In order to prepare the transition of the ATLAS project and the scaling up at the national level, its teams, with the support of WHO, have accompanied the Senegalese Ministry of Health and Social Action (MSAS) and the National AIDS Council (CNLS) in the development of the National Strategy on Self-Testing and the Practical Guide to HIV Self-Testing. As Dr. Sanata Diallo, head of the ATLAS project in Senegal, pointed out, “the strategy provides the necessary guidelines and the guide allows for its operationalization in the field”. Officially handed over on January 25, 2021, the strategy comes, according to Dr. Safiatou Thiam, Executive Secretary of the CNLS, “to complete the document Policy, Standards and Protocols of HIV testing services published in 2018 and allows to define the strategic orientations adapted to our context as well as the development of the national policy”. She also recalled that since the beginning of the implementation of the ATLAS project in 2018, “the results obtained are encouraging”, and that this complementary strategy expands the range of screening. A necessary step because “the classic strategy is not enough, so we need to diversify our offer and cover all the needs.”
In addition to the strategy, it was also decided to develop a practical user guide. As Abdoulaye Diouf Sarr, Minister of Health and Social Action and author of the preface, points out, “gaps persist [in screening, editor’s note] and have increased in key and vulnerable populations. This is why Senegal has adopted the HIV self-testing strategy to reach these targets. MSAS has therefore decided to develop this guide to help stakeholders in our country to appropriate this innovative HIV testing strategy”. Professor Cheick Tidiane Ndour, Director of the Division of AIDS Control and Sexually Transmitted Infections (DLSI), also said that the advantage of the practical guide to HIV self-testing in Senegal, officially handed over on March 16, was “to harmonize operational practices within the framework of an innovative strategy. Indeed, he added, “self-testing has aroused great enthusiasm, particularly in the community, and therefore requires the establishment of a framework to implement the strategy on the ground. “
The guide describes in concrete terms the strategies and delivery channels chosen by the country and, in particular, sets minimum standards for training, awareness-raising, monitoring and evaluation, and quality assurance for inputs. As part of this transition process, the ATLAS project teams, with technical support from WHO, are currently assisting the Ivorian and Malian health authorities in the development of these same documents. The Malian national strategy and practical guide will be available soon, as the validation workshop took place at the end of February.
The Covid-19 crisis affected the ATLAS project’s intervention countries starting in March 2020. In response to this new disease, governments quickly took strong measures by declaring a state of health emergency and implementing, depending on the country, travel restrictions, gathering limits and curfews. Like the Ebola epidemic in West Africa (2014-2015), the Covid-19 pandemic has had a strong impact on the management of other diseases, focusing attention and increasing mistrust of health facilities, thus causing a drop in attendance.
As early as May 2020, UNAIDS warned of the risk of losing the progress made in recent years. The latest data (October 2020) show a significant decline in HIV testing services in almost all countries.
Thus, it was essential to continue and adapt HIV control activities, including prevention and testing. While working with its various partners to deploy Covid-19 awareness tools, the ATLAS project developed several initiatives to maintain the provision of HIV self-testing kits while ensuring the safety of providers and users. From the provision of personal protective equipment to the adaptation of advanced strategies and the proposal of HIVST kits during the community distribution of antiretrovirals, these adaptations have allowed the ATLAS project teams and partners to continue their activities at an equal or even higher level than that which prevailed before Covid-19.
This adaptation to the situation has proved to be all the more important as self-testing, in addition to being a tool that allows people to be tested when and where they want, also makes it possible to limit physical contact. It is therefore particularly appropriate in this pandemic context to maintain the possibility of knowing one’s HIV status.
In Dakar, Maguette drives an association of sex workers and provides these young women with benevolence and support.
Dakar, in a discreet alleyway, a small house, a little worn out by the years, hides under the leafy mango trees. A young aficionado of Lionel Messi, Barça jersey on his back, comes out with a ball at his feet. “Mommy, if you look for me, I’m playing soccer outside. Mamoudou, 11 years old, is Maguette’s youngest child. He is the pride and joy of Maguette, as are his grandchildren, whose toys are scattered all over the courtyard of his modest home. It is also in this house that Maguette regularly welcomes sex workers who are members of Karlène, the sex workers’ association she drives. “I wasn’t predestined to take care of people, the community fell on me, but today I can’t do without it. »
Maguette is a mother, a grandmother and a landmark for those around her. “Sex work is tolerated, but the law is obsolete*. Many girls remain in hiding because they refuse to register; even with the card, they can be arrested because soliciting is prohibited. “Community structures are therefore essential for many girls who have little support. Every month, Karlène brings the sex workers together for an awareness session. Self-testing for HIV is one of the topics regularly discussed. “They need to be sensitized and informed. They need to be able to benefit from what we haven’t had. They represent the future, future generations. They must have healthy youth. »
About twenty young women are present that day, smiling, happy to share a moment of non-judging conviviality. Very attentive, they are particularly interested in HIV self-testing. “It’s a practical tool, without needles, without pain,” says one of them. And Maguette confirms: “they have a lot of risky practices, so they use and give HIV self-tests to their peers and clients, because it allows them to test themselves regularly. Then, they call us or the hotline* and are referred to a structure not too close to their home in order not to be stigmatized”.
