World AIDS Day, observed annually on December 1, draws attention to the status of the human immun... more World AIDS Day, observed annually on December 1, draws attention to the status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Approximately 37.9 million persons worldwide are living with HIV infection, including 1.7 million persons newly infected in 2018 (1). With support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), several African countries are on track to achieve HIV epidemic control. In 2017, an estimated 1,020,419 persons in the United States and dependent areas were living with diagnosed HIV infection; 37,832 new cases were diagnosed in 2018 (2). The aim of the U.S. Department of Health and Human Services' proposed Ending the HIV Epidemic: A Plan for America initiative (3) is to end the U.S. HIV epidemic within 10 years. Through global efforts, including PEPFAR, in 2018, 23.3 million persons worldwide received antiretroviral therapy. A report in this issue of MMWR describes the status of implementation of HIV case-based surveillance systems in 39 PEPFAR-supported countries (4).
The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study ... more The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study assessing the delivery of daily oral PrEP to HIV-negative female sex workers (FSWs) in four Ministry of Health (MoH)-run clinics in Dakar, Senegal. We assessed uptake, retention in care, and adherence over up to 12 months of follow-up as well as HIV infection rates. Between July and November 2015, 350 individuals were approached and 324 (92.6%) were preliminarily eligible. Uptake was high, with 82.4% of eligible participants choosing to enroll and take PrEP. The mean age of those enrolled was 37.7 years (SD = 8.7), and approximately half had not attended school (41.2%). Among the 267 participants who were prescribed PrEP, 79.9 and 73.4% were retained in PrEP care at 6 and 12 months, respectively. Older age among FSWs was found to be the only significant predictor of lower discontinuation. We did not find significant differences in retention by site, education, condom use, or HIV risk per...
There is an urgent need for improvements in maternal and newborn health despite the efforts of nu... more There is an urgent need for improvements in maternal and newborn health despite the efforts of numerous stakeholders and the adoption of specific targets as in the Sustainable Development Goals. In 2018, using an evidence-based and design-thinking approach involving communities, three stakeholders (a foundation, an NGO, and a startup) decided to combine their expertise to better understand and potentially revisit the drivers for improving maternal and newborn health. The AIM – Accelerated Impact Model - has been designed as a systemic, needs-led innovation framework for improving maternal and newborn health in low and middle-income countries. The AIM is currently being tested to assess its real-world impact in the Saint-Louis region of Senegal. This paper aims to explain the rationale and methodology for designing this innovative model, as well as presenting hypotheses concerning its impact. This novel, integrated approach is associated with community empowerment and accompanied by “glocal” experts and organizations. It represents the backbone of the AIM method. The first step of the AIM application was the pre-pilot phase, as the population itself identified the health and medical-social barriers contributing to maternal and newborn mortality together with the corresponding corrective measures. The second step integrated co-created projects into a three-pillar program centered on awareness of community engagement, optimizing the attractiveness of the health pyramid base, and the empowerment of women. To test the sustainability of the model, the third step of the AIM approach resulted in the creation of a local pilot team to accelerate the implementation of new co-created projects and optimize existing initiatives supported by local and global sponsors. Over the course of one month, the newly formed “Rawal ak Diam” platform transformed the COVID-19 epidemic into an opportunity to mobilize the community and connect with the authorities. This step was crucial for gaining legitimation for the platform and helped design and implement a three-pillar program. The community program focus here is on the two first deadlines (the decision to request help and access care) in maternal health while remaining aligned with the Sustainable Development Goal of reducing maternal and neonatal mortality in low- and middle-income countries.
Paul De Lay and co-authors introduce a Collection on the design of targets for ending the AIDS ep... more Paul De Lay and co-authors introduce a Collection on the design of targets for ending the AIDS epidemic.
