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Scaling Up HIV Self-Testing in Africa: Insights From National Programmatic Data in Eight Countries Adrien Allorant, Anne Bekelynck, Aliza Monroe‐Wise, Carlota Baptista da Silva, Thato Chidarikire, et al. Journal of the International AIDS Society, 2026 Introduction Evidence from routine, national programme data on HIV self‐testing (HIVST) scale‐up is limited. This study examines HIVST scale‐up in eight African countries, describing how HIVST has been integrated into testing strategies and how testing coverage, test positivity, and linkage to antiretroviral therapy (ART) have evolved. Methods We conducted a retrospective descriptive analysis of national programme data from January 2019 to December 2023 across Kenya, Lesotho, Malawi, Mozambique, South Africa, Tanzania, Uganda and Zimbabwe. Data were disaggregated by quarter and subnational district. Indicators included HIVST kits distributed, conventional testing volumes, new HIV diagnoses and new ART initiations. We derived testing rates, testing positivity, ART linkage, and stability of HIVST distribution by district and over time. Results HIVST scale‐up varied across countries. By the most recent quarter, HIVST accounted for 63% of total testing in Lesotho, 19%–25% in Malawi and Zimbabwe, but <15% in Kenya, Tanzania, Uganda and South Africa. In Malawi, Lesotho and Zimbabwe, large volumes of HIVST partially offset declines in conventional testing during the COVID‐19 pandemic. HIVST remained modest (<15% of total tests) in Kenya and Tanzania. In Mozambique, both conventional testing and HIVST expanded. In South Africa, conventional testing remained high after COVID‐19, while HIVST expanded slowly. Despite divergent trajectories, new HIV diagnoses and ART initiations remained stable in most settings, indicating programmes adapted to maintain case‐finding even as testing volumes shifted. Conclusions This descriptive analysis shows HIVST has been scaled to different degrees, with its contribution to overall testing shaped by national contexts, and distribution models. Interpretation is constrained by incomplete reporting, the inability to identify kits used out of kits distributed and distinguishing first‐time from repeat testers. These findings can guide optimizing HIV testing services, an essential step towards meeting global HIV targets and ending AIDS by 2030.
Knowledge, attitudes and practices relating to HIV self-testing following its introduction in the Bas-Sassandra region of Côte d’Ivoire: the case of the ATLAS project Arlette Simo Fotso, Christian Koukobo, Romain Silhol, Arsène Kouassi Kra, Marie-Claude Boily, et al. Plos One, 2026 Background Awareness of HIV status is crucial for accessing HIV care and prevention but remains suboptimal in West Africa. The ATLAS initiative, launched in Côte d’Ivoire, Mali, and Senegal, addressed this gap by distributing approximately 380,000 HIV self-testing (HIVST) kits from 2019 to 2021, primarily to key populations and their social networks. This study assessed levels and correlates of Knowledge, Attitudes, and Practices (KAP) related to HIVST in the Bas-Sassandra region of Côte d’Ivoire following ATLAS’s introduction. Method A cross-sectional population-based survey was conducted in the Bas-Sassandra region in 2021 among individuals aged 15–49. A total of 6,271 people (3,203 men and 3,068 women) were interviewed. They were selected using a three-stage stratified sampling approach in the Bas-Sassandra region. Bivariate statistics and multivariable logistic regressions were used to assess KAP levels and the associated factors. Results Although few participants reported having heard about HIVST (11%) or having used it (3%), most of them reported that if it were freely available, they would be interested/very interested in using it for themselves (76%), as well as for their sexual partners (75%). Education and wealth were positively associated with knowledge and positive attitudes towards HIVST among both men and women, whereas age was positively correlated to knowledge and use of HIVST among men only. The number of sexual partners over the last 12 months was positively associated with knowledge of HIVST and willingness to use HIVST for themselves or their sexual partners among both sexes. We also found that high HIV-related knowledge and low levels of negative attitude were positively associated with positive attitudes towards HIVST, while exposure to the media appeared to be correlated to knowledge of HIVST. Conclusion The high level of positive attitudes towards HIVST calls for a scaling up of access to HIVST in the region. Specific attention to groups with the worst KAP, such as the less educated, the poor or those with more HIV-related negative attitude, could enhance the success of such initiatives.
