Since the beginning of the project, the research team, coordinated by Joseph Larmarange (CEPED-IRD), has been working on five work packages (qualitative survey on key populations, anthropological survey on the screening of partners of PLwHIV, coupon survey, economic component, modeling component). With some preliminary data from this research now available, the ATLAS project teams organized dissemination meetings in April and May as part of the knowledge transfer activities.
These workshops brought together the project’s national partners, as well as actors involved in screening and more broadly in the fight against HIV/AIDS, and made it possible to present the operational advances, involving the ATLAS project partners who also presented their own feedback. Preliminary research results were also made available to all stakeholders in order to provide them with useful elements for the implementation of self-testing strategies. Marc d’Elbée, from the London School of Hygiene and Tropical Medicine, presented the economics aspects of the project, including an expected reduction in costs from $17 to $10 per kit provided at scale. Odette Ky-Zerbo, from the TransVIHMI/IRD IMU, presented data from the key population survey conducted at the beginning of the project. They expressed a rather favorable attitude, but with some doubts due to lack of knowledge. Additional components of this survey are being conducted to assess changes in the perception of HIV self-testing following its deployment. Finally, Sokhna Boye, from CEPED / IRD, presented the results of the survey she conducted on the self-testing of partners of PLwHIV, which revealed the difficulty of proposing HIV self-testing to one’s partner when the status has not been shared, and the need to work on the patient’s circuit in order to avoid longer consultations by providing the self-testing kit. The discussions that followed these presentations allowed the ATLAS project teams to specify the modalities of its knowledge transfer strategy, in order to ensure that the data disseminated will be adapted to the needs and recipients, and their appropriation facilitated. Deliberative workshops will be held between late 2021 and early 2022 to continue knowledge transfer, and further presentations by ATLAS investigators will take place at the International AIDS Society conference (virtual conference, July 18-21).
Find the presentations of the preliminary research data (in French) :
Now in its final stage, the ATLAS project is continuing its capitalization process. The objective is to document the good practices but also the challenges of the implementation of the project in order to promote and facilitate the development of new HIV self-testing initiatives (HIVSTD).
In a context of increasing integration of HIV testing into testing strategies in West and Central Africa, particularly in the context of the implementation of the 2021-2023 Global Fund grants, the availability of contextualized knowledge on this innovation is essential to ensure its successful implementation.
As the main experience in deploying ADVIH in West Africa, the ATLAS project has therefore decided to share its experiences, particularly in terms of cultural and epidemiological contexts, but also in terms of the specificities of ATLAS in terms of delivery channels and target populations.
The first two capitalization sheets are devoted to the integration of ADVIH into national systems on the one hand, and the creation of user demand on the other.
The first documents the approach used by ATLAS to ensure the integration of HIV testing and to raise awareness among HIV stakeholders of the challenges associated with integrating HIV testing as a complementary testing strategy. The second contributes to improving practices in terms of promoting and raising awareness about HIV testing and identifies the challenges and good practices for creating a sustainable demand for self-testing among the hardest-to-reach populations.
These capitalization sheets are available in free access on our website.
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.