MMWR. Morbidity and Mortality Weekly Report, Nov 29, 2019
World AIDS Day, observed annually on December 1, draws attention to the status of the human immun... more World AIDS Day, observed annually on December 1, draws attention to the status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Approximately 37.9 million persons worldwide are living with HIV infection, including 1.7 million persons newly infected in 2018 (1). With support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), several African countries are on track to achieve HIV epidemic control. In 2017, an estimated 1,020,419 persons in the United States and dependent areas were living with diagnosed HIV infection; 37,832 new cases were diagnosed in 2018 (2). The aim of the U.S. Department of Health and Human Services' proposed Ending the HIV Epidemic: A Plan for America initiative (3) is to end the U.S. HIV epidemic within 10 years. Through global efforts, including PEPFAR, in 2018, 23.3 million persons worldwide received antiretroviral therapy. A report in this issue of MMWR describes the status of implementation of HIV case-based surveillance systems in 39 PEPFAR-supported countries (4).
BackgroundIn Senegal in 2015, an estimated 4800 children were living with HIV, with 1200 receivin... more BackgroundIn Senegal in 2015, an estimated 4800 children were living with HIV, with 1200 receiving ARV treatment, of whom half had follow-up care in decentralized sites outside Dakar.However, until now no studies have determined the efficacy of pediatric treatment in decentralized settings, even though the emergence of viral resistance, particularly among children in Africa, is a well-known phenomenon. This study aimed to assess the virological status of HIV-infected children in all decentralized facilities to help improve access to quality care.MethodsA cross-sectional epidemiological and virological study was conducted in all of Senegal’s regions, except Dakar, between March and June 2015 and sought to include all HIV-infected children and adolescents (0–19 years), treated or not with ARVs.Socio-demographic and clinical data and a blood sample on blotting paper were collected for children from treatment sites. Samples were routed on public transportation, assisted by a network of ...
Background The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three We... more Background The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Côte 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, epidemiolo...
Paul De Lay and co-authors introduce a Collection on the design of targets for ending the AIDS ep... more Paul De Lay and co-authors introduce a Collection on the design of targets for ending the AIDS epidemic.
The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study ... more The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study assessing the delivery of daily oral PrEP to HIV-negative female sex workers (FSWs) in four Ministry of Health (MoH)-run clinics in Dakar, Senegal. We assessed uptake, retention in care, and adherence over up to 12 months of follow-up as well as HIV infection rates. Between July and November 2015, 350 individuals were approached and 324 (92.6%) were preliminarily eligible. Uptake was high, with 82.4% of eligible participants choosing to enroll and take PrEP. The mean age of those enrolled was 37.7 years (SD = 8.7), and approximately half had not attended school (41.2%). Among the 267 participants who were prescribed PrEP, 79.9 and 73.4% were retained in PrEP care at 6 and 12 months, respectively. Older age among FSWs was found to be the only significant predictor of lower discontinuation. We did not find significant differences in retention by site, education, condom use, or HIV risk per...
HIV/AIDS is a serious health problem among prisoners and constitutes a big challenge for prison a... more HIV/AIDS is a serious health problem among prisoners and constitutes a big challenge for prison administration services, public health services and governments. Aims: Determine the prevalence of HIV infection among prisoners and describe associated factors. Population and Methods: This was a descriptive and analytical cross-sectional study conducted from December 2015 to October 2016. A sample of 600 prisoners was randomly interviewed nationwide. They were selected directly from the sample frame from across the country and proportionally from all sites. Pre-established questionnaires providing information on the sociodemographic and biological characteristics of prisoners were used for the collection of data. Data entry and analysis were performed using EXCEL and SPSS 18 software. Results: The survey was based on a randomised sample of 600 prisoners, 593 of whom accepted blood extraction for the HIV testing. The series was mainly composed of males (89%). The median age was 33 years (18 - 69). The level of education among respondents was 60%. Regarding marital status, the proportion of married prisoners was 51.8%. Almost three-quarters (71.5%) were at their first imprisonment and 51.8% were on preventive detention. The reasons for imprisonment varied and were dominated by drug use (35.3%), while only 4.6% confessed that they continued using drugs while in prison. 97.8% of prisoners have had a sexual experience. Their median age was 19 years at their first sexual intercourse. 20.5% reported using a condom during their first intercourse. Multi partnership was estimated at 17.8%. The prevalence of HIV infection was high among prisoners (2%), the quadruple of the national rate. This prevalence was associated with female sex (4.5%) (p = 0.012) and housewives (12.5%) (p = 0.002). Conclusion: Prisoners are very vulnerable to HIV infection with a high prevalence compared to the national rate, hence the need for the enforcement of effective HIV prevention and care measures in prisons.
