Willingness to use and distribute HIV self-test kits to clients and partners: a qualitative analysis of female sex workers' collective opinion and attitude in Cote d'Ivoire, Mali, and Senegal

Background: In West Africa, female sex workers are at increased risk of HIV acquisition and transmission. HIV self-testing could be an effective tool to improve access to and frequency of HIV testing to female sex workers, their clients and partners. This article explores their perceptions regarding HIV self-testing use and the redistribution of HIV self-testing kits to their partners and clients. Methods: Embedded within ATLAS, a qualitative study was conducted in Côte-d’Ivoire, Mali, and Senegal in 2020. Nine focus group discussions were conducted. A thematic analysis was performed. Results: A total of 87 participants expressed both positive attitudes toward HIV self-testing and their willingness to use or reuse HIV self-testing. HIV self-testing was perceived to be discreet, confidential, and convenient. HIV self-testing provides autonomy from testing by providers and reduces stigma. Some perceived HIV self-testing as a valuable tool for testing their clients who are willing to offer a premium for condomless sex. While highlighting some potential issues, overall, female sex workers were optimistic about linkage to confirmatory testing following a reactive HIV self-testing. Female sex workers expressed positive attitudes toward secondary distribution to their partners and clients, although it depended on relationship types. They seemed more enthusiastic about secondary distribution to their regular/emotional partners and regular clients with whom they had difficulty using condoms, and whom they knew enough to discuss HIV self-testing. However, they expressed that it could be more difficult with casual clients; the duration of the interaction being too short to discuss HIV self-testing, and they fear violence and/or losing them. Conclusion: Overall, female sex workers have positive attitudes toward HIV self-testing use and are willing to redistribute to their regular partners and clients. However, they are reluctant to promote such use with their casual clients. HIV self-testing can improve access to HIV testing for female sex workers and the members of their sexual and social network

Drying colloidal systems: laboratory models for a wide range of applications

The drying of complex fluids provides a powerful insight into phenomena that take place on time and length scales not normally accessible. An important feature of complex fluids, colloidal dispersions and polymer solutions is their high sensitivity to weak external actions. Thus, the drying of complex fluids involves a large number of physical and chemical processes. The scope of this review is the capacity to tune such systems to reproduce and explore specific properties in a physics laboratory. A wide variety of systems are presented, ranging from functional coatings, food science, cosmetology, medical diagnostics and forensics to geophysics and art

Mesure de l’impact populationnel de l’auto-dépistage du VIH par la triangulation de données programmatiques de routine : Exemple du projet ATLAS en Côte d’Ivoire

International audienceObjectifsL’auto-dépistage du VIH (ADVIH) est recommandé comme stratégie de dépistage par l’OMS. Il a pour avantage de permettre aux personnes de réaliser elles-mêmes leur test et de garantir la discrétion et confidentialité, permettant de toucher des populations non testées et difficiles à atteindre. Cependant, son caractère confidentiel et l'approche de distribution via les réseaux (ciblant les population clés et leurs proches et partenaires) rendent difficile l'estimation de l’impact de l’ADVIH au niveau populationnel. Cette étude propose un moyen de surmonter ce défi et utilise des données programmatiques de routine pour estimer indirectement les impacts du projet ATLAS sur l'accès au dépistage du VIH, le dépistage du VIH conventionnel (c'est-à-dire autre que l’ADVIH), les nouveaux diagnostics du VIH et l’initiation de traitement antirétroviral (TAR) en Côte d'Ivoire.Matériels et MéthodesLes données sur le nombre de kits d’ADVIH distribués par ATLAS proviennent des rapports des partenaires de mise en oeuvre entre le troisième trimestre (T3) de 2019 et le T1 2021. Nous utilisons également les indicateurs de routine du PEPFAR agrégées par districts sanitaires et par trimestre. Les analyses se font par une régression de séries chronologiques écologiques à l'aide de modèles mixtes linéaires.RésultatsEntre T3 2019 et T1 2021, 99353 kits d’ADVIH ont été distribués par ATLAS dans les 78 districts sanitaires inclus dans l'analyse. Les résultats (tableau 1) montrent un effet négatif mais non significatif sur le volume de tests conventionnels (-195) ce qui traduirait une légère substitution entre ADVIH et test conventionnel. Malgré cela l’effet net est positif sur l’accès au dépistage : pour 1000 ADVIH distribués via ATLAS, 589 personnes supplémentaires ont eu accès au dépistage du VIH avec l’hypothèse d’un taux d'utilisation d’ADVIH (TU) de 80 % et 393 avec une hypothèse de 60%. L'effet de l’ADVIH sur le diagnostic du VIH était significatif et positif (8). Pas d’effet significatif observé sur l’initiation TAR (-2).ConclusionNos résultats mettent en évidence qu'une stratégie de distribution de l’ADVIH basée sur les réseaux ciblant les population clés et leurs proches et partenaires augmentent l’accès au dépistage du VIH et améliore le diagnostic. La méthodologie utilisée dans cet article pourrait être reproduite dans différents contextes pour l'évaluation des programmes d’ADVIH, sans nécessité de systèmes de collecte additionnels

