Abstract
BackgroundThe ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Côte d’Ivoire, Mali, and Senegal. During 2019–2021, in close collaboration with the national AIDS implementing partners and communities, ATLAS plans to distribute 500,000 HIVST kits through eight delivery channels, combining facility-based, community-based strategies, primary and secondary distribution of HIVST.Considering the characteristics of West African HIV epidemics, the targets of the ATLAS programme are hard-to-reach populations: key populations (female sex workers, men who have sex with men, and drug users), their clients or sexual partners, partners of people living with HIV and patients diagnosed with sexually transmitted infections and their partners.The ATLAS programme includes research support implementation to generate evidence for HIVST scale-up in West Africa.The main objective is to describe, analyse and understand the social, health, epidemiological effects and cost-effectiveness of HIVST introduction in Côte d’Ivoire, Mali and Senegal to improve the overall HIV testing strategy (accessibility, efficacy, ethics).MethodsATLAS research is organised into five multidisciplinary workpackages (WPs):Key Populations WP: qualitative surveys (individual in-depth interviews, focus group discussions) conducted with key actors, key populations, and HIVST users.Index testing WP: ethnographic observation of three HIV care services introducing HIVST for partner testing.Coupons survey WP: an anonymous telephone survey of HIVST users.Cost study WP: incremental economic cost analysis of each delivery model using a top-down costing with programmatic data, complemented by a bottom-up costing of a representative sample of HIVST distribution sites, and a time-motion study for health professionals providing HIVST.Modelling WP: Adaptation, parameterisation and calibration of a dynamic compartmental model that considers the varied populations targeted by the ATLAS programme and the different testing modalities and strategies.DiscussionATLAS is the first comprehensive study on HIV self-testing in West Africa. The ATLAS programme focuses particularly on the secondary distribution of HIVST. This protocol was approved by three national ethic committees and the WHO’s Ethical Research Committee.
Highlights
The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Côte d’Ivoire, Mali, and Senegal
In 2019, only 68% of people living with HIV (PLHIV) in West Africa were aware of their HIV status, 58% were on antiretroviral (ARV) therapy and 45% had an undetectable viral load [1], all of which are far from the levels required to achieve epidemic control
HIV testing at Sexually transmitted infections (STI) consultations is recommended, the percentage of testing initiated in this context remains low
Summary
15–20 in-depth interviews will be conducted in each country. 3 focus group discussions (FGDs) will be conducted with members of each key population in each country (i.e., 9 FGDs in Côte d’Ivoire, 6 FGDs in Mali and 9 FGDs in Senegal, i.e., 24 FGDs in total). The data collected will cover both the costs of dispensing HIV kits and other HIV testing activities conducted on-site It will include specific costs of the ATLAS programme, as well as costs covered by other donors (e.g., Global Fund, Pepfar) and economic costs not reported in financial reports (e.g., donations of goods and services), as well as allocation factors for the disaggregation of costs by delivery models. The specific objectives of the Modelling WP are to identify population groups most likely to acquire and transmit HIV and to identify their testing and diagnostic delays; to estimate the population impact of the introduction of HIVST in the three ATLAS countries, at the scale achieved by the ATLAS programme and under possible scale-up scenarios; and to estimate the costeffectiveness of these scale-up scenarios and conduct sensitivity analysis. A representative of the Ministry of Health of each country is associated with the research team which meets annually
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