Introduction: Key populations including female sex workers (FSW) and men who have sex with men (M... more Introduction: Key populations including female sex workers (FSW) and men who have sex with men (MSM) bear a disproportionate burden of HIV. However, the role of focusing prevention efforts on these groups for reducing a country's HIV epidemic is debated. We estimate the extent to which HIV transmission among FSW and MSM contributes to overall HIV transmission in Dakar, Senegal, using a dynamic assessment of the population attributable fraction (PAF). Methods: A dynamic transmission model of HIV among FSW, their clients, MSM and the lower-risk adult population was parameterized and calibrated within a Bayesian framework using setting-specific demographic, behavioural, HIV epidemiological and antiretroviral treatment (ART) coverage data for 1985 to 2015. We used the model to estimate the 10-year PAF of commercial sex between FSW and their clients, and sex between men, to overall HIV transmission (defined as the percentage of new infections prevented when these modes of transmission are removed). In addition, we estimated the prevention benefits associated with historical increases in condom use and ART uptake, and impact of further increases in prevention and treatment. Results: The model projections suggest that unprotected sex between men contributed to 42% (2.5 to 97.5th percentile range 24 to 59%) of transmissions between 1995 and 2005, increasing to 64% (37 to 79%) from 2015 to 2025. The 10-year PAF of commercial sex is smaller, diminishing from 21% (7 to 39%) in 1995 to 14% (5 to 35%) in 2015. Without ART, 49% (32 to 71%) more HIV infections would have occurred since 2000, when ART was initiated, whereas without condom use since 1985, 67% (27 to 179%) more HIV infections would have occurred, and the overall HIV prevalence would have been 60% (29 to 211%) greater than what it is now. Further large decreases in HIV incidence (68%) can be achieved by scaling up ART in MSM to 74% coverage and reducing their susceptibility to HIV by two-thirds through any prevention modality. Conclusions: Unprotected sex between men may be an important contributor to HIV transmission in Dakar, due to suboptimal coverage of evidence-informed interventions. Although existing interventions have effectively reduced HIV transmission among adults, it is crucial that further strategies address the unmet need among MSM.
Journal of the International AIDS Society, Jun 30, 2017
The science presented at the 21st International AIDS Conference in Durban, South Africa, in July ... more The science presented at the 21st International AIDS Conference in Durban, South Africa, in July 2016, addressed the state of the field across basic, clinical, prevention, law and policy and implementation science. The AIDS response has seen remarkable achievements in scientific advances, in translation of those advances into prevention, treatment and care for affected individuals and communities, and in large scale implementation - reaching 18 million people with antiviral therapy by mid-year 2016. Yet incident HIV infections in adults remain stubbornly stable and are increasing in some regions and among adolescents and adults in some key populations, challenging current science, policy and programming. There have been important advances in both preventive vaccines and in cure research, but both areas require ongoing investment and innovation. Clinical research has flourished with new agents, regimens, delivery modes and diagnostics but has been challenged by aging and increasingly...
To study the effectiveness, adherence and tolerance of a once-a-day highly active antiretroviral ... more To study the effectiveness, adherence and tolerance of a once-a-day highly active antiretroviral therapy regimen in adults in Senegal. In a prospective, open-label one-arm study, 40 treatment-naive HIV-1-infected patients took the following three drugs once a day at bedtime: didanosine, lamivudine and efavirenz. The primary endpoint was the percentage of patients with plasma HIV-1 RNA below 500 copies/ml at 6 months. The analysis was done on an intent-to treat basis. Eighty-five per cent of patients were at Centers for Disease Control and Prevention stage B or C and the plasma HIV RNA level was 5.4 +/- 0.4 log(10) copies/ml at baseline. The percentage of patients with plasma HIV-1 RNA below 500 copies/ml at 6 months was 95% [95% confidence interval (CI), 83-99]. The proportions of patients with plasma HIV-1 RNA below 50 copies/ml at months 3, 6, 9, 12 and 15 were 26% (n = 39; 95% CI, 12-39), 78% (n = 40; 95% CI, 65-90), 70% (n = 40; 95% CI, 56-84), 77% (n = 39; 95% CI, 64-90) and 69...