Is manufacturer’s Instructions-For-Use sufficient in a multilingual and low literacy context? The example of HIV self-testing in West Africa

Background: The ATLAS project aims to promote the use of HIV self-testing (HIVST) in Côte d'Ivoire, Mali and Senegal. In order to ensure accurate HIVST use, it was necessary to evaluate if the manufacturer’s Instructions-For-Use (IFUs), standardized at the international level, provides complete, accessible and adapted information in the 3 countries’ contexts.Materials & Methods: In December 2018, cognitive interviews were conducted with 64 participants, mostly Men who have Sex with Men (40,6%) and Female Sex Workers (43,8%) in Côte d'Ivoire, Mali and Senegal. Among them, 17,2 % never performed HIV test before and 38% of participants cannot read. They were invited to perform an oral HIVST (OraQuick®) and were requested, at each step of the procedure to share their understanding of the IFU for HIVST use, of the result interpretation and of related actions to be taken. All participants had in hands the manufacturer's IFUs in French, including the free national hotline number. Half of them additionally received manufacturer's demonstration video translated into local languages. Directive interviews guide included 50 questions to collect participants’ perception of what was missing or unclear in the supporting tools. The methodology was validated with all national AIDS programmes and ministries of health.Results: Out of 64 HIVST performed, 5 results were positive (7,8%) and confirmed with additional tests. Overall, the IFU was well understood: 58 participants (92%) were able to interpret their HIVST result correctly without assistance. However, some misuses were observed at various stages, particularly for people who cannot read, with some instructions misunderstood or perceived as not adapted. Only participants who can read have access to information as “do not eat” or “do not use the test if you are on ART” as it is not illustrated in the IFUs. Most of the participants did not spontaneously identify the promotion of the free hotline number and/or the link to the demonstration video. Some procedure’s steps were misinterpreted: 7 participants (11%) did not swab correctly the flat pad along the gum, 3 participants (5%) have read the result at inaccurate time (at 20 seconds, at 5 minutes or after 40 minutes), 13 participants (20%) did not put the stand (for the tube including the liquid) in the right way and 8 other participants struggled to slide tube into the stand. Among 42 participants who can not read and/or who had not seen the video beforehand, 14 of them (33%) had at least one difficulty to interpret the result or to understand what to do after the test/result. On the other hand, the results of the cognitive interviews showed that demonstration video provides a real added value to the user’s understanding and accurate HIVST use (31 participants out of 32 found it very easy to understand with 9 of them who felt they do not need the IFUs if they previously watched the demonstration video). The video translation into local languages, produced by the ATLAS project, was very much appreciated by the participants.Conclusion: The manufacturer's IFUs alone appear not to be sufficient in a multilingual, low-literacy context to ensure accurate HIVST use. Access to additional supporting tools (complementary leaflet, demonstration video or free hotline) is essential in the 3 countries’ contexts

Modelling the population-level impact of a national HIV self-testing strategy among key populations in Côte d'Ivoire

Background: A third of people living with HIV (PLHIV) in Western Africa are not diagnosed, hindering progress towards HIV elimination. Scaling-up HIV self-testing (HIVST) among key populations (KP) such as female sex workers (FSW), their clients, and men who have sex with men (MSM), may further curb HIV transmission in this region. Using data from the ATLAS program in Côte d’Ivoire, we projected the potential impact of a national HIVST strategy among KP in the country.Methods: A deterministic model of HIV transmission and different testing modalities among key and lower-risk populations was parameterized following a review of demographic, behavioural, HIV and intervention data of the epidemic in Côte d’Ivoire over time. The model was then calibrated to empirical outcomes, including HIV prevalence, the fractions of PLHIV ever HIV tested, diagnosed, and treated, by risk group. Based on interim ATLAS HIVST programme data among KP in southern Côte d’Ivoire, we assumed that 440,000 HIVST are distributed annually (i.e. 10% of all tests in the country), including 29%, 22%, 32%, and 18% to FSW, their clients, MSM, and lower-risk populations, respectively. We predicted the potential impact of this HIVST strategy on new HIV infections and deaths, and new diagnoses over 10 years.Results: After 10 years, the HIVST strategy is expected to increase the fraction of all PLHIV diagnosed by 18%-points in both FSW (86% vs 69% without HIVST) and MSM (95% vs 77%), resulting in small increases overall (85% vs 83%). Overall, this strategy may avert 10,800 (5,100-24,200) new HIV infections over 10 years; equivalent to one infection averted per 400 HIVST distributed. This corresponds to a relative decrease in new infections of 10% (5-17%), 9% (4-21%), and 32% (23-48%) among FSW, their clients, and MSM, respectively, and 5% (3-10%) overall. However, given the larger population size, two-thirds (63%; 44-78%) of all infections prevented over 10 years were among all lower-risk populations, reflecting the indirect effects of prioritizing KP. HIV mortality among FSW and MSM may be reduced by around 15% over 10 years, vs 4% among FSW clients and 2% overall (i.e. 2700 (1400-5600) total deaths averted).Conclusions and recommendations: A national HIVST strategy may prevent 3-10% of new HIV infections in Côte d’Ivoire, especially among FSW clients and MSM. This would help reduce disparities in HIV burden by reaching key populations and addressing their unmet treatment needs

