Introducing and Implementing HIV Self-Testing in Côte d'Ivoire, Mali, and Senegal: What Can We Learn From ATLAS Project Activity Reports in the Context of the COVID-19 Crisis?

Abstract

Background: The ATLAS program promotes and implements HIVST in Côte d'Ivoire, Mali, and Senegal. Priority groups include members of key populations—female sex workers (FSW), men having sex with men (MSM), and people who use drugs (PWUD)—and their partners and relatives. HIVST distribution activities, which began in mid-2019, were impacted in early 2020 by the COVID-19 pandemic.Methods: This article, focusing only on outreach activities among key populations, analyzes quantitative, and qualitative program data collected during implementation to examine temporal trends in HIVST distribution and their evolution in the context of the COVID-19 health crisis. Specifically, we investigated the impact on, the adaptation of and the disruption of field activities.Results: In all three countries, the pre-COVID-19 period was marked by a gradual increase in HIVST distribution. The period corresponding to the initial emergency response (March-May 2020) witnessed an important disruption of activities: a total suspension in Senegal, a significant decline in Côte d'Ivoire, and a less pronounced decrease in Mali. Secondary distribution was also negatively impacted. Peer educators showed resilience and adapted by relocating from public to private areas, reducing group sizes, moving night activities to the daytime, increasing the use of social networks, integrating hygiene measures, and promoting assisted HIVST as an alternative to conventional rapid testing. From June 2020 onward, with the routine management of the COVID-19 pandemic, a catch-up phenomenon was observed with the resumption of activities in Senegal, the opening of new distribution sites, a rebound in the number of distributed HIVST kits, a resurgence in larger group activities, and a rebound in the average number of distributed HIVST kits per primary contact.Conclusions: Although imperfect, the program data provide useful information to describe changes in the implementation of HIVST outreach activities over time. The impact of the COVID-19 pandemic on HIVST distribution among key populations was visible in the monthly activity reports. Focus groups and individual interviews allowed us to document the adaptations made by peer educators, with variations across countries and populations. These adaptations demonstrate the resilience and learning capacities of peer educators and key populations.

Using routine programmatic data to estimate the population-level impacts of HIV self-testing: The example of the ATLAS program in Cote d’Ivoire

“…Moreover, the descriptive data showed that a decrease in conventional testing occurred in all districts, including those not covered by ATLAS activities, this is linked to the fact that PEPFAR’s testing strategies are revised annually and favoring more targeted approaches. 26 Our results suggest that ATLAS HIVST distribution allowed to maintain access to HIV testing in its implementation districts despite the slowdown observed in Q2 2020 when governmental COVID-19 measures were introduced. In fact, the first results of the ATLAS project have shown that HIVST distribution activities among KPs could be easily adapted, including in the context of the COVID-19 pandemic.…”

Routine programmatic data show a positive population-level impact of HIV self-testing: the case of Côte d’Ivoire and implications for implementation

“…Our results suggest that ATLAS HIVST distribution help maintain access to HIV testing in its implementation districts despite the slowdown observed in Q2 2020 when governmental COVID-19 measures were introduced. In fact, a main takeaway from the ATLAS project is that HIVST distribution activities among KPs can be easily adapted, including in the context of the COVID-19 pandemic [21]. Due to its confidential nature, HIVST could overcome several structural barriers for HIV diagnoses -such as stigma and opportunity costs -and create new approaches to reach first-time testers and boost HIV retesting for KPs, therefore improving access to HIV testing overall.…”

“…Our results suggest that ATLAS HIVST distribution help maintain access to HIV testing in its implementation districts despite the slowdown observed in Q2 2020 when governmental COVID-19 measures were introduced. In fact, a main takeaway from the ATLAS project is that HIVST distribution activities among KPs can be easily adapted, including in the context of the COVID-19 pandemic [ 21 ].…”

“…This specificity of HIVST kit distribution implies that HIVST beneficiaries (end-users) are not limited to primary contacts. ATLAS's program results have shown that HIVST can reduce stigma; preserve anonymity and confidentiality; reach KPs that do not access testing via other testing approaches; save opportunity costs for users and providers; empower users with autonomy and responsibility; and is noninvasive and easy to use [19][20][21][22].…”

The impacts of COVID-19 on structural inequities faced by people living with HIV who inject drugs: A qualitative study in St. Petersburg, Russia

“…(2020) . Program evaluations conducted in Europe, North America, Asia, and Africa suggested that most health care and harm reduction services for PWID, including HIV testing ( Frost et al., 2021 ; Htun Nyunt et al., 2021 ; Kra et al., 2021 ), HIV treatment ( Mistler et al., 2021 ), access to sterile injection equipment ( Croxford et al., 2021 ; Van Hout et al., 2021 ), and post-overdose care in emergency departments ( Collins et al., 2021 ), were negatively affected by the pandemic, though some programs were able to adapt quickly and innovate new forms of service delivery ( Van Hout et al., 2021 ; Wenger et al., 2021 ). Qualitative research exploring how the COVID-19 pandemic has shaped the lived experience of PWID remains limited to studies of overdose risks and the necessity of harm reduction services during pandemic conditions in parts of the United States and Canada ( Perri et al., 2021 ; Russell et al., 2021 ; Stack et al., 2021 ).…”