{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T01:34:08Z","timestamp":1790472848927,"version":"4.1.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T00:00:00Z","timestamp":1621382400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012947","name":"Institut de Recherche pour le D\u00c3\u00a9veloppement","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012947","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p><jats:bold>Context:<\/jats:bold> The rate of HIV status disclosure to partners is low in Mali, a West African 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). The <jats:italic>AutoTest-VIH, Libre d'acc\u00e9der \u00e0 la connaissance de son Statut<\/jats:italic> (ATLAS) program was launched in West Africa with the objective of distributing nearly half a million HIV self-tests from 2019 to 2021 in C\u00f4te d'Ivoire, Mali, and Senegal. The ATLAS program integrates several research activities. This article presents the preliminary results of the qualitative study of the ATLAS program in Mali. This 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.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This qualitative study was conducted in 2019 in an HIV care clinic in Bamako. It 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. The interviews with health professionals and the observations notes have been subject to content analysis.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> HIVST was discussed in only 9% of the observed consultations (51\/591). When 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). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three 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.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> It is essential to strengthen strategies to support the disclosure of HIV+ status. It 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. This 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.<\/jats:p>","DOI":"10.3389\/fpubh.2021.653543","type":"journal-article","created":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T04:40:40Z","timestamp":1621399240000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Challenges of HIV Self-Test Distribution for Index Testing When HIV Status Disclosure Is Low: Preliminary Results of a Qualitative Study in Bamako (Mali) as Part of the ATLAS Project"],"prefix":"10.3389","volume":"9","author":[{"given":"Sokhna","family":"Boye","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seydou","family":"Bouar\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Odette","family":"Ky-Zerbo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Rouveau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arlette","family":"Simo Fotso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"d'Elb\u00e9e","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Silhol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Maheu-Giroux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Vautier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Breton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelaye","family":"Keita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Bekelynck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Desclaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Larmarange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolor\u00e8s","family":"Pourette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,19]]},"reference":[{"key":"B1","unstructured":"90\u201390\u201390: good progress, but the world is off-track for hitting the 2020 targets2020"},{"key":"B2","first-page":"773","article-title":"Sp\u00e9cificit\u00e9s de l'\u00e9pid\u00e9mie VIH au Sud","volume-title":"VIH H\u00e9patites virales et sant\u00e9 sexuelle","author":"Ekou\u00e9vi","year":"2020"},{"key":"B3","doi-asserted-by":"publisher","first-page":"20292","DOI":"10.1097\/QAD.0000000000000671","article-title":"Safer disclosure of HIV serostatus for women living with HIV who experience or fear violence: a systematic review","volume":"18","author":"Kennedy","year":"2015","journal-title":"J Int AIDS Soc"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.18.6.20292","article-title":"Safer disclosure of HIV serostatus for women living with HIV who experience or fear violence: a systematic review","volume":"18","author":"Kennedy","year":"2015","journal-title":"J Int AIDS Soc."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1007\/s10461-015-1006-1","article-title":"Effectiveness of interventions promoting HIV serostatus disclosure to sexual partners: a systematic review","volume":"19","author":"Conserve","year":"2015","journal-title":"AIDS Behav."