@article{fdi:010082121, title = {{C}hallenges of {HIV} self-test distribution for index testing when {HIV} status disclosure is low : preliminary results of a qualitative study in {B}amako ({M}ali) as part of the {ATLAS} project}, author = {{B}oye, {S}okhna and {B}ouare, {S}. and {K}y-{Z}erbo, {O}. and {R}ouveau, {N}icolas and {S}imo {F}otso, {A}rlette and {D}'{E}lbee, {M}. and {S}ilhol, {R}. and {M}aheu-{G}iroux, {M}. and {V}autier, {A}. and {B}reton, {G}. and {K}eita, {A}. and {B}ekelynck, {A}. and {D}esclaux, {A}lice and {L}armarange, {J}oseph and {P}ourette, {D}olores and {ATLAS} {T}eam}, editor = {}, language = {{ENG}}, abstract = {{C}ontext: {T}he rate of {HIV} status disclosure to partners is low in {M}ali, a {W}est {A}frican country with a national {HIV} prevalence of 1.2%. {HIV} self-testing ({HIVST}) could increase testing coverage among partners of people living with {HIV} ({PLHIV}). {T}he {A}uto{T}est-{VIH}, {L}ibre d'acceder a la connaissance de son {S}tatut ({ATLAS}) program was launched in {W}est {A}frica with the objective of distributing nearly half a million {HIV} self-tests from 2019 to 2021 in {C}ote d'{I}voire, {M}ali, and {S}enegal. {T}he {ATLAS} program integrates several research activities. {T}his article presents the preliminary results of the qualitative study of the {ATLAS} program in {M}ali. {T}his study aims to improve our understanding of the practices, limitations and issues related to the distribution of {HIV} self-tests to {PLHIV} so that they can offer the tests to their sexual partners. {M}ethods: {T}his qualitative study was conducted in 2019 in an {HIV} care clinic in {B}amako. {I}t consisted of (i) individual interviews with eight health professionals involved in the distribution of {HIV} self-tests; (ii) 591 observations of medical consultations, including social service consultations, with {PLHIV}; (iii) seven observations of peer educator-led {PLHIV} group discussions. {T}he interviews with health professionals and the observations notes have been subject to content analysis. {R}esults: {HIVST} was discussed in only 9% of the observed consultations (51/591). {W}hen {HIVST} was discussed, the discussion was almost always initiated by the health professional rather than {PLHIV}. {HIVST} was discussed infrequently because, in most of the consultations, it was not appropriate to propose partner {HIVST} (e.g., when {PLHIV} were widowed, did not have partners, or had delegated someone to renew their prescriptions). {S}ome {PLHIV} had not disclosed their {HIV} status to their partners. {D}ispensing {HIV} self-tests was time-consuming, and medical consultations were very short. {T}hree main barriers to {HIVST} distribution when {HIV} status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering {HIVST} to {PLHIV} when they thought or knew that the {PLHIV} had not disclosed their {HIV} status to partners; (2) {PLHIV} were reluctant to offer {HIVST} to their partners if they had not disclosed their {HIV}-positive status to them; (3) there was limited use of strategies to support the disclosure of {HIV} status. {C}onclusion: {I}t is essential to strengthen strategies to support the disclosure of {HIV}+ status. {I}t is necessary to develop a specific approach for the provision of {HIV} self-tests for the partners of {PLHIV} by rethinking the involvement of stakeholders. {T}his approach should provide them with training tailored to the issues related to the (non)disclosure of {HIV} status and gender inequalities, and improving counseling for {PLHIV}.}, keywords = {{HIV} self-testing ; index testing ; knowledge of {HIV} status ; {HIV} status ; disclosure ; {M}ali ; partners of {PLHIV} ; people living with {HIV} ; screening ; {MALI}}, booktitle = {}, journal = {{F}rontiers in {P}ublic {H}ealth}, volume = {9}, numero = {}, pages = {653543 [11 ]}, year = {2021}, DOI = {10.3389/fpubh.2021.653543}, URL = {https://www.documentation.ird.fr/hor/fdi:010082121}, }