A Life course approach to investigate breast cancer and migration in the greater Paris area: the SENOVIE study protocol Karna Coulibaly, Clémence Schantz, Luis Teixeira, Annabel Degrées du Loû, Gaëtan Des Guetz, et al. BMJ Open, 2025 IntroductionBreast cancer is a global public health challenge. It is the most commonly diagnosed cancer and the leading cause of cancer-related death in women. Several inequalities remain among women facing this disease, depending on their country of birth and their sociodemographic characteristics. The SENOVIE study (Therapeutic mobility and breast cancer) aims to understand the life trajectories of women born in France and in sub-Saharan Africa treated for breast cancer in four hospitals in the greater Paris area.Methods and analysisThe SENOVIE study is a mixed methods study, combining a quantitative and a qualitative approach. A quantitative retrospective life-event survey is conducted in four hospital centres in the greater Paris area, France, to (1) understand how breast cancer (diagnosis, treatment and possibly reconstruction) impacts the life trajectories of women in many spheres (migration, family life, professional life, financial situation, etc); (2) study the access to healthcare by women living with breast cancer and their determinants; and (3) examine how gender relations may shape breast cancer experience. Women born in France and women born in sub-Saharan Africa are recruited: 1000 women, including 500 per group. In the standardised, face-to-face questionnaire, each dimension of interest is collected year by year from birth until the time of the survey. Clinical and laboratory information is documented with a short medical questionnaire filled out by the medical teams. The qualitative survey is conducted specifically with women born in sub-Saharan Africa who came to France for treatment to better understand their trajectories and the specific obstacles they faced. To analyse the quantitative data collected, descriptive analyses will be used to visualise trajectories (sequence analysis), along with longitudinal analysis methods (survival models and duration models).Ethics and disseminationThe study is conducted in accordance with the Declaration of Helsinki. The French Data Protection Authority (Commission Nationale de l’Informatique et des Libertés, declaration number 2231238) and the Committee for Persons’ Protection East I (Comité de Protection des Personnes Est I, national number 2023-A01311-44) approved it. We will disseminate the findings through scientific publications, policy briefs, conferences and workshops.Trial registration numberThe SENOVIE France study is registered on Clinicaltrial.gov (NCT06503393; registration date: 7 September 2024;https://clinicaltrials.gov/study/NCT06503393).
Syndromic and biological screening for sexually transmitted infections in female sex workers in Côte d’Ivoire: the ANRS 12381 PRINCESSE cohort study Marcellin N’zebo Nouaman, Patrick Ahuatchi Coffie, Aline A. Agoua, Clémence Zébago, Hervé Z. Dao, et al. Frontiers in Public Health, 2025 BackgroundFemale sex workers (FSWs) are at high risk of contracting STIs, in particular in Sub-Saharan Africa. The implementation of oral HIV pre-exposure prophylaxis provided an opportunity to draw attention to the sexual health needs of FSWs. Innovative strategies to screen for and reduce the burden of STIs is thus a priority. This study describes STI screening among FSWs enrolled in the PRINCESSE project in Côte d’Ivoire.MethodsThe PRINCESSE project (2019–2023) was an interventional cohort of FSWs ≥18 years, evaluating a comprehensive, community-based sexual and reproductive health care package, including the management of STIs, offered through mobile clinics operating on prostitution sites in San Pedro area. HIV testing and syndromic STI testing were offered at baseline and every 3 months. Biological testing of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) was offered annually. Clinical forms included sociodemographic, behavioral and sex-work-related characteristics. We describe baseline characteristics, coverage of clinical examination, and vaginal, anal swab collection. Social, behavioral and sex work-related factors associated with an STI syndromic diagnosis were explored. A multivariable logistic regression model was used to identify factors associated with diagnosing a symptomatic STI.Results489 FSWs were included in the PRINCESSE cohort. Median age was 29 years (24–35 years), 28.6% had had sex without a condom in the last 7 days. The prevalence of HIV at baseline was 10.5%. Only one case of HIV seroconversion was observed during the project. The most frequent symptom was ano-vaginal discharge (19.1%). The prevalence of STI based on clinical symptoms was 26.6%. The proportion of vaginal swab samples for which the PCR result was positive was 8.0% for CT and 4.0% for NG. Only age remained significantly associated with diagnosing a symptomatic STI in the multivariable analysis.ConclusionThis study revealed a high prevalence of HIV and STIs, similar to national estimates among FSWs enrolled in a sexual health cohort. Screening for these generically asymptomatic bacterial STIs must be combined with the syndromic approach used in key populations, especially with the introduction of new PrEP programs, to reduce the exposure of individuals in these populations to STIs.
