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 Côte d’Ivoire, Mali, and Senegal

Ky-Zerbo, Odette; Desclaux, Alice; Boye, Sokhna; Vautier, Anthony; Rouveau, Nicolas; Kouadio, Brou Alexis; Fotso, Arlette Simo; Pourette, Dolorès; Maheu‐Giroux, Mathieu; Sow, Salif; Camara, Cheick Sidi; Doumenc-Aïdara, Clémence; Keita, Abdelaye; Boily, Marie Claude; Silhol, Romain; d’Elbée, Marc; Bekelynck, Anne; Gueye, Papa Alioune; Diop, Papa Moussa; Geoffroy, Olivier; Kamemba, Odé Kanku; Diallo, Sanata; Ehui, E.; Ndour, Cheick Tidiane; Larmarange, Joseph

doi:10.1177/17455057221092268

Cited by 8 publications

(6 citation statements)

References 28 publications

(67 reference statements)

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“…Other experiences of secondary distribution have been reported in Southern and Eastern Africa: it was acceptable and allowed to reach clients of FSW [ 41 , 46 ], partners of MSM [ 47 ], or partners of pregnant women [ 42 , 48 , 49 ]. Within ATLAS, a qualitative survey conducted showed that FSW were willing to redistribute the HIVST to their regular partners and clients [ 50 ] .…”

Section: Discussionmentioning

confidence: 99%

Can HIV self-testing reach first-time testers? A telephone survey among self-test end users in Côte d’Ivoire, Mali, and Senegal

Kra,

Fotso,

N’guessan

et al. 2023

BMC Infect Dis

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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.

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Section: Discussionmentioning

confidence: 99%

Can HIV self-testing reach first-time testers? A telephone survey among self-test end users in Côte d’Ivoire, Mali, and Senegal

Kra,

Fotso,

N’guessan

et al. 2023

BMC Infect Dis

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“…Further details on the ATLAS project can be found in the research protocol [25]. Further, project's results have been published on stakeholders' attitudes and perceptions on HIVST in West Africa [21], the relevance of HIVST secondary distribution to resilient testing services [16], challenges faced by HIVST secondary distribution in contexts of low disclosure of HIV test result [26], FSW's willingness to distribute HIVST kits [27], and the impact of HIVST in Côte d'Ivoire [28]. Cost and scale-up costs of integrating HIVST in community-led programs for key population were also published [29].…”

Section: Study Contextmentioning

confidence: 99%

“I take it and give it to my partners who will give it to their partners”: Secondary distribution of HIV self-tests by key populations in Côte d’Ivoire, Mali, and Senegal

Ky-Zerbo¹,

Desclaux²,

Boye³

et al. 2023

BMC Infect Dis

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Introduction HIV epidemics in Western and Central Africa (WCA) remain concentrated among key populations, who are often unaware of their status. HIV self-testing (HIVST) and its secondary distribution among key populations, and their partners and relatives, could reduce gaps in diagnosis coverage. We aimed to document and understand secondary HIVST distribution practices by men who have sex with men (MSM), female sex workers (FSW), people who use drugs (PWUD); and the use of HIVST by their networks in Côte d’Ivoire, Mali, and Senegal. Methods A qualitative study was conducted in 2021 involving (a) face-to-face interviews with MSM, FSW, and PWUD who received HIVST kits from peer educators (primary users) and (b) telephone interviews with people who received kits from primary contacts (secondary users). These individual interviews were audio-recorded, transcribed, and coded using Dedoose software. Thematic analysis was performed. Results A total of 89 participants, including 65 primary users and 24 secondary users were interviewed. Results showed that HIVST were effectively redistributed through peers and key populations networks. The main reported motivations for HIVST distribution included allowing others to access testing and protecting oneself by verifying the status of partners/clients. The main barrier to distribution was the fear of sexual partners’ reactions. Findings suggest that members of key populations raised awareness of HIVST and referred those in need of HIVST to peer educators. One FSW reported physical abuse. Secondary users generally completed HIVST within two days of receiving the kit. The test was used half the times in the physical presence of another person, partly for psychological support need. Users who reported a reactive test sought confirmatory testing and were linked to care. Some participants mentioned difficulties in collecting the biological sample (2 participants) and interpreting the result (4 participants). Conclusion The redistribution of HIVST was common among key populations, with minor negative attitudes. Users encountered few difficulties using the kits. Reactive test cases were generally confirmed. These secondary distribution practices support the deployment of HIVST to key populations, their partners, and other relatives. In similar WCA countries, members of key populations can assist in the distribution of HIVST, contributing to closing HIV diagnosis gaps.

