@article{fdi:010077777, title = {{P}epfar 3.0's {HIV} testing policy in {C}ote d'{I}voire (2014 to 2018) : fragmentation, acceleration and disconnection}, author = {{B}ekelynck, {A}. and {L}armarange, {J}oseph and {A}ssoumou, {N}. and {D}anel, {C}. and {D}oumbia, {M}. and {K}one, {M}. and {K}ouadio, {A}. and {K}ra, {A}. and {N}iangoran, {S}. and {O}uantchi, {H}. and {S}ika, {L}. and {C}arillon, {S}{\'e}verine and {I}ngheis, {M}. and {ANRS} {D}od-{C}i {S}tudy {G}roup}, editor = {}, language = {{ENG}}, abstract = {{I}ntroduction {HIV} {T}esting and {C}ounselling ({HTC}) remains a key challenge in achieving control of the {HIV} epidemic by 2030. {I}n the early 2010s, the {P}resident's {E}mergency {P}lan for {AIDS} {R}elief ({P}epfar) adopted targeted {HTC} strategies for populations and geographical areas most affected by {HIV}. {W}e examine how {P}epfar defined targeted {HTC} in {C}ote d'{I}voire, a country with a mixed {HIV} epidemic, after a decade of expanding {HTC} services. {M}ethods {W}e explored the evolution of {HTC} strategies through the {C}ountry {O}perational {P}lans ({COP}) of {P}epfar during its phase 3.0, from {COP} 14 to {COP} 17 ({O}ctober 2014 to {S}eptember 2018) in {C}ote d'{I}voire. {W}e conducted an analysis of the grey literature over the period 2014 to 2018 ({B}udget & {T}arget {R}eport, {S}trategic {D}irection {S}ummary, {S}ustainability {I}ndex and {D}ashboard {S}ummary, ). {W}e also conducted a qualitative study in {C}ote d'{I}voire (2015 to 2018) using in-depth interviews with stakeholders in the {AIDS} public response: {CDC}/{P}epfar (3), {M}inistry of {H}ealth (3), intermediary {NGO}s (7); and public meeting observations (14). {R}esults {S}ince the {COP} 14, {P}epfar's {HIV} testing strategies have been characterized by significant variations in terms of numerical, geographical and population targets. {W}hile 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. {C}onclusions {T}hese 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 {W}ashington.}, keywords = {{P}epfar ; {HIV} testing ; {H}ealth policy ; {COP} ({C}ountry operational {P}lan) ; {C}ote d'{I}voire ; {A}frica ; {COTE} {D}'{IVOIRE}}, booktitle = {}, journal = {{J}ournal of the {I}nternational {A}ids {S}ociety}, volume = {22}, numero = {12}, pages = {e25424 [7 ]}, year = {2019}, DOI = {10.1002/jia2.25424}, URL = {https://www.documentation.ird.fr/hor/fdi:010077777}, }