From conceptualising to modelling structural determinants and interventions in HIV transmission dynamics models: a scoping review and methodological framework for evidence-based analyses James Stannah, Jorge Luis Flores Anato, Michael Pickles, Joseph Larmarange, Kate M. Mitchell, et al. BMC Medicine, 2024 Background Including structural determinants (e.g. criminalisation, stigma, inequitable gender norms) in dynamic HIV transmission models is important to help quantify their population-level impacts and guide implementation of effective interventions that reduce the burden of HIV and inequalities thereof. However, evidence-based modelling of structural determinants is challenging partly due to a limited understanding of their causal pathways and few empirical estimates of their effects on HIV acquisition and transmission. Methods We conducted a scoping review of dynamic HIV transmission modelling studies that evaluated the impacts of structural determinants, published up to August 28, 2023, using Ovid Embase and Medline online databases. We appraised studies on how models represented exposure to structural determinants and causal pathways. Building on this, we developed a new methodological framework and recommendations to support the incorporation of structural determinants in transmission dynamics models and their analyses. We discuss the data and analyses that could strengthen the evidence used to inform these models. Results We identified 17 HIV modelling studies that represented structural determinants and/or interventions, including incarceration of people who inject drugs (number of studies [n] = 5), violence against women (n = 3), HIV stigma (n = 1), and housing instability (n = 1), among others (n = 7). Most studies (n = 10) modelled exposures dynamically. Almost half (8/17 studies) represented multiple exposure histories (e.g. current, recent, non-recent exposure). Structural determinants were often assumed to influence HIV indirectly by influencing mediators such as contact patterns, condom use, and antiretroviral therapy use. However, causal pathways’ assumptions were sometimes simple, with few mediators explicitly represented in the model, and largely based on cross-sectional associations. Although most studies calibrated models using HIV epidemiological data, less than half (7/17) also fitted or cross-validated to data on the prevalence, frequency, or effects of exposure to structural determinants. Conclusions Mathematical models can play a crucial role in elucidating the population-level impacts of structural determinants and interventions on HIV. We recommend the next generation of models reflect exposure to structural determinants dynamically and mechanistically, and reproduce the key causal pathways, based on longitudinal evidence of links between structural determinants, mediators, and HIV. This would improve the validity and usefulness of predictions of the impacts of structural determinants and interventions.
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, Mathieu Maheu-Giroux, Nirali Soni, Arlette Simo Fotso, Nicolas Rouveau, et al. AIDS, 2024 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.
Knowledge gaps in existing research exploring sexual fluidity and mental health among young adults Pierre-Julien Coulaud, Travis Salway, Nick Adams, William Ball, Joseph Larmarange, et al. Journal of Epidemiology and Community Health, 2024 While there is a large body of evidence indicating that sexual minority youth experience inequitably high rates of mental health problems (eg, depression, suicidality), we know little about how temporal changes in sexual attractions, identities and behaviour may impact mental health (and other) outcomes. In this essay, we review existing research regarding sexual fluidity and mental health among young adults in order to identify critical knowledge gaps with respect to an epidemiological understanding of the relationship between these factors. We describe three gaps that in turn inform a larger public health research agenda on this topic. First, there are a number of methodological challenges given that fluidity can occur over short or long periods of time and across multiple dimensions of sexual orientation (eg, attractions, identities and behaviour) with various patterns (eg, directionality of change). Tailored measures that accurately and inclusively reflect diversities of sexual fluidity trajectories are needed. Second, causal relationships between sexual fluidity and mental health remain uncertain and unquantified. Third, little is known about how features of context (eg, gender norms and political climate) influence youth experiences with sexual fluidity and mental health. Finally, we propose a set of recommendations to address these knowledge gaps to improve the quality of epidemiological research involving young people.
