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. 2022 Nov 1;36(13):1871-1879.
doi: 10.1097/QAD.0000000000003328. Epub 2022 Aug 3.

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

Arlette Simo Fotso  1   2 , Cheryl Johnson  3 , Anthony Vautier  4 , Konan Blaise Kouamé  5 , Papa Moussa Diop  4 , Romain Silhol  6 , Mathieu Maheu-Giroux  7 , Marie-Claude Boily  6 , Nicolas Rouveau  1 , Clémence Doumenc-Aïdara  4 , Rachel Baggaley  3 , Eboi Ehui  5 , Joseph Larmarange  1 ; for the ATLAS team
Affiliations

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

Arlette Simo Fotso et al. AIDS. .

Abstract

Objectives: We estimate the effects of ATLAS's HIV self-testing (HIVST) kit distribution on conventional HIV testing, diagnoses, and antiretroviral treatment (ART) initiations in Côte d'Ivoire.

Design: Ecological study using routinely collected HIV testing services program data.

Methods: We used the ATLAS's programmatic data recorded between the third quarter of 2019 and the first quarter of 2021, in addition to data from the President's Emergency Plan for AIDS Relief dashboard. We performed ecological time series regression using linear mixed models. Results are presented per 1000 HIVST kits distributed through ATLAS.

Results: We found a negative but nonsignificant effect of the number of ATLAS' distributed HIVST kits on conventional testing uptake (-190 conventional tests; 95% confidence interval [CI]: -427 to 37). The relationship between the number of HIVST kits and HIV diagnoses was significant and positive (+8 diagnosis; 95% CI: 0 to 15). No effect was observed on ART initiation (-2 ART initiations; 95% CI: -8 to 5).

Conclusions: ATLAS' HIVST kit distribution had a positive impact on HIV diagnoses. Despite the negative signal on conventional testing, even if only 20% of distributed kits are used, HIVST would increase access to testing. The methodology used in this paper offers a promising way to leverage routinely collected programmatic data to estimate the effects of HIVST kit distribution in real-world programs.

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Conflict of interest statement

C.J. declares that WHO receives grants to support activities on HIV testing including self-testing from USAID, Unitaid and the Bill and Melinda Gates Foundation

All the other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Number of conventional testing and HIV self-testing (HIVST) kits distributed through PEPFAR and ATLAS from Q3 2019 to Q1 2021 in (a) all 78 health districts monitored by PEPFAR in Côte d’Ivoire, (b) the nine ATLAS districts only, and (c) the 69 districts not covered by ATLAS.
Fig. 2
Fig. 2
Number of HIV diagnoses and ART initiations in the 78 health districts monitored by PEPFAR in Côte d’Ivoire (Q3 2019 to Q1 2021).
See this image and copyright information in PMC

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