HIV Self-Testing (HIVST) aims to increase HIV testing coverage and can facilitate reaching the UN... more HIV Self-Testing (HIVST) aims to increase HIV testing coverage and can facilitate reaching the UNAIDS 90-90-90 targets. In Senegal, key populations bear a disproportionate burden of HIV and report limited uptake of HIV testing given pervasive stigma and criminalization. In these contexts, HIVST may represent a complementary approach to reach populations reporting barriers to engagement with existing and routine HIV testing services. In this study, 1839 HIVST kits were distributed in Senegal, with 1149 individuals participating in a pre-test questionnaire and 817 participating in a post-test questionnaire. Overall, 46.9% (536/1144) were first-time testers and 26.2% (300/1144) had tested within the last year; 94.3% (768/814) reported using the HIVST, and 2.9% (19/651) reported a reactive result which was associated with first-time testers (p = 0.024). HIVST represents an approach that reached first-time testers and those who had not tested recently. Implementation indicators suggest the importance of leveraging existing community structures and programs for distribution. Keywords HIV • Self-Testing • Key populations • Senegal • Sub-Saharan Africa Resumen El autodiagnóstico del VIH (ADVIH) busca incrementar la cobertura de las pruebas del VIH y puede facilitar el alcance de los objetivos 90-90-90 de ONUSIDA. En Senegal, los grupos de población clave soportan una carga desproporcionada del VIH y reportan una utilización limitada de las pruebas del VIH, dada la generalización del estigma y la criminalización. En este contexto, el ADVIH puede servir como enfoque complementario para alcanzar a las poblaciones que reportan barreras al compromiso con los servicios de pruebas del VIH existentes y de rutina. En este estudio se distribuyeron 1839 ADVIH en Senegal, donde 1149 individuos participaron en una encuesta antes de recibir la prueba y 817 participaron en una encuesta después de recibir la prueba. En general, el 46.9% (536/1144) se realizó la prueba por primera vez y el 26.2% (300/1144)
World AIDS Day, observed annually on December 1, draws attention to the status of the human immun... more World AIDS Day, observed annually on December 1, draws attention to the status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Approximately 37.9 million persons worldwide are living with HIV infection, including 1.7 million persons newly infected in 2018 (1). With support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), several African countries are on track to achieve HIV epidemic control. In 2017, an estimated 1,020,419 persons in the United States and dependent areas were living with diagnosed HIV infection; 37,832 new cases were diagnosed in 2018 (2). The aim of the U.S. Department of Health and Human Services' proposed Ending the HIV Epidemic: A Plan for America initiative (3) is to end the U.S. HIV epidemic within 10 years. Through global efforts, including PEPFAR, in 2018, 23.3 million persons worldwide received antiretroviral therapy. A report in this issue of MMWR describes the status of implementation of HIV case-based surveillance systems in 39 PEPFAR-supported countries (4).
The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study ... more The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study assessing the delivery of daily oral PrEP to HIV-negative female sex workers (FSWs) in four Ministry of Health (MoH)-run clinics in Dakar, Senegal. We assessed uptake, retention in care, and adherence over up to 12 months of follow-up as well as HIV infection rates. Between July and November 2015, 350 individuals were approached and 324 (92.6%) were preliminarily eligible. Uptake was high, with 82.4% of eligible participants choosing to enroll and take PrEP. The mean age of those enrolled was 37.7 years (SD = 8.7), and approximately half had not attended school (41.2%). Among the 267 participants who were prescribed PrEP, 79.9 and 73.4% were retained in PrEP care at 6 and 12 months, respectively. Older age among FSWs was found to be the only significant predictor of lower discontinuation. We did not find significant differences in retention by site, education, condom use, or HIV risk per...
