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. 2024 Oct 1;38(12):1783-1793.
doi: 10.1097/QAD.0000000000003974. Epub 2024 Jul 1.

The impact of past HIV interventions and diagnosis gaps on new HIV acquisitions, transmissions, and HIV-related deaths in Côte d'Ivoire, Mali, and Senegal

Romain Silhol  1 , Mathieu Maheu-Giroux  2 , Nirali Soni  1 , Arlette Simo Fotso  3   4 , Nicolas Rouveau  3 , Anthony Vautier  5 , Clémence Doumenc-Aïdara  6 , Olivier Geoffroy  7 , Kouassi Noël N'Guessan  7 , Younoussa Sidibé  8 , Odé Kanku Kabemba  8 , Papa Alioune Gueye  6 , Pauline Dama Ndeye  6 , Christinah Mukandavire  9   10 , Peter Vickerman  11 , Abdelaye Keita  12 , Cheikh Tidiane Ndour  13 , Eboi Ehui  14 , Joseph Larmarange  3   4 , Marie-Claude Boily  1 ; for the ATLAS Team
Affiliations

The impact of past HIV interventions and diagnosis gaps on new HIV acquisitions, transmissions, and HIV-related deaths in Côte d'Ivoire, Mali, and Senegal

Romain Silhol et al. AIDS. .

Abstract

Objectives: To estimate the epidemiological impact of past HIV interventions and the magnitude and contribution of undiagnosed HIV among different risk groups on new HIV acquisitions in Côte d'Ivoire, Mali and Senegal.

Design: HIV transmission dynamic models among the overall population and key populations [female sex workers (FSW), their clients, and MSM].

Methods: Models were independently parameterized and calibrated for each set of country-specific demographic, behavioural, and epidemiological data. We estimated the fraction of new HIV infections over 2012-2021 averted by condom use and antiretroviral therapy (ART) uptake among key populations and non-key populations, the direct and indirect contribution of specific groups to new infections [transmission population-attributable fraction (tPAF)] over 2012-2021 due to prevention gaps, and the distribution of undiagnosed people with HIV (PWH) by risk group in January 2022 and their tPAF over 2022-2031.

Results: Condom use and ART may have averted 81-88% of new HIV infections over 2012-2021 across countries, mostly due to condom use by key population. The tPAF of all key populations combined over 2012-2021 varied between 27% (Côte d'Ivoire) and 79% (Senegal). Male key populations (clients of FSW and MSM) contributed most to new infections (>60% in Mali and Senegal) owing to their higher HIV prevalence and larger prevention gaps. In 2022, men represented 56% of all PWH with an undiagnosed infection in Côte d'Ivoire (male key populations = 15%), 46% in Mali (male key populations = 23%), and 69% in Senegal (male key populations = 55%). If HIV testing and ART initiation rates remain at current levels, 20% of new HIV infections could be due to undiagnosed key populations living with HIV in Côte d'Ivoire over 2022-2031, 53% in Mali, and 65% in Senegal.

Conclusion: Substantial HIV diagnosis gaps remain in Western Africa, especially among male key populations. Addressing these gaps is key to impacting the HIV epidemics in the region and achieving the goal of ending AIDS by 2030.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Median fraction of new HIV infections which were acquired (left side of panels) and directly transmitted (right side of panels) by different risk groups in (a) Côte d’Ivoire, (b) Mali, and (c) Senegal over 2012–2021.
Fig. 2
Fig. 2
Transmission population-attributable fraction (direct and indirect transmission) estimated for people with HIV of different diagnosis and treatment stages.
See this image and copyright information in PMC

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