# Knowledge, attitude and practices towards HIV testing following the introduction of self-testing: The case of the ATLAS project in Côte d'Ivoire

Arlette Simo Fotso, Arsene Kra Kouassi, Marie-Claude Boily, Romain Silhol, Anthony Vautier, Joseph Larmarange

<figure><img src="image_1.png" /></figure>

## To cite this version:

Arlette Simo Fotso, Arsene Kra Kouassi, Marie-Claude Boily, Romain Silhol, Anthony Vautier, et al. "Knowledge, attitude and practices towards HIV testing following the introduction of self-testing: The case of the ATLAS project in Côte d'Ivoire." AIDS Impact Conference, Jun 2023, Stockholm, Sweden. hal-04120627

HAL Id: hal-04120627

https://hal.science/hal-04120627

Submitted on 7 Jun 2023

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.

L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

<figure><img src="image_2.png" /></figure>
<figure><img src="image_3.png" /></figure>

# Knowledge, attitude and practices towards HIV testing following the introduction of self-testing: The case of the ATLAS project in Côte d'Ivoire

arlette.simo-fotso@ined.fr

Arlette Simo Fotso ¹,², Arsène Kouassi Kra², Marie Claude Boily³, Romain Silhol³, Anthony Vautier ⁴, Joseph Larmarange ¹,²

<figure><img src="image_4.png" /></figure>

1 Institut National d'Études Démographiques (Ined) ; 2 Centre Population et Développement (Ceped), Université Paris Cité, Institut de Recherche pour le Développement (IRD), Inserm, France; 3 MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London; 4 Solidarité Thérapeutique et Initiatives pour la Santé (Solthis), Sénégal

<figure><img src="image_5.png" /></figure>

AIDS Impact

Stockholm, Sweden
12-14 June 2023

<figure><img src="image_6.png" /></figure>

## Background

* HIV testing is a central element of the strategy to end AIDS epidemic, as status awareness is the entry point to HIV prevention and care.

* In Côte d'Ivoire, only 85% of people living with HIV (PLHIV) were aware of their HIV status in 2021 (UNAIDS, 2023).

* To address this gap, the ATLAS project distributed a total of ~200000 kits self-tests (HIVST) in Côte d'Ivoire between 2019 and 2022, including ~75000 in Bas-Sassandra region, targeting key populations aged 16+ and their network.

* Concurrently, a multi-media campaign Shuga-Babi, promoting testing and HIVST, was launched by MTV foundation targeting mainly population aged 15-24

* The aim of this study is to assess levels and correlates of knowledge, attitude and practice (KAP) towards HIV testing and self-testing in general population after the introduction of HIVST in Bas-Sassandra, Côte d'Ivoire.

<figure><img src="image_7.png" /></figure>

## Method

* We conducted a population-based cross-sectional survey of the population aged 15-49 years in the Bas-Sassandra region of Côte d'Ivoire, in December 2021

* Survey: **24 months** after HIVST was introduced in the region by ATLAS and **6 months** after Shuga-Babi campaign

* The survey used a three-stage stratified sampling approach with 8 strata:

* 3 of the strata are the 3 departments where ATLAS was implemented

* 1 strata includes departments with almost no ATLAS activities

* each further stratified on urban and rural settings

* Weighed proportions were used to assess level of KAP toward HIV testing,

* Logistic regressions were used to identify factors associated to KAP toward HIV testing

<figure><img src="image_8.png" /></figure>

## Results

* A total of 6271 people were interviewed (3203 males and 3068 females).

* 11% of participants reported having heard about HIVST

* Most participants showed a positive attitude toward HIVST and reported that they would be interested/very interested to use it if freely available

* About 14% reported having performed at least 1 conventional test or HIVST in the last 12 months

* While 3% of participants had already used a HIVST in the past.

<table><caption>**Table 1: Level of knowledge, attitude and practice (KAP) towards HIV testing**</caption><thead><tr><th>Outcomes</th><th>(n=6271)[CI]</th></tr></thead><tbody><tr><td>Ever heard about HIVST</td><td>10.6% (643)[8.3%, 13%]</td></tr><tr><td>Interested to use HIVST for themselves</td><td>75.6% (4762)[72%, 79%]</td></tr><tr><td>Interested to use HIVST for sexual partners</td><td>74.8% (4688)[71%, 78%]</td></tr><tr><td>Ever used HIVST</td><td>2.6% (144)[1.7%, 4.0%]</td></tr><tr><td>Tested for HIV (last 12 months)</td><td>14.0% (923)[12%, 16%]</td></tr></tbody></table>

Sex woman (ref.)

Age group 15-19 (ref.)

Highest level of education none (ref.)

Interventions none (ref.)

Currently in couple no (ref.)

Absent from home for 1 month or more in the past year no (ref.)

Usually, who makes the decisions about your own health care? ego (ref.)

Number of sexual partners over the last 12 months 0 partner (ref.)

Watch TV at least once a month no (ref.)

Listen to radio at least once a month no (ref.)

Navigate on internet at least once a month no (ref.)

Had to skip one or more meals for lack of money in the past month no (ref.)

Place of residence rural (ref.)

<figure><img src="image_9.png" /><figcaption>**Figure 1: Logistic regression of knowledge, attitude and practice (KAP) towards HIV testing**</figcaption></figure>

* Being exposed to Shuga-Babi was associated with a higher odds of **Knowing about HIVST** and the odds was even higher for those exposed to Shuga-Babi campaign who lived in ATLAS implementation strata

* Living in ATLAS implementation strata and exposure to Shuga-Babi alone was not significantly associated with the use of HIVST, but being exposed to both interventions was positively associated with previous **use of HIVST**

* Interest to use HIVST for self was not associated with interventions

* Interest to use for sexual partners was associated with exposure to Shuga-Babi campaign

* HIV-Testing in the last 12 months was positively associated with exposure to Shuga-Babi campaign but was not associated to living in ATLAS implementation strata alone.

<figure><img src="image_10.png" /></figure>

## Conclusion

* ATLAS program combined with Shuga-babi intervention was strongly and significantly associated with HIVST use

* Residence in ATLAS implementation strata alone was not significantly associated with KAP towards HIV testing and self-testing

* The weak association between ATLAS intervention and those outcomes could be explained by the fact that:

* ATLAS targeted key populations and vulnerable groups which represent a small proportion of the population interviewed

* ATLAS intervention was indirectly captured through the residence in an ATLAS strata

* These hypotheses need to be further investigated in upcoming analysis