There is an urgent need for improvements in maternal and newborn health despite the efforts of nu... more There is an urgent need for improvements in maternal and newborn health despite the efforts of numerous stakeholders and the adoption of specific targets as in the Sustainable Development Goals. In 2018, using an evidence-based and design-thinking approach involving communities, three stakeholders (a foundation, an NGO, and a startup) decided to combine their expertise to better understand and potentially revisit the drivers for improving maternal and newborn health. The AIM – Accelerated Impact Model - has been designed as a systemic, needs-led innovation framework for improving maternal and newborn health in low and middle-income countries. The AIM is currently being tested to assess its real-world impact in the Saint-Louis region of Senegal. This paper aims to explain the rationale and methodology for designing this innovative model, as well as presenting hypotheses concerning its impact. This novel, integrated approach is associated with community empowerment and accompanied by “glocal” experts and organizations. It represents the backbone of the AIM method. The first step of the AIM application was the pre-pilot phase, as the population itself identified the health and medical-social barriers contributing to maternal and newborn mortality together with the corresponding corrective measures. The second step integrated co-created projects into a three-pillar program centered on awareness of community engagement, optimizing the attractiveness of the health pyramid base, and the empowerment of women. To test the sustainability of the model, the third step of the AIM approach resulted in the creation of a local pilot team to accelerate the implementation of new co-created projects and optimize existing initiatives supported by local and global sponsors. Over the course of one month, the newly formed “Rawal ak Diam” platform transformed the COVID-19 epidemic into an opportunity to mobilize the community and connect with the authorities. This step was crucial for gaining legitimation for the platform and helped design and implement a three-pillar program. The community program focus here is on the two first deadlines (the decision to request help and access care) in maternal health while remaining aligned with the Sustainable Development Goal of reducing maternal and neonatal mortality in low- and middle-income countries.
Paul De Lay and co-authors introduce a Collection on the design of targets for ending the AIDS ep... more Paul De Lay and co-authors introduce a Collection on the design of targets for ending the AIDS epidemic.
MMWR. Morbidity and Mortality Weekly Report, Nov 29, 2019
World AIDS Day, observed annually on December 1, draws attention to the status of the human immun... more World AIDS Day, observed annually on December 1, draws attention to the status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. Approximately 37.9 million persons worldwide are living with HIV infection, including 1.7 million persons newly infected in 2018 (1). With support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), several African countries are on track to achieve HIV epidemic control. In 2017, an estimated 1,020,419 persons in the United States and dependent areas were living with diagnosed HIV infection; 37,832 new cases were diagnosed in 2018 (2). The aim of the U.S. Department of Health and Human Services' proposed Ending the HIV Epidemic: A Plan for America initiative (3) is to end the U.S. HIV epidemic within 10 years. Through global efforts, including PEPFAR, in 2018, 23.3 million persons worldwide received antiretroviral therapy. A report in this issue of MMWR describes the status of implementation of HIV case-based surveillance systems in 39 PEPFAR-supported countries (4).
BackgroundIn Senegal in 2015, an estimated 4800 children were living with HIV, with 1200 receivin... more BackgroundIn Senegal in 2015, an estimated 4800 children were living with HIV, with 1200 receiving ARV treatment, of whom half had follow-up care in decentralized sites outside Dakar.However, until now no studies have determined the efficacy of pediatric treatment in decentralized settings, even though the emergence of viral resistance, particularly among children in Africa, is a well-known phenomenon. This study aimed to assess the virological status of HIV-infected children in all decentralized facilities to help improve access to quality care.MethodsA cross-sectional epidemiological and virological study was conducted in all of Senegal’s regions, except Dakar, between March and June 2015 and sought to include all HIV-infected children and adolescents (0–19 years), treated or not with ARVs.Socio-demographic and clinical data and a blood sample on blotting paper were collected for children from treatment sites. Samples were routed on public transportation, assisted by a network of ...
Background The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three We... more Background The ATLAS programme aims to promote and implement HIV self-testing (HIVST) in three West African countries: Côte 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, epidemiolo...
Paul De Lay and co-authors introduce a Collection on the design of targets for ending the AIDS ep... more Paul De Lay and co-authors introduce a Collection on the design of targets for ending the AIDS epidemic.
