Introducing HIV self-testing in Senegal: innovative strategies, challenges and perspectives in a fast-track context - Pr Cheikh Tidiane NDOUR ...
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Introducing HIV self-testing in Senegal:
innovative strategies, challenges and perspectives
in a fast-track context
Pr Cheikh Tidiane NDOUR
Division de Lutte contre le Sida et les IST
HIV prevalence by regions from 2011 and 1017
Geographical distribution of HIV prevalence among MSM
Situation of the HIV care cascade and the the three 90 target
Evolution de la cible des 90-90-90 de 2016 à 2018
85% 87%
79% 79%
71%
72% 76% 75%
54%
PVVIH connaissant leur PVVIH sous TARV Suppression virale
diagnostic
2016 2017 2018
MSM care cascade in 2018
1800 1712
1600
1400
1200
1000
800
600
400 334 316
200
0
ESTIMATION MSM MSM VIH+ DIAGNOSTIQUES MSM VIH+ SOUS ARV
SEROPOSITIFS
PSW care cascade in 2018
1400
1300
1200
1000
800
618
600
397
400
200
0
ESTIMATION PS SEROPOSITIVES PS VIH+ DIAGNOSTIQUEES PS VIH+ SOUS ARV
1st 90: Gaps to be filled • Limitations of provider initiated HIV testing and mobile strategies • Inadequate estimate of KP size and hotspot mapping • Inadequacies in sibling and spouse screening • Inadequate screening and follow-up of children born from HIV-positive mothers • Under-optimal consideration of young people, especially teenagers • Inadequate integration between HIV and reproductive health programs
Use and acceptability of HIV self-testing among first-time testers at
risk for HIV in Senegal
John Hopkins University & Enda santé
• Main objective: assess the acceptability of HIVST for key populations and people in their
social and sexual networks and secondly
• Secondary objectives
1. assess the efectiveness of HIVST in reaching first-time testers.
2. inform appropriately scaled implementation of HIVST in Senegal & across West AfricaAcceptability • 94.3% reported using the HIVST of which 43.5% were first-time testers • 74.5% participants reported being comfortable using the HIVST • 88.9% used the HIVST within 2 days: 54.3% at the distribution site and 45.7% at home • 2.9% reported a reactive result, and 2.0% had an invalid result • 86.1% found the instructions easy to follow • 94.4% thought their family of friends would use the HIVST • 78.5% would be comfortable asking a primary sexual partner to use an HIVST • 65.8% (150/228) would be comfortable asking a casual sexual partner to use an HIVST
Senegal Experience : environment Enabling environment to introduce HIVST (2017-2018): • HIVST integrated within HIV national strategy and HIV testing politics and norms document. • Supportive legal environment even though some barriers exist (KP) • Effective access to testing and treatment services • Existing community/outreach testing strategies and implementation • Existing testing national technical working group to share and validate recommendations and tools. • A 1st pilot initiative (3000 HIVST, 1 region) in 2017
Projet ATLAS in Senegal
IMPLEMENTING
ZONES REGIONS
D’INTERVENTION
.Partners
1. Institutional partnerships
• SOLTHIS/CNLS/DLSI agreement in November 2018
• CNLS/National Procurement Pharmacy (PNA) partnership agreement in February 2019 for the
management of self-tests
• Temporary Import Authorization for Emergency Order and First Year Order in December 2018
2. Partenaires de Mise en œuvre
• DLSI and the health facilities involved
• CTA for the Green Line
• CEPIAD for CDIs
• ENDA and OCB partners at community level1st results
HIVST distribution per target population
Senegal July to Oct 2019
1600
1400 1352
1200
1032
1000
800
621
600
400 288 326 340
172 198
200 62 95
0
FSW and MSM & partners PlWHIV partners STI partners DU and parnters
partners/clients
Estimated target Distributed1st results
Cumulative HIVST distribution vs estimated target
Senegal 2019
8000
7363
7000
6000
5498
5000
4000
3633
3000
2000
1768
1000 1132
853
566 617
212 372
0
juil.-19 août-19 sept.-19 oct.-19 nov.-19 déc.-19
Estimated target DistributedHIVST integration and scaling up • 4 HIVST indicators in DHIS2 • PSM integrated in the national system (National Pharmacy) • ATLAS implementation (60 000 HIVST) in 3 regions from 07/19 to 11/21 and catalytic funds to cover all other Medical regions than ATLAS (44 000 HIVST) from 10/19 to late 2021 • HIVST quantification exercise done at national level integrating ATLAS and GFATM contributions
Challenges • OraQuick technical evaluation in process (with IRESSEF) to officially register the product. • WHO technical assistance about to start for HIVST national strategy and HIVST national guideline development (end 2019- early 2020) integration private sector strategy. • Delivery channels, dispensing strategies and HIVST impact evaluation with M&E system in place, data triangulation and researches (ATLAS) • Effective national and sustainable scaling up and transition (post ATLAS and catalytic fund starting from 2022): opportunity with New GFATM Round/NFM to be developed early 2020.
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