Advising, orienting, protecting, such is the daily life of Maguette whose body bears the stigma of fifty years of struggle. “I had a close relative who was a drug user and a person living with HIV. I myself was a sex worker. I joined the association and eventually became its president. I am also vice-president of RENAPOC. Helping is my life. » Thanks to Enda Santé, partner of the ATLAS Project in Senegal, Karlène was able to join the pool of relay associations for the dispensing of HIV self-tests. “Enda has been supporting us for a very long time, and has strengthened us enormously at the community level. This has enabled us to make great progress, by accompanying us in the talk sessions, in the implementation of demedicalized testing. Myself, they have allowed me to acquire a diploma as a medical sales representative. »
The past year has not been without difficulties for Karlène, with the COVID-19 pandemic. A lot of activities have stopped,” says Maguette. Girls are working less. I was worried about many of them. We recommended that the barrier measures be respected, but with the situation, it was complicated. They had to eat. It is the survival instinct that dominates. » Moved, but with an irreducible strength in her eyes, Maguette confides: “I will always fight for them, they are counting on me. This is Maguette! »
*In Senegal, sex workers can legally register as such, and thus benefit from a health and other monitoring record. *Anonymous and free toll-free toll-free number: 800 30 30
The coronavirus pandemic has once again demonstrated the importance of investing in health systems, strengthening equitable access to care and improving preparedness for epidemic prevention and control. Presented by Dr. Matshidiso Rebecca Moeti, Regional Director for Africa of the World Health Organization, this approach is advocated by Solthis, an expert organization in health, which has been working in Africa for years. Read, in french, Dr. Serge Breysse’s opinion, published in the French daily L’Opinion on September 11th.
The ATLAS project was present at the 23rd World Conference on HIV/AIDS
HIV Self-Testing in West Africa: from the Field – Dr Aminata Saran Sidibé (Soutoura, Mali) – Dr Patricia Zougouni (Espace Confiance, Côte d’Ivoire) – Dr Odé Kanku Kabemba (ATLAS Project, Mali)
To see in replay : https://www.psi.org/wp-content/uploads/2020/07/Atlas-Project-HIVST-in-West-Africa.mp4
Satellite Symposium : Towards sustainability and scability of hivst: solutions for low-and middle-income countries
Presentation by Clémence Doumenc Aïdara, Director of the ATLAS project
Presentation by Dr Safiatou Thiam, Executive Secretary of CNLS Senegal
Presentation film HIVST in West Africa
Poster: Challenges of HIV self-tests distribution for index testing in a context where HIV status disclosure is low: preliminary experience of the ATLAS project in Bamako, Mali. Sokhna Boye (Centre for Population and Development, Research Institute for the Développement, Université Paris Descartes, Inserm) et al.
In the context of the coronavirus pandemic, the ATLAS Project participates in the response by developing and/or promoting awareness tools adapted for vulnerable populations and those living with HIV.
After participating in equipping their partners with protective equipment; in order to ensure that their exercise could continue under optimal security conditions, the ATLAS Project teams worked, in conjunction with their implementing partners, on the development and implementation of awareness actions. In addition to the posters specifically developed, in collaboration with UNAIDS, for people living with HIV and reminding them of the particular conduct to be observed in the event of uncontrolled HIV infection, the materials published by the health authorities and visuals on the wearing of masks have been reproduced.
In Mali, the ATLAS project supports the measures of the Ministry of Health and Social Affairs and supports the broadcasting of awareness spots on community radio stations in French and Bambara on barrier gestures, thus making it possible to reach populations far from mass broadcasting channels. Two listeners of the free information line on COVID-19, hosted by PSI Mali’s KENEYAKO line, which already receives calls for ATLAS HIV self-test kits, are also supported by the Project to inform and orient people on the issue of coronavirus.
In Senegal, in order to increase the level of knowledge of the population, the ATLAS Project has financed and developed awareness programmes, broadcast on community radio stations in Mbour, Dakar and Ziguinchor. These weekly programmes, scheduled to be broadcast until the end of July, will systematically cover a reminder on barrier gestures and then devote forty minutes of airtime to a specific theme, accompanied by an expert to present the subject and answer listeners’ questions. While COVID-19, its modes of transmission, epidemiology and symptomatology will of course be discussed, programmes will also be devoted to vulnerabilities and prevention measures, the role of communities and continuity of care for PLWHA and vulnerable populations, the aim being to communicate accurate and accessible information in order to stop community transmissions.
Listen to the awareness messages of the Malian Ministry of Health and Social Affairs :