Socio-economic inequalities in access to information before cancers diagnosis. The case of women with breast cancer in Mali K Coulibaly, H Niangaly, J Robin, A Coulibaly, K Kanté, S Traoré, I Téréra, ... 2026
Implementing HIV pre-exposure prophylaxis (PrEP) among female sex workers: a worldwide scoping review to guide the future research agenda for HIV prevention M Plazy, V Becquet, S Amador-Paz, M Nouaman, E Maouhoub, ... 2026
Package ‘prevR’ J Larmarange 2026 Citations: 1
PrEP: perceptions et ressentis des potentiels utilisateurs J Larmarange 13e conférence francophone AFRAVIH sur le VIH, les hépatites virales, la … , 2026 2026
Repenser la mesure des pratiques préventives: l’exemple des besoins non couverts en santé sexuelle à partir de l’enquête CSF 2023 K Coulibaly, J Larmarange 13e conférence francophone AFRAVIH sur le VIH, les hépatites virales, la … , 2026 2026
Enjeux de la mise en œuvre de la PrEP auprès d’une population précaire, mobile et vulnérable: leçons du projet ANRS 12381 PRINCESSE auprès de travailleuses du sexe en Côte d … V Becquet, M Plazy, M Nouaman, E Kissi, RM Dedocoton, P Coffie, ... 13e conférence francophone AFRAVIH sur le VIH, les hépatites virales, la … , 2026 2026
Facteurs de maintien et obstacles à l’engagement des éducatrices de paires auprès des travailleuses du sexe sur le projet ANRS 12381 PRINCESSE en Côte d’Ivoire RM Dedocoton, E Kissi, M Nouaman, M Plazy, P Coffie, A Agoua, ... 13e conférence francophone AFRAVIH sur le VIH, les hépatites virales, la … , 2026 2026
S'informer sur la santé sexualité et la sexualité: quelles données? comment les jeunes y accèdent-ils? quel accès à une éducation sexuelle complète et compréhensive? J Larmarange 13e conférence francophone AFRAVIH sur le VIH, les hépatites virales, la … , 2026 2026
Scaling Up HIV Self‐Testing in Africa: Insights From National Programmatic Data in Eight Countries A Allorant, A Bekelynck, A Monroe‐Wise, CB da Silva, T Chidarikire, ... Journal of the International AIDS Society 29 (5), e70120 , 2026 2026
High prevalence of anxiety and depression among cancer patients in Bamako, Mali: a multicenter study of psychosocial and healthcare determinants T Adégné, SP Coulibaly, LA Diarra, C Schantz, Z Saye, FM Sidibé, ... 2026
Comparing modelled HIV incidence estimates with empirical HIV incidence observations in high-burden HIV African epidemic settings: systematic review and meta-regression O Stevens, M Moffa, JH Hunt, K Patel, T Aytenfisu, A Akullian, ... medRxiv, 2026.02. 05.26345548 , 2026 2026 Citations: 1
Knowledge, attitudes and practices relating to HIV self-testing following its introduction in the Bas-Sassandra region of Côte d’Ivoire: the case of the ATLAS project AS Fotso, C Koukobo, R Silhol, AK Kra, MC Boily, A Vautier, ... PLoS One 21 (1), e0314947 , 2026 2026
webin-R# 26: Graphiques statistiques avec guideR J Larmarange 2026
Enseigner R sur YouTube en temps de COVID-19: retour d'expérience des webin R J Larmarange Centre Population et Développement , 2026 2026
Immigrés subsahariens, exposition au VIH, vulnérabilités, facteurs sociaux et enjeux de prévention J Larmarange, K Coulibaly Colloque URACA , 2025 2025
The Effect of Sexual and Gender Minority Violence on Depression, Hazardous Drinking, Condom Use, and HIV Acquisition: An Individual Participant Data Meta-Analysis of the CohMSM … J Stannah, J Knight, T Sandfort, C Laurent, FO Otieno, J Larmarange, ... AIDS and Behavior 29 (11), 3557-3572 , 2025 2025
How a quantitative biographical approach can help in understanding the complex intersections of breast cancer, migration and gender? The case of the SENOVIE France study K Coulibaly, C Schantz, L Teixeira, G Des Guetz, L Zelek, J Larmarange, ... SLLS Annual Conference 2025 , 2025 2025
Perceptions regarding long-acting pre-exposure prevention (PrEP) among female sex workers and men having sex with men in San Pedro and Abidjan, Côte d’Ivoire E Kissi, J Larmarange, RM Dedocoton, M Plazy, M Nouaman, P Coffie, ... IAS 2025, the 13th IAS Conference on HIV Science , 2025 2025
Adoption of HIV preexposure prophylaxis (PrEP) among female sex workers (FSWs) in Côte d’Ivoire: complex trajectories and early adopters J Larmarange, M Plazy, M Nouaman, E Kissi, RM Dedocoton, P Coffie, ... IAS 2025, the 13th IAS Conference on HIV Science , 2025 2025 Citations: 1