},{"key":"B6","unstructured":"Lignes directrices sur l'autod\u00e9pistage du VIH et la notification aux partenaires2016"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e25249","DOI":"10.1002\/jia2.25249","article-title":"The Self-Testing AfRica (STAR) Initiative: accelerating global access and scale-up of HIV self-testing","volume":"22","author":"Ingold","year":"2019","journal-title":"J Int AIDS Soc."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e25244","DOI":"10.1002\/jia2.25244","article-title":"HIV self-testing: breaking the barriers to uptake of testing among men and adolescents in sub-Saharan Africa, experiences from STAR demonstration projects in Malawi, Zambia and Zimbabwe","volume":"22","author":"Hatzold","year":"2019","journal-title":"J Int AIDS Soc."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.1186\/s12889-018-6120-3","article-title":"The effectiveness and cost-effectiveness of community-based lay distribution of HIV self-tests in increasing uptake of HIV testing among adults in rural Malawi and rural and peri-urban Zambia: protocol for STAR (self-testing for Africa) cluster randomized evaluations","volume":"18","author":"Neuman","year":"2018","journal-title":"BMC Public Health."},{"key":"B10","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1097\/QAI.0000000000001601","article-title":"High acceptability and increased HIV-testing frequency after introduction of HIV self-testing and network distribution among south african msm","volume":"77","author":"Lippman","year":"2018","journal-title":"JAIDS"},{"key":"B11","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1007\/s10461-014-0818-8","article-title":"What Should the Ideal HIV Self-Test Look Like? A usability study of test prototypes in unsupervised HIV self-testing in Kenya, Malawi, and South Africa","volume":"18","author":"Peck","year":"2014","journal-title":"AIDS Behav."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e277","DOI":"10.1016\/S2352-3018(18)30044-4","article-title":"Reliability of HIV rapid diagnostic tests for self-testing compared with testing by health-care workers: a systematic review and meta-analysis","volume":"5","author":"Figueroa","year":"2018","journal-title":"Lancet HIV."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e0202491","DOI":"10.1371\/journal.pone.0202491","article-title":"Performance and usability evaluation of the INSTI HIV self-test in Kenya for qualitative detection of antibodies to HIV","volume":"13","author":"Bwana","year":"2018","journal-title":"PLoS ONE."},{"key":"B14","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1186\/1471-2458-13-735","article-title":"Acceptability of HIV self-testing: a systematic literature review","volume":"13","author":"Krause","year":"2013","journal-title":"BMC Public Health."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e0195391","DOI":"10.1371\/journal.pone.0195391","article-title":"Acceptability and performance of a directly assisted oral HIV self-testing intervention in adolescents in rural Mozambique","volume":"13","author":"Hector","year":"2018","journal-title":"PLoS ONE."},{"key":"B16","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/s10461-014-0830-z","article-title":"Factors associated with acceptability of HIV self-testing among health care workers in Kenya","volume":"18","author":"Kalibala","year":"2014","journal-title":"AIDS Behav."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09540121.2020.1828564","article-title":"Increases in HIV status 644 disclosure and sexual communication between South African men who have sex with men and 645 their partners following use of HIV self-testing kits","author":"Chen","year":"2020","journal-title":"AIDS Care"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2491","DOI":"10.1007\/s10461-018-2038-0","article-title":"Discordance, disclosure and normative gender roles: barriers to couple testing within a community-level HIV self-testing intervention in Urban Blantyre, Malawi","volume":"22","author":"Kumwenda","year":"2018","journal-title":"AIDS Behav."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1503784","DOI":"10.1080\/16549716.2018.1503784","article-title":"\u2018If I had not taken it [HIVST kit] home, my husband would not have come to the facility to test for HIV': HIV self-testing perceptions, delivery strategies, and post-test experiences among pregnant women and their male partners in Central Uganda","volume":"11","author":"Matovu","year":"2018","journal-title":"Global Health Action"},{"key":"B20","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1186\/s12889-021-10212-1","article-title":"Describing, analysing and understanding the effects of the introduction of HIV self-testing in West Africa through the ATLAS programme in C\u00f4te d'Ivoire, Mali and Senegal","volume":"21","author":"Rouveau","year":"2021","journal-title":"BMC Public Health."