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Demande et offre de dépistage du VIH dans un contexte d’épidémie mixte. Le cas de la Côte d’Ivoire.

Abstract : With 2.8% of its adult population infected, Côte d’Ivoire is one of the West African countries most affected by the HIV epidemic. Its epidemic, known as a mixed epidemic, is characterized by high prevalence among so-called key populations (Men who have Sex with other Men – MSM – and sex workers) and a middle prevalence in the general population. The specificity of this epidemic has led to a change in donors strategy during the last years, with donors redirecting HIV-testing activities towards health facilities and among key populations. However, in a country where only 54% of the infected people aware of their status, it is all the more important to assess whether the current testing strategies allow (i) a large and repeated HIV-testing in the most exposed populations and (ii) a continued access to HIV-testing in the general population. Thus, the aim of this thesis is to study the factors related to the demand and the offer of HIV-testing in Côte d’Ivoire, in the context of a mixed epidemic that requires separate consideration of HIV-testing in the general population and screening in sub-populations at high risk of HIV. The thesis is structured around two axes: —the general population testing axis which raises the questions of (i) the voluntary HIV-testing (i.e. patient-initiated) to ensure access to testing for anyone wishing to test and (ii) the access to Provider-Initiated HIV-Testing and Counselling (PITC) in recommended situations for testing (e.g. pregnancy, marriage, HIV-related symptoms); —the key populations axis through the example of MSM, which raises the questions of (i) the repeated use of HIV-testing (given the high incidence of HIV among MSM) and (ii) the adequacy of community-based HIV-testing for all MSM populations (this testing form is increasingly favoured by donors to reach key populations). The originality of this research is its globalizing approach, which addresses both the demand for HIV-testing (individuals) and the offer side (health professionals). The different barriers and levers of offer and demand are studied through the prism of a conceptual framework for the use of testing through four dimensions: information, perceptions, capacities and the environment. This research is based on the results of a meta-analysis, a systematic literature reviews and four cross-sectional surveys conducted in Côte d’Ivoire, some of which develop innovative methodologies: national telephone survey, Respondent Driven Sampling by telephone. These four surveys, part of two research projects (DOD-CI ANRS 12,323 and PRECO-CI ANRS 12,277), consider four distinct populations: the general population, health professionals, MSM and people living with HIV. The results of this research show barriers to voluntary HIV-testing in the general population that are related to access to information, financial capacity (men), autonomy in the couple (women) and social environment (men). The use of HIV-testing in recommended situations (pregnancy, sexually transmitted infections, marriage) remains low mainly due to the absence of a test proposal by a professional during medical consultations. These missed testing opportunities mean that some infected populations are not early diagnosed. The practice of PITC by health professionals remains suboptimal and the dimensions associated with their practice differ according to their rofession (doctor, nurse, midwife). Community-based screening allows for broad and repeated HIV-testing of some MSM populations, but it is not always well known and accepted by all the populations it targets. Some MSM prefer undifferentiated (‘all public’) testing offers. In Côte d’Ivoire, improving the use of HIV-testing in the general population and among MSM requires: (i) a better communication on the HIV-testing offer, (ii) to strengthen the testing proposal by health professionals in recommended situations and (iii) to maintain a ‘public’ HIV-testing offer alongside the community offer.
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Maxime Inghels. Demande et offre de dépistage du VIH dans un contexte d’épidémie mixte. Le cas de la Côte d’Ivoire.. Démographie. Université de Paris / Université Paris Descartes (Paris 5), 2019. Français. ⟨tel-03590421⟩

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