MOST CITED SCHOLAR PUBLICATIONS
Reproducible summary tables with the gtsummary package DD Sjoberg, K Whiting, M Curry, JA Lavery, J Larmarange The R journal 13 (1), 570-580 , 2021 2021 Citations: 1458
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Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial CC Iwuji, J Orne-Gliemann, J Larmarange, E Balestre, R Thiebaut, ... The lancet HIV 5 (3), e116-e125 , 2018 2018 Citations: 269
Uptake of home-based HIV testing, linkage to care, and community attitudes about ART in rural KwaZulu-Natal, South Africa: descriptive results from the first phase of the ANRS … CC Iwuji, J Orne-Gliemann, J Larmarange, N Okesola, F Tanser, ... PLoS medicine 13 (8), e1002107 , 2016 2016 Citations: 172
What do the Universal Test and Treat trials tell us about the path to HIV epidemic control? D Havlir, S Lockman, H Ayles, J Larmarange, G Chamie, T Gaolathe, ... Journal of the International AIDS Society 23 (2), e25455 , 2020 2020 Citations: 143
Lubridate: make dealing with dates a little easier V Spinu, G Grolemund, H Wickham, D Vaughan, I Lyttle, I Costigan, J Law, ... R package version 1 (0) , 2021 2021 Citations: 114
Participation dynamics in population-based longitudinal HIV surveillance in rural South Africa J Larmarange, J Mossong, T Bärnighausen, ML Newell PloS one 10 (4), e0123345 , 2015 2015 Citations: 102
Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster‐randomized trial in rural South Africa M Plazy, KE Farouki, C Iwuji, N Okesola, J Orne‐Gliemann, J Larmarange, ... Journal of the International AIDS Society 19 (1), 20913 , 2016 2016 Citations: 90
Methods for mapping regional trends of HIV prevalence from Demographic and Health Surveys (DHS) J Larmarange, R Vallo, S Yaro, P Msellati, N Méda Cybergeo: European Journal of Geography , 2011 2011 Citations: 77
Factors associated with antiretroviral treatment initiation amongst HIV-positive individuals linked to care within a universal test and treat programme: early findings of the … S Boyer, C Iwuji, A Gosset, C Protopopescu, N Okesola, M Plazy, B Spire, ... AIDS care 28 (sup3), 39-51 , 2016 2016 Citations: 74
Linkage to HIV care after home‐based HIV counselling and testing in sub‐Saharan Africa: a systematic review E Ruzagira, K Baisley, A Kamali, S Biraro, H Grosskurth, ... Tropical medicine & international health 22 (7), 807-821 , 2017 2017 Citations: 72
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Reduction in risk-taking behaviors among MSM in Senegal between 2004 and 2007 and prevalence of HIV and other STIs. ELIHoS Project, ANRS 12139 AS Wade, J Larmarange, AK Diop, O Diop, K Gueye, A Marra, A Sene, ... AIDS care 22 (4), 409-414 , 2010 2010 Citations: 69
questionr: Functions to make surveys processing easier J Barnier, F Briatte, J Larmarange R package version 0.6 1 , 2018 2018 Citations: 67
The impact of universal test and treat on HIV incidence in a rural South African population: ANRS 12249 TasP trial, 2012-2016 C Iwuji, J Orne-Gliemann, E Balestre, J Larmarange, R Thiebaut, F Tanser, ... 21st International AIDS Conference (AIDS 2016) , 2016 2016 Citations: 61
Factors associated with unprotected anal intercourse among men who have sex with men in Douala, Cameroon E Henry, F Marcellin, Y Yomb, L Fugon, S Nemande, C Gueboguo, ... Sexually transmitted infections 86 (2), 136-140 , 2010 2010 Citations: 60
HIV estimates at second subnational level from national population-based surveys J Larmarange, V Bendaud Aids 28, S469-S476 , 2014 2014 Citations: 59
Labelled: Manipulating labelled data J Larmarange, D Ludecke, H Wickham, M Bojanowski, F Briatte 2023 Citations: 57
Homosexuality and bisexuality in Senegal: A multiform reality J Larmarange, AD Du Loû, C Enel, A Wade Population 64 (4), 635-666 , 2009 2009 Citations: 56
Retention in care trajectories of HIV-positive individuals participating in a universal test-and-treat program in rural South Africa (ANRS 12249 TasP Trial) A Gosset, C Protopopescu, J Larmarange, J Orne-Gliemann, N McGrath, ... JAIDS Journal of Acquired Immune Deficiency Syndromes 80 (4), 375-385 , 2019 2019 Citations: 53