Abstract
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 Côte d’Ivoire, Mali and Senegal. We predicted the potential impact of ATLAS and of national HIVST scale-up strategies among KP.
Methods:
A transmission-dynamic model calibrated to country-specific empirical HIV and intervention data over time 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), and estimated their impacts on HIV diagnosis, new HIV infections, and deaths.
Findings:
ATLAS may have increased HIV diagnosis by 1%-point overall by the end of 2021. The increase was more substantial among KP (e.g. from medians across model estimates of 43% and 51% among MSM in Mali). It may avert a median total of 1800 new HIV infections over 2019-2028 (0·4-3·3% of all new HIV infections across countries), including 700 new HIV infections among KP, and 600 HIV-related deaths overall. HIVST scale-up is predicted to increase HIV diagnosis by the end of 2028 by 1%-point (Côte d’Ivoire) to 11%-point (Senegal), and by around 8%-point among FSW and 33%-point among MSM in each country. HIVST scale-up may avert 2-16% of all new HIV infections across countries over 2019-2028, including 3-5% among FSW, 3-10% among clients of FSW, 20-28% among MSM, and avert 13-18% of HIV-related deaths among MSM.
Interpretation:
Scaling-up HIVST distribution among KP in Western Africa may substantially attenuate disparities in access to HIV testing and reduce infections and deaths among KP and their partners.
Funding: Unitaid, Solthis, the UK Medical Research Council Centre for Global Infectious Disease Analysis, the EU European & Developing Countries Clinical Trials Partnership programme, and the Wellcome Trust.
Keywords:
AIDS; HIV; HIV testing; HIV self-test; key populations; female sex workers; men who have sex with men; treatment and care cascade; Western Africa.
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 Côte d’Ivoire, Mali and Senegal. We predicted the potential impact of ATLAS and of national HIVST scale-up strategies among KP.
Methods:
A transmission-dynamic model calibrated to country-specific empirical HIV and intervention data over time 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), and estimated their impacts on HIV diagnosis, new HIV infections, and deaths.
Findings:
ATLAS may have increased HIV diagnosis by 1%-point overall by the end of 2021. The increase was more substantial among KP (e.g. from medians across model estimates of 43% and 51% among MSM in Mali). It may avert a median total of 1800 new HIV infections over 2019-2028 (0·4-3·3% of all new HIV infections across countries), including 700 new HIV infections among KP, and 600 HIV-related deaths overall. HIVST scale-up is predicted to increase HIV diagnosis by the end of 2028 by 1%-point (Côte d’Ivoire) to 11%-point (Senegal), and by around 8%-point among FSW and 33%-point among MSM in each country. HIVST scale-up may avert 2-16% of all new HIV infections across countries over 2019-2028, including 3-5% among FSW, 3-10% among clients of FSW, 20-28% among MSM, and avert 13-18% of HIV-related deaths among MSM.
Interpretation:
Scaling-up HIVST distribution among KP in Western Africa may substantially attenuate disparities in access to HIV testing and reduce infections and deaths among KP and their partners.
Funding: Unitaid, Solthis, the UK Medical Research Council Centre for Global Infectious Disease Analysis, the EU European & Developing Countries Clinical Trials Partnership programme, and the Wellcome Trust.
Keywords:
AIDS; HIV; HIV testing; HIV self-test; key populations; female sex workers; men who have sex with men; treatment and care cascade; Western Africa.
| Original language | English |
|---|---|
| Pages (from-to) | e531-e541 |
| Number of pages | 11 |
| Journal | Lancet HIV |
| Volume | 11 |
| Issue number | 8 |
| Early online date | 8 Jul 2024 |
| DOIs | |
| Publication status | E-pub ahead of print - 8 Jul 2024 |
Bibliographical note
Publisher Copyright:© 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