The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study ... more The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study assessing the delivery of daily oral PrEP to HIV-negative female sex workers (FSWs) in four Ministry of Health (MoH)-run clinics in Dakar, Senegal. We assessed uptake, retention in care, and adherence over up to 12 months of follow-up as well as HIV infection rates. Between July and November 2015, 350 individuals were approached and 324 (92.6%) were preliminarily eligible. Uptake was high, with 82.4% of eligible participants choosing to enroll and take PrEP. The mean age of those enrolled was 37.7 years (SD = 8.7), and approximately half had not attended school (41.2%). Among the 267 participants who were prescribed PrEP, 79.9 and 73.4% were retained in PrEP care at 6 and 12 months, respectively. Older age among FSWs was found to be the only significant predictor of lower discontinuation. We did not find significant differences in retention by site, education, condom use, or HIV risk per...
HIV/AIDS is a serious health problem among prisoners and constitutes a big challenge for prison a... more HIV/AIDS is a serious health problem among prisoners and constitutes a big challenge for prison administration services, public health services and governments. Aims: Determine the prevalence of HIV infection among prisoners and describe associated factors. Population and Methods: This was a descriptive and analytical cross-sectional study conducted from December 2015 to October 2016. A sample of 600 prisoners was randomly interviewed nationwide. They were selected directly from the sample frame from across the country and proportionally from all sites. Pre-established questionnaires providing information on the sociodemographic and biological characteristics of prisoners were used for the collection of data. Data entry and analysis were performed using EXCEL and SPSS 18 software. Results: The survey was based on a randomised sample of 600 prisoners, 593 of whom accepted blood extraction for the HIV testing. The series was mainly composed of males (89%). The median age was 33 years (18 - 69). The level of education among respondents was 60%. Regarding marital status, the proportion of married prisoners was 51.8%. Almost three-quarters (71.5%) were at their first imprisonment and 51.8% were on preventive detention. The reasons for imprisonment varied and were dominated by drug use (35.3%), while only 4.6% confessed that they continued using drugs while in prison. 97.8% of prisoners have had a sexual experience. Their median age was 19 years at their first sexual intercourse. 20.5% reported using a condom during their first intercourse. Multi partnership was estimated at 17.8%. The prevalence of HIV infection was high among prisoners (2%), the quadruple of the national rate. This prevalence was associated with female sex (4.5%) (p = 0.012) and housewives (12.5%) (p = 0.002). Conclusion: Prisoners are very vulnerable to HIV infection with a high prevalence compared to the national rate, hence the need for the enforcement of effective HIV prevention and care measures in prisons.
Introduction: Key populations including female sex workers (FSW) and men who have sex with men (M... more Introduction: Key populations including female sex workers (FSW) and men who have sex with men (MSM) bear a disproportionate burden of HIV. However, the role of focusing prevention efforts on these groups for reducing a country's HIV epidemic is debated. We estimate the extent to which HIV transmission among FSW and MSM contributes to overall HIV transmission in Dakar, Senegal, using a dynamic assessment of the population attributable fraction (PAF). Methods: A dynamic transmission model of HIV among FSW, their clients, MSM and the lower-risk adult population was parameterized and calibrated within a Bayesian framework using setting-specific demographic, behavioural, HIV epidemiological and antiretroviral treatment (ART) coverage data for 1985 to 2015. We used the model to estimate the 10-year PAF of commercial sex between FSW and their clients, and sex between men, to overall HIV transmission (defined as the percentage of new infections prevented when these modes of transmission are removed). In addition, we estimated the prevention benefits associated with historical increases in condom use and ART uptake, and impact of further increases in prevention and treatment. Results: The model projections suggest that unprotected sex between men contributed to 42% (2.5 to 97.5th percentile range 24 to 59%) of transmissions between 1995 and 2005, increasing to 64% (37 to 79%) from 2015 to 2025. The 10-year PAF of commercial sex is smaller, diminishing from 21% (7 to 39%) in 1995 to 14% (5 to 35%) in 2015. Without ART, 49% (32 to 71%) more HIV infections would have occurred since 2000, when ART was initiated, whereas without condom use since 1985, 67% (27 to 179%) more HIV infections would have occurred, and the overall HIV prevalence would have been 60% (29 to 211%) greater than what it is now. Further large decreases in HIV incidence (68%) can be achieved by scaling up ART in MSM to 74% coverage and reducing their susceptibility to HIV by two-thirds through any prevention modality. Conclusions: Unprotected sex between men may be an important contributor to HIV transmission in Dakar, due to suboptimal coverage of evidence-informed interventions. Although existing interventions have effectively reduced HIV transmission among adults, it is crucial that further strategies address the unmet need among MSM.
