# From Key Populations to beyond: using HIV self-testing to increasingly reach vulnerable groups in West-Africa

Joseph Larmarange

► To cite this version:

Joseph Larmarange. From Key Populations to beyond: using HIV self-testing to increasingly reach vulnerable groups in West-Africa. 11th IAS Conference on HIV Science, International AIDS Society, Jul 2021, Berlin, France. ird-04058413

HAL Id: ird-04058413

https://ird.hal.science/ird-04058413

Submitted on 4 Apr 2023

HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-
entific research documents, whether they are pub-
lished 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_1.png" /></figure>

Distributed under a Creative Commons Attribution 4.0 International License
<figure><img src="image_2.png" /></figure>

# From Key Populations to beyond:
using HIVST to increasingly reach
vulnerable groups in West-Africa

Joseph Larmarange on behalf of ATLAS Team
HIV Self-Testing, What's next? Symposium @ IAS 2021

<figure><img src="image_3.png" /></figure>
# The importance of peripheral populations in West Africa

* Key Populations (FSW, MSM, PWUD) are overwhelmingly infected by HIV

* In Western & Central Africa (Unaids data 2020), new HIV infections in 2019: 42% among KP and 27% among clients of FSW and sexual partners of KP

* Peripheral part of KP (e.g. occasional sex workers, hidden MSM...) are difficult to reach by peer educators and have less access to HIV testing

* Modelling work by Maheu-Giroux et al. (JAIDS 2017), in Côte d'Ivoire, between 2005 and 2015, 44% of new HIV infections occurred between a FSW client and a non FSW partner

> It is crucial to reach peripheral and vulnerable populations beyond key populations to achieve 95-95-95 targets.
# ATLAS project (2019-2022)

Funded by **Unitaid** (with additional funding of AFD)

Coordinated by **Solthis & IRD**

> 170 distribution sites

> 1400 agents trained for distributing HIVST

> 260 000 HIVST kits distributed since mid 2019

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

<figure><img src="image_5.png" /><figcaption>Côte d'Ivoire</figcaption></figure>

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

<figure><img src="image_7.png" /><figcaption>Senegal</figcaption></figure>
# ATLAS self-testing distribution models

## Primary distribution

for personal use

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

## Secondary distribution

to be redistributed to
partners and relatives

<figure><img src="image_9.png" /></figure>
# ATLAS Strategy for key populations

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

Other FSW

Regular partner

Clients

~66% of distributed HIVST kits

<figure><img src="image_11.png" /></figure>

Other MSM

Male partners

Female partners

~24% of distributed HIVST kits

<figure><img src="image_12.png" /></figure>

Other PWUD

Sexual partners

~4% of distributed HIVST kits
# Secondary distribution is feasible for KP

## MSM, Mali (in-depth qualitative interview)

> "Because of the self-test, I found out I was infected... Then I tested my fiancée [girlfriend] with it, but she got a non-reactive test."

See E-Poster PEC320 by Odette Ky-Zerbo et al. @ IAS 2021
https://theprogramme.ias2021.org/Abstract/Abstract/972

## FSW, Mali (in-depth qualitative interview)

> "I also have a client who I go to in his flat [...] I gave him three [HIVST] kits, because he showed me clearly that he has another partner, so I told him that there is no problem, so he wanted that one to be tested with the self-test too."

## Qualitative survey among HIVST users

Detailed results to be presented
by Odette Ky-Zerbo @ ICASA 2021
Increase of secondary distribution over time

<figure><img src="image_13.png" /><figcaption>Mean number of HIVST kits distributed per primary contact (outreach activities targeting KP)</figcaption></figure>

More information: Kra Kouassi et al. “Introducing and implementing HIV self-testing in Côte d'Ivoire, Mali and Senegal: what can we learn from ATLAS project activity reports in the context of the COVID-19 crisis?”
Frontiers in Public Health (https://www.frontiersin.org/articles/10.3389/fpubh.2021.653565)
# Field adaptation

## Direct distribution to secondary targets

* Following suggestions from peer educators, they have been invited to distribute HIVST kits directly to secondary targets when relevant (for example a sexual partner of KP seen on site)

* Other strategies have been developed, e.g. HIVST kits left at the reception of a brother/"love hotel" to be redistributed to the clients

## In the context of sanitary measures (Covid-19)

* Relocation of activities

* Use of social networks (Facebook, WhatsApp...)

* Integration of hygiene measures...

