Describing, analysing and understanding the effects of the introduction of HIV self-testing in West Africa through the ATLAS programme in Cote d'Ivoire, Mali and Senegal

BackgroundThe ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Cote d'Ivoire, Mali, and Senegal. During 2019-2021, in close collaboration with the national AIDS implementing partners and communities, ATLAS plans to distribute 500,000 HIVST kits through eight delivery channels, combining facility-based, community-based strategies, primary and secondary distribution of HIVST.Considering the characteristics of West African HIV epidemics, the targets of the ATLAS programme are hard-to-reach populations: key populations (female sex workers, men who have sex with men, and drug users), their clients or sexual partners, partners of people living with HIV and patients diagnosed with sexually transmitted infections and their partners.The ATLAS programme includes research support implementation to generate evidence for HIVST scale-up in West Africa.The main objective is to describe, analyse and understand the social, health, epidemiological effects and cost-effectiveness of HIVST introduction in Cote d'Ivoire, Mali and Senegal to improve the overall HIV testing strategy (accessibility, efficacy, ethics).MethodsATLAS research is organised into five multidisciplinary workpackages (WPs): qualitative surveys (individual in-depth interviews, focus group discussions) conducted with key actors, key populations, and HIVST users.Key Populations WP: ethnographic observation of three HIV care services introducing HIVST for partner testing.Index testing WP: an anonymous telephone survey of HIVST users.Coupons survey WP: incremental economic cost analysis of each delivery model using a top-down costing with programmatic data, complemented by a bottom-up costing of a representative sample of HIVST distribution sites, and a time-motion study for health professionals providing HIVST.Cost study WP: Adaptation, parameterisation and calibration of a dynamic compartmental model that considers the varied populations targeted by the ATLAS programme and the different testing modalities and strategies.DiscussionATLAS is the first comprehensive study on HIV self-testing in West Africa. The ATLAS programme focuses particularly on the secondary distribution of HIVST. This protocol was approved by three national ethic committees and the WHO's Ethical Research Committee.

Automated summary

The ATLAS program aims to promote HIV self-testing in West Africa through multiple delivery channels, focusing on hard-to-reach populations. Research will assess the social, health, epidemiological effects, and cost-effectiveness of introducing HIVST in Cote d'Ivoire, Mali, and Senegal.