Journal of the International AIDS Society, Jun 30, 2017
The science presented at the 21st International AIDS Conference in Durban, South Africa, in July ... more The science presented at the 21st International AIDS Conference in Durban, South Africa, in July 2016, addressed the state of the field across basic, clinical, prevention, law and policy and implementation science. The AIDS response has seen remarkable achievements in scientific advances, in translation of those advances into prevention, treatment and care for affected individuals and communities, and in large scale implementation - reaching 18 million people with antiviral therapy by mid-year 2016. Yet incident HIV infections in adults remain stubbornly stable and are increasing in some regions and among adolescents and adults in some key populations, challenging current science, policy and programming. There have been important advances in both preventive vaccines and in cure research, but both areas require ongoing investment and innovation. Clinical research has flourished with new agents, regimens, delivery modes and diagnostics but has been challenged by aging and increasingly...
To study the effectiveness, adherence and tolerance of a once-a-day highly active antiretroviral ... more To study the effectiveness, adherence and tolerance of a once-a-day highly active antiretroviral therapy regimen in adults in Senegal. In a prospective, open-label one-arm study, 40 treatment-naive HIV-1-infected patients took the following three drugs once a day at bedtime: didanosine, lamivudine and efavirenz. The primary endpoint was the percentage of patients with plasma HIV-1 RNA below 500 copies/ml at 6 months. The analysis was done on an intent-to treat basis. Eighty-five per cent of patients were at Centers for Disease Control and Prevention stage B or C and the plasma HIV RNA level was 5.4 +/- 0.4 log(10) copies/ml at baseline. The percentage of patients with plasma HIV-1 RNA below 500 copies/ml at 6 months was 95% [95% confidence interval (CI), 83-99]. The proportions of patients with plasma HIV-1 RNA below 50 copies/ml at months 3, 6, 9, 12 and 15 were 26% (n = 39; 95% CI, 12-39), 78% (n = 40; 95% CI, 65-90), 70% (n = 40; 95% CI, 56-84), 77% (n = 39; 95% CI, 64-90) and 69...
HIV Self-Testing (HIVST) aims to increase HIV testing coverage and can facilitate reaching the UN... more HIV Self-Testing (HIVST) aims to increase HIV testing coverage and can facilitate reaching the UNAIDS 90-90-90 targets. In Senegal, key populations bear a disproportionate burden of HIV and report limited uptake of HIV testing given pervasive stigma and criminalization. In these contexts, HIVST may represent a complementary approach to reach populations reporting barriers to engagement with existing and routine HIV testing services. In this study, 1839 HIVST kits were distributed in Senegal, with 1149 individuals participating in a pre-test questionnaire and 817 participating in a post-test questionnaire. Overall, 46.9% (536/1144) were first-time testers and 26.2% (300/1144) had tested within the last year; 94.3% (768/814) reported using the HIVST, and 2.9% (19/651) reported a reactive result which was associated with first-time testers (p = 0.024). HIVST represents an approach that reached first-time testers and those who had not tested recently. Implementation indicators suggest the importance of leveraging existing community structures and programs for distribution. Keywords HIV • Self-Testing • Key populations • Senegal • Sub-Saharan Africa Resumen El autodiagnóstico del VIH (ADVIH) busca incrementar la cobertura de las pruebas del VIH y puede facilitar el alcance de los objetivos 90-90-90 de ONUSIDA. En Senegal, los grupos de población clave soportan una carga desproporcionada del VIH y reportan una utilización limitada de las pruebas del VIH, dada la generalización del estigma y la criminalización. En este contexto, el ADVIH puede servir como enfoque complementario para alcanzar a las poblaciones que reportan barreras al compromiso con los servicios de pruebas del VIH existentes y de rutina. En este estudio se distribuyeron 1839 ADVIH en Senegal, donde 1149 individuos participaron en una encuesta antes de recibir la prueba y 817 participaron en una encuesta después de recibir la prueba. En general, el 46.9% (536/1144) se realizó la prueba por primera vez y el 26.2% (300/1144)
Uploads
Papers by Safiatou Thiam