in Côte d'Ivoire. Wide-scale adoption of this method will improve HIVST data quality and inform evidence-based programming.

Simo Fotso et al. - 2022 - Estimating the impact of HIV self-testing on HIV t.pdf 541.2 KiB

Stannah James, Flores Anato Jorge Luis, Mitchell Kate M, Larmarange Joseph, Maheu-Giroux Mathieu and Boily Marie‐Claude (2022) “Improving our understanding of how structural determinants impact HIV epidemics: a scoping review of dynamic models to guide future research” (poster), presented at the 24th International AIDS Conference, Montreal. https://programme.aids2022.org/Abstract/Abstract/?abstractid=6564.

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Abstract: BACKGROUND: Dynamic models of HIV transmission have proven valuable tools for informing HIV prevention strategies. Including structural determinants in models is crucial to estimate their population-level impacts on HIV transmission and inform efforts towards HIV elimination. However, this is challenging due to a lack of coherent conceptual frameworks, limited understanding of their specific causal pathways, and few empirical estimates of their impacts on downstream mediators. METHODS: With the overarching aim to improve models, we conducted a scoping review of studies that used dynamic HIV transmission models to evaluate the impact of structural determinants. From included studies, we extracted information on the types of structural determinants and methods used to model their impacts on HIV transmission. We appraised studies on how they conceptualized structural exposures and represented their causal relationships over time within models. RESULTS: We identified 9 dynamic transmission modelling studies that incorporated structural determinants of HIV, including violence (N=3), incarceration (N=2), stigma (N=2), housing instability (N=2), migration (N=1), and education (N=1). Only one study modelled multiple determinants simultaneously. In most models, structural determinants were conceptualized using current, recent, non-recent and/or lifetime exposure categories. Modelled structural determinants largely impacted HIV transmission through mediated effects on one or more proximate risk factors, including sharing injection equipment, condom use, number of partners, and access to treatment. However, causal pathways were simplistic, with few mediators and/or lack of clear empirical justification. To measure impact, most studies simply assumed the elimination of structural determinants in counterfactual comparison scenarios. Few models included long-term and/or delayed effects of past, recurrent, or acute exposure, potentially overestimating impacts of determinants. CONCLUSIONS: Despite the importance of structural determinants for HIV prevention, methods for including them in dynamic HIV transmission models remain insufficient. Few studies have attempted to incorporate structural determinants in HIV models, and methods vary considerably. To improve inferences, models should adopt precise exposure definitions, deconstruct and estimate their complex causal pathways, and translate them into their mechanistic components. The need for development of coherent frameworks to conceptualize the synergistic interplay between strengthened empirical data analysis and the inclusion of structural determinants in dynamic models is pressing.

Stannah et al. - 2022 - Improving our understanding of how structural dete.pdf 538.6 KiB

Joseph Larmarange

Comparing modelled HIV incidence estimates with empirical HIV incidence observations in high-burden HIV African epidemic settings: systematic review and meta-regression

Comparing modelled HIV incidence estimates with empirical HIV incidence observations in high-burden HIV African epidemic settings: systematic review and meta-regression

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FLUID · Développement d'une cohorte longitudinale sur la fluidité sexuelle chez les jeunes adultes au Canada, en France et au Royaume-Uni

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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

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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

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Orientation sexuelle et identité de genre : quelles catégories d'enquête en Afrique subsaharienne ?

Orientation sexuelle et identité de genre : quelles catégories d'enquête en Afrique subsaharienne ?

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Estimating health care costs at scale in low- and middle-income countries: Mathematical notations and frameworks for the application of cost functions

Estimating health care costs at scale in low‐ and middle‐income countries: Mathematical notations and frameworks for the application of cost functions

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Achieving the UNAIDS 90–90-90 targets: a comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce HIV transmission in sub-Saharan Africa

Achieving the UNAIDS 90–90-90 targets: a comparative analysis of four large community randomised trials delivering universal testing and treatment to reduce HIV transmission in sub-Saharan Africa

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Décrire les épidémies, Comprendre les populations : une démographie du VIH en Afrique subsaharienne

Routine programmatic data show a positive population-level impact of HIV self-testing: the case of Côte d'Ivoire and implications for implementation

Routine programmatic data show a positive population-level impact of HIV self-testing: the case of Côte d'Ivoire and implications for implementation

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24th International AIDS Conference @ Montreal

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