PAC-CI/ANRS Research Site Program, Treichville University Hospital, Abidjan, Ivory Coast.
Centre Population et Développement (Ceped), Université Paris Descartes, IRD, Inserm, Paris, France.
J Int AIDS Soc. 2019 Dec;22(12):e25424. doi: 10.1002/jia2.25424.
HIV Testing and Counselling (HTC) remains a key challenge in achieving control of the HIV epidemic by 2030. In the early 2010s, the President's Emergency Plan for AIDS Relief (Pepfar) adopted targeted HTC strategies for populations and geographical areas most affected by HIV. We examine how Pepfar defined targeted HTC in Côte d'Ivoire, a country with a mixed HIV epidemic, after a decade of expanding HTC services.
We explored the evolution of HTC strategies through the Country Operational Plans (COP) of Pepfar during its phase 3.0, from COP 14 to COP 17 (October 2014 to September 2018) in Côte d'Ivoire. We conducted an analysis of the grey literature over the period 2014 to 2018 (Budget & Target Report, Strategic Direction Summary, Sustainability Index and Dashboard Summary, https://data.pepfar.gov). We also conducted a qualitative study in Côte d'Ivoire (2015 to 2018) using in-depth interviews with stakeholders in the AIDS public response: CDC/Pepfar (3), Ministry of Health (3), intermediary NGOs (7); and public meeting observations (14).
Since the COP 14, Pepfar's HIV testing strategies have been characterized by significant variations in terms of numerical, geographical and population targets. While the aim of COP 14 and COP 15 seemed to be the improvement of testing efficacy in general and testing yield in particular, COP 16 and COP 17 prioritized accelerating progress towards the "first 90" (i.e. reducing the proportion of people living with HIV who are unaware of their HIV). A shift was observed in the definition of testing targets, with less focus on the inclusion of programmatic data and feedback from field actors, and greater emphasis on the use of models to estimate and disaggregate the targets by geographical units and sub-populations (even if the availability of data by this disaggregation was limited or uncertain); increasingly leading to gaps between targets and results.
These trials and tribulations question the real and long-term effectiveness of annually-revised, fragmented strategies, which widen an increasing disparity between the realities of the actors on the ground and the objectives set in Washington.
艾滋病毒检测和咨询（HTC）仍然是到 2030 年实现艾滋病毒流行控制目标的关键挑战。在 21 世纪 10 年代初，总统艾滋病紧急救援计划（Pepfar）为受艾滋病毒影响最严重的人群和地理区域采用了有针对性的 HTC 战略。我们研究了 Pepfar 在科特迪瓦实施了十年的 HTC 服务扩展后，如何为这个艾滋病毒混合流行的国家定义有针对性的 HTC。
我们通过 Pepfar 在其 3.0 阶段的第 14 至 17 期国家业务计划（COP）（2014 年 10 月至 2018 年 9 月），探讨了 HTC 战略的演变。我们对 2014 年至 2018 年期间的灰色文献进行了分析（预算和目标报告、战略方向摘要、可持续性指数和仪表板摘要，https://data.pepfar.gov）。我们还在科特迪瓦（2015 年至 2018 年）进行了一项定性研究，对艾滋病公共应对中的利益攸关方进行了深入访谈：疾病预防控制中心/ Pepfar（3）、卫生部（3）、中介非政府组织（7）；以及公共会议观察（14）。
自第 14 期 COP 以来，Pepfar 的艾滋病毒检测策略在数字、地理和人口目标方面存在显著差异。虽然第 14 期和第 15 期 COP 的目标似乎是提高检测效果，特别是提高检测效果，但第 16 期和第 17 期 COP 则优先加快实现“第一个 90”的进展（即减少不知道自己艾滋病毒状况的艾滋病毒感染者比例）。在检测目标的定义上发生了转变，较少关注纳入方案数据和实地行为者的反馈，更多地强调使用模型按地理单位和子人群来估计和分解目标（即使按这种分解提供数据的可用性有限或不确定）；这导致目标与结果之间的差距越来越大。
这些尝试和磨难质疑了每年修订的、分散的战略的实际和长期有效性，这些战略加剧了华盛顿设定的目标与实地行为者之间日益扩大的差距。