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“…ATLAS aimed to address the diagnosis gap and evaluate the potential impact of HIVST in Côte d'Ivoire, Mali and Senegal, 20 with an emphasis on secondary distribution of HIVST whereby KP directly reached by the programme could re-distribute some of their HIVST kits to their sexual partners, clients, and/or peers. [20][21][22] In addition to the distribution of a total of 380 000 self-test kits to people at higher risk of HIV (of which 340 000 were distributed through activities targeting FSW and MSM) over 2019-2021, the programme included different work packages to understand the practicality, costs and populationlevel impact of HIVST, combining population studies, 11,23 qualitative studies, 21,24,25 economic analyses, 26 and mathematical modelling.…”

Section: Introductionmentioning

confidence: 99%

Assessing the potential population-level impacts of HIV self-testing distribution among key populations in Côte d’Ivoire, Mali, and Senegal: a mathematical modelling analysis

Silhol,

Maheu-Giroux,

Soni

et al. 2023

Preprint

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Background: A third of people living with HIV (PLHIV) in Western Africa had an undiagnosed infection in 2020. In 2019-2021, the ATLAS programme has distributed a total of 380 000 HIV self-testing (HIVST) kits to key populations (KP) including female sex workers (FSW) and men who have sex with men (MSM), and their partners in Cote d'Ivoire, Mali and Senegal. We predicted the potential impact of ATLAS and of national HIVST scale-up strategies among KP. Methods: A deterministic model of HIV transmission was calibrated to country-specific empirical HIV and intervention data over time. We simulated scenarios reflecting 1) the actual ATLAS HIVST distribution only over 2019-2021 (~2% of all tests done in countries), and 2) ATLAS followed by a scale-up of HIVST distribution to KP (total of ~570 000 kits distributed each year). Impacts on HIV diagnosis, new HIV infections and deaths were derived using counterfactual scenarios without HIVST. Findings: ATLAS was predicted to substantially increase HIV diagnosis among KP by the end of 2021, especially among MSM in Mali (94.3 percentage point [pp] increase), and a 1.0pp increase overall. ATLAS might have averted a median of 706 new HIV infections among KP over 2019-2028 in the 3 countries combined, especially among MSM, and 1794 new HIV infections (0.4-3.3% of all new HIV infections across countries) and 591 HIV-related deaths overall. HIVST scale-up increased HIV diagnosis at the end of 2028 by around 8pp among FSW and 33pp among MSM in every country. Overall increases ranged from 1.0pp (Cote d'Ivoire) to 11.0pp (Senegal). HIVST scale-up may avert 3-5% of new HIV infections among FSW, 3-10% among FSW clients, and 20-28% among MSM across countries (and 2-16% overall), and avert 13-18% of HIV-related deaths among MSM over 2019-2028. Interpretation: Scaling-up HIVST distribution among KP in Western Africa may substantially attenuate disparities in access to HIV testing and help reduce HIV infections and deaths among KP and their partners.

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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 Côte d’Ivoire, Mali, and Senegal

Cited by 8 publications

References 28 publications

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

“I take it and give it to my partners who will give it to their partners”: Secondary distribution of HIV self-tests by key populations in Côte d’Ivoire, Mali, and Senegal

Assessing the potential population-level impacts of HIV self-testing distribution among key populations in Côte d’Ivoire, Mali, and Senegal: a mathematical modelling analysis

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