Community-based HIV care accelerates viral suppression in gold-mining sites in Mali: ANRS 12392 – Sanu Gundo
Abstract
BACKGROUND: In Mali, informal gold mining sites (IGMS) are characterized by circular migration, convergence of key populations, geographic isolation, and the absence of health services. There is an important potential risk of acquisition and dissemination of HIV. This study aimed to assess the impact of a proximity community-based HIV care compared with services delivered by the public sector on linkage-to-care, retention, and viral suppression among HIV-positive people diagnosed in two IGMS.
METHODS: ARCAD Santé PLUS in Mali, offered community-based medical consultations including HIV testing in two IGMS. Adults newly tested/confirmed positive for HIV in Kofoulatié were offered with the community-based HIV care (intervention group) and those in Diassa were referred to the public sector, as recommended by the national guidelines (control group). Sociobehavioral and clinical data were collected quarterly for 12 months, along with dried blood spots at M0, M6, and M12 (2020-2022). The intervention's impact was assessed by comparing between groups the percentages of linkage to care at M3, viral suppression (<200 cp/mL) at M6, and retention in care at M12 (using logistic regressions), and the mean viral loads at M6 (using Wilcoxon test). To account for confounding factors, we adjusted our analysis using propensity scores.
RESULTS: Out of the 9774 individuals offered an HIV test, 170 tested positive and were enrolled (56 men; 41 female sex workers: 73 female non-sex workers). The linkage to care at M3 was 86% (IC95: 80-91), and retention in care at M12 was 93% (88-96), with no observed difference between groups. At M6 (n=79), the intervention group exhibited significantly lower mean viral loads (42,325 cp/mL vs. 5,986 cp/mL; p=0.039) compared to the control group, along with higher proportions of viral suppression (73% vs. 44%, Odds Ratio 4.05 [95% CI: 1.52-11.8], p=0.007). No significant differences between the groups were observed at M0 (p=0.2).
CONCLUSIONS: The community-based HIV care intervention had a faster effect in decreasing viral loads after 6 months, compared with public services. Implementing on-site community-based HIV testing and care is a promising strategy for controlling HIV epidemics within and emanating from remote areas that convey mobile, vulnerable, and at-risk populations for HIV.
Domains
Santé publique et épidémiologieOrigin | Files produced by the author(s) |
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