<figure><img src="image_14.png" /></figure>

<figure><img src="image_15.png" /></figure>

<figure><img src="image_16.png" /></figure>

Janvier 2021

<figure><img src="image_17.png" /></figure>

<figure><img src="image_18.png" /></figure>
<figure><img src="image_19.png" /></figure>

Phone survey among HIVST users
Detailed results to be presented
by Arsène K Kouassi @ ICASA 2021

# Profile of HIVST users

> Phone survey conducted between March & June 2021

> Survey flyers distributed with HIVST kits, inviting people to call anonymously a toll free phone number

> 2615 participants

> Despite some recruitment biases, 1/3 received their HIVST kit through secondary distribution (friend, sexual partner, relative...)

> 41% were first-time testers (first HIV test in their lifetime)

> 50% perceived themselves as not exposed at all to HIV risk

> MSM-based channel:

> 1/10 of participants were female

> 45% of males did not report any male sexual partner ("hidden MSM")

> FSW-based channel:

> 1/2 of participants were male
Scale-up is sustainable

Observed Costs (2019-2020) → Full scale-up costs (2023)
(unit costs per distributed HIVST kit – community-based distribution)

<table><thead><tr><th></th><th>Côte d'Ivoire</th><th>Mali</th><th>Sénégal</th></tr></thead><tbody><tr><td>FSW</td><td>$13 → $8</td><td>$16 → $10</td><td>$17 → $12</td></tr><tr><td>MSM</td><td>$15 → $8</td><td>$28 → $16</td><td>$27 → $22</td></tr><tr><td>PWUD</td><td>$16 → $13</td><td></td><td>$144 → $48</td></tr></tbody></table>

<figure><img src="image_20.png" /></figure>

More information:
d'Elbée et al., May 2021,
Frontiers in Public Health
https://doi.org/
10.3389/fpubh.2021.653612

See also E-Poster PED500 by Marc d'Elbée et al. @ IAS 2021

https://theprogramme.ias2021.org/Abstract/Abstract/476
To conclude...

HIV self-testing and secondary distribution is feasible and sustainable
among key populations in West Africa.

Our results show that HIV self-testing is an opportunity to reach,
beyond key populations, vulnerable groups who never tested before.
PARTNERS

<figure><img src="image_21.png" /></figure>

Consortium

<figure><img src="image_22.png" /></figure>

<figure><img src="image_23.png" /></figure>

Implementation partners

Côte d'Ivoire

Ministère de la Santé et de l'Hygiène Publique

PNLS

<figure><img src="image_24.png" /></figure>

<figure><img src="image_25.png" /></figure>

Alliance CI
Aprosam
Arc en Ciel
Ariel Glaser
Blety
Eloé
Espace Confiance
Heartland Alliance
Orasur
Ruban Rouge

Research partners

<figure><img src="image_26.png" /></figure>

<figure><img src="image_27.png" /></figure>

LONDON
SCHOOL of
HYGIENE
&TROPICAL
MEDICINE

<figure><img src="image_28.png" /></figure>

Imperial College
London

<figure><img src="image_29.png" /></figure>

<figure><img src="image_30.png" /></figure>

INRSP

<figure><img src="image_31.png" /></figure>

<figure><img src="image_32.png" /></figure>

<figure><img src="image_33.png" /></figure>

<figure><img src="image_34.png" /></figure>

le cnam

<figure><img src="image_35.png" /></figure>

McGill

<figure><img src="image_36.png" /></figure>

Yale University

<figure><img src="image_37.png" /></figure>

<figure><img src="image_38.png" /></figure>

Funding

<figure><img src="image_39.png" /></figure>

Unitaid
Innovation in Global Health

<figure><img src="image_40.png" /></figure>

AFD

Mali

Ministère de la Santé et des Affaires sociales

HCNLS

<figure><img src="image_41.png" /></figure>

<figure><img src="image_42.png" /></figure>

AKS
Amprode Sahel
ARCAD Santé
Danayaso
FHI 360
Plan International
PSI
Soutoura

Technical partner

<figure><img src="image_43.png" /></figure>

World Health
Organization

Sénégal

Ministère de la Santé et de l'Action Sociale

CNLS

<figure><img src="image_44.png" /></figure>

<figure><img src="image_45.png" /></figure>

CNLS

CONSEIL NATIONAL DE LUTTE
CONTRE LE SIDA DU SÉNÉGAL

CTA
CEPIAD
Enda Santé

Partner
projects

<figure><img src="image_46.png" /></figure>

HIV SELF-TESTING
AFRICA
INITIATIVE

<figure><img src="image_47.png" /></figure>