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

International audienceBACKGROUND: 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

Le semis très précoce : une stratégie agronomique pour améliorer les performances du soja en France ?

Le semis très précoce du soja a été étudié dans l’objectif d’améliorer le potentiel de rendement et/ou de réduire les besoins en eau. Trois variétés, appartenant à différents groupes de maturité, ont été retenues afin d’identifier les traits variétaux d’intérêt pour le semis très précoce. Un ensemble d’essais multilocaux, comportant deux modalités de semis avec irrigation, a été réalisé au cours de 5 années culturales (2010−2014). Le rendement et les besoins en eau ont été déterminés; un suivi dynamique du développement et de la croissance a été réalisé pour la variété Santana. Les effets combinés des basses températures et de la photopériode en réponse au semis précoce se traduisent par une production de biomasse aérienne réduite en phase végétative et une augmentation de la durée de remplissage des graines. Les valeurs maximales de rendement sont observées pour le semis très précoce, mais en moyenne le rendement est sensiblement plus faible en semis très précoce (3,7 t/ha vs. 3,9 t/ha). L’irrigation pour conduire les cultures dans des conditions proches de l’ETM a été sensiblement plus faible en semis très précoce (170 mm vs. 182 mm). Une variété tardive (groupe de maturité II) apparaît mieux adaptée au semis très précoce qu’une variété de groupe de maturité I. Cette étude constitue une première référence agronomique d’évaluation du semis très précoce du soja et suggère que des types variétaux très tardifs pourraient améliorer le potentiel de rendement du soja en semis très précoce pour des conduites irriguées dans le Sud-Ouest de la France

Le semis très précoce : une stratégie agronomique pour améliorer les performances du soja en France ?

Le semis très précoce du soja a été étudié dans l’objectif d’améliorer le potentiel de rendement et/ou de réduire les besoins en eau. Trois variétés, appartenant à différents groupes de maturité, ont été retenues afin d’identifier les traits variétaux d’intérêt pour le semis très précoce. Un ensemble d’essais multilocaux, comportant deux modalités de semis avec irrigation, a été réalisé au cours de 5 années culturales (2010-2014). Le rendement et les besoins en eau ont été déterminés; un suivi dynamique du développement et de la croissance a été réalisé pour la variété Santana. Les effets combinés des basses températures et de la photopériode en réponse au semis précoce se traduisent par une production de biomasse aérienne réduite en phase végétative et une augmentation de la durée de remplissage des graines. Les valeurs maximales de rendement sont observées pour le semis très précoce, mais en moyenne le rendement est sensiblement plus faible en semis très précoce (3,7 t/ha vs. 3,9 t/ha). L’irrigation pour conduire les cultures dans des conditions proches de l’ETM a été sensiblement plus faible en semis très précoce (170 mm vs. 182 mm). Une variété tardive (groupe de maturité II) apparaît mieux adaptée au semis très précoce qu’une variété de groupe de maturité I. Cette étude constitue une première référence agronomique d’évaluation du semis très précoce du soja et suggère que des types variétaux très tardifs pourraient améliorer le potentiel de rendement du soja en semis très précoce pour des conduites irriguées dans le Sud-Ouest de la France.This study was carried out on very early sowing of soybean in order to improve potential yield and/or reduce water requirements. Three varieties belonging to different maturity groups were selected to identify varietal traits of interest in very early sowing. A set of multi-location irrigated trials consisting in two sowing dates was performed from 2010 to 2014. Yield and water requirements were determined; crop development and growth was monitored on cv. Santana. The combined effects of low temperatures and photoperiod in very early sowing resulted in limited aboveground biomass production during vegetative period and increased grain filling duration. Maximal values for yield were observed in very early sowing modality, although yield was slightly lower in very early sowing compared to conventional one (3.7 t/ha vs. 3.9 t/ha). The amount of water brought by irrigation for meeting ETM conditions was slightly lower in very early sowing (170 mm vs. 182 mm). A late variety (maturity group II) appears better adapted to very early sowing compared to a maturity group I variety. This study stands as the first agronomical reference for evaluating early sowing of soybean and suggests that late-varietal type could improve soybean potential yield for early sowing in irrigated cropping conditions of South-Western France

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

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

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

International audienceBACKGROUND: 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