HIV self-testing positivity rate and linkage to confirmatory testing and care: a telephone survey in Côte d’Ivoire, Mali, and Senegal

Abstract

HIV self-testing (HIVST) empowers individuals by allowing them to decide when and where to test and with whom to share their results. From 2019 to 2022, the ATLAS program distributed ≈ 400 000 HIVST kits in Côte d Ivoire, Mali, and Senegal. It prioritised key populations, including female sex workers and men who have sex with men, and encouraged secondary distribution of HIVST to their partners, peers and clients. To preserve the confidential nature of HIVST, use of kits and HIVST results were not systematically tracked. Therefore, an anonymous phone survey was conducted to estimate HIVST positivity rates and linkage to confirmatory testing and care. This two-step survey involved an initial recruitment phase from March to June 2021 where participants were encouraged via leaflets to call a free phone number and complete a sociobehavioural questionnaire. This was followed by a second phase in September and October 2021, where participants who reported a reactive HIVST result were re-contacted to complete a further questionnaire. Of the 2 615 participants recruited during the first phase, 89.7% reported consistent results (2 visible lines and result interpreted as reactive; one line and interpreted as non-reactive; or no/one line and interpreted as invalid). HIVST positivity rates varied between 2.4% to 9.1% based on calculation methods (i.e. self-interpreted result or reported number of lines, inclusion or exclusion of don t knows and refusals). The second phase saw 78 out of 126 eligible participants complete the questionnaire. Of the 27 who reported a consistent reactive result in the first phase, 15 (56%, 95%CI: 36 to 74%) underwent confirmatory HIV testing, with 12 (80%) confirmed as HIV-positive, all of whom began antiretroviral treatment. The confirmation rate of HIVST results was fast, with 53% doing so within a week and 91% within three months of self-testing. Two-thirds (65%) went to a general public facility, and one-third to a facility dedicated to key populations. The ATLAS HIVST distribution strategy reached people living with HIV in West Africa. Linkage to confirmatory testing remained sub-optimal in these first years of HIVST implementation. However, if confirmed HIV-positive, almost all initiated treatment. HIVST constitutes a relevant complementary tool to existing screening services.

Cost‐effectiveness analysis of community‐led HIV self‐testing among key populations in Côte d'Ivoire, Mali, and Senegal

“…According to STAR data, 80% of the distributed test kits were used [28]. An anonymous phone‐based ATLAS survey suggested that 50% of individuals with reactive HIVST results proceed to confirmatory testing and, if confirmed HIV positive, will be linked to care [29,30]. Those who did not proceed to confirmatory testing may be picked up again by HTS and retested in the future.…”