},{"key":"B21","article-title":"Partage du diagnostic d'infection VIH et d\u00e9pistage des partenaires de PVVIH au Mali : Enqu\u00eate S\u00e9ropart","volume-title":"Communication orale presented at: 10 \u00e9me conf\u00e9rence Francophone sur le VIH et les H\u00e9patites virales (AFRAVIH)","author":"Tubiana","year":"2020"},{"key":"B22","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.pec.2017.07.030","article-title":"Empowering Malian women living with HIV regarding serostatus disclosure management: short-term effects of a community-based intervention","volume":"101","author":"Bernier","year":"2018","journal-title":"Patient Educ Counsel."},{"key":"B23","unstructured":"GUNDO-SO: the chamber of confidentiality. A community-based projectdealing with the issue of disclosing one's HIV statusamong women living with HIV in Mali\n            CoalitionPLUS\n          Coalition PLUS.2014"},{"key":"B24","unstructured":"Mali : les femmes vivant avec le VIH face \u00e0 la question du partage du statut s\u00e9rologique\n            RichertM\n          Coalition PLUS.2019"},{"key":"B25","unstructured":"VidalL\n          ParisLa D\u00e9couverteFaire de l'anthropologie. Sant\u00e9, science et d\u00e9veloppement2010"},{"key":"B26","first-page":"p. 479","volume-title":"Medical Anthropology: A Handbook of Theory and Method","author":"Johnson","year":"1990"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1136\/bmj.321.7273.1400","article-title":"Ethnography and health care","volume":"321","author":"Savage","year":"2000","journal-title":"BMJ."},{"key":"B28","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1111\/j.1365-2648.2004.03249.x","article-title":"Grounded theory: reflections on the emergence vs. forcing debate","volume":"48","author":"Boychuk","year":"2004","journal-title":"J Adv Nurs."},{"key":"B29","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"Elo","year":"2008","journal-title":"J Adv Nurs."},{"key":"B30","first-page":"p. 409","volume-title":"La d\u00e9couverte de la th\u00e9orie ancr\u00e9e: strat\u00e9gies pour la recherche qualitative.","author":"Glaser","year":"2010"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.2307\/1864376","article-title":"Gender: a useful category of historical analysis","volume":"91","author":"Scott","year":"1986","journal-title":"Am Histor Rev."},{"key":"B32","article-title":"Le partage du statut s\u00e9rologique avec l'entourage","volume-title":"Evaluation de l'impact bioclinique et social, individuel et collectif, du traitement ARV chez des patients VIH-1 pris en charge depuis 10 ans dans le cadre de l'ISAARV -Cohorte ANRS. 1215 Rapport final","author":"Coutherut","year":"2012"},{"key":"B33","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3406\/sosan.2006.1679","article-title":"Pourquoi et comment en parler? Dialogue conjugal autour de l'annonce de la s\u00e9ropositivit\u00e9 dans des couples s\u00e9rodiscordants \u00e0 Abidjan (C\u00f4te d'Ivoire)","volume":"24","author":"Tijou","year":"2006","journal-title":"Sci Soc et sant\u00e9"},{"key":"B34","first-page":"291","article-title":"L'annonce de la s\u00e9ropositivit\u00e9 au VIH en Afrique","volume":"26","author":"Collignon","year":"1994","journal-title":"Psychopathol Afric"},{"key":"B35","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.1080\/02664763.2012.755319","article-title":"The social and gender context of HIV disclosure in sub-Saharan Africa: a review of policies and practices","volume":"10","author":"Bott","year":"2013","journal-title":"SAHARA J."},{"key":"B36","doi-asserted-by":"publisher","first-page":"19160","DOI":"10.7448\/IAS.17.1.19160","article-title":"\u201cMen are always scared to test with their partners \u2026 it is like taking them to the Police\u201d: motivations for and barriers to couples' HIV counselling and testing in Rakai, Uganda: a qualitative study","volume":"17","author":"Matovu","year":"2014","journal-title":"J Int AIDS Soc"},{"key":"B37","first-page":"17","article-title":"Genre et exp\u00e9rience du d\u00e9pistage du VIH au Burkina Faso","volume-title":"Les femmes \u00e0 l'\u00e9preuve du VIH dans les pays du Sud : genre et acc\u00e8s universel \u00e0 la prise en charge","author":"Obermeyer","year":"2011"},{"key":"B38","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1051\/medsci\/2008242s184","article-title":"Couple et sexualit\u00e9 des femmes d'Afrique sub-saharienne vivant avec le VIH\/sida en France","volume":"24","author":"Pourette","year":"2008","journal-title":"Med Sci (Paris)."},{"key":"B39","doi-asserted-by":"publisher","first-page":"3826","DOI":"10.1007\/s10461-018-2062-0","article-title":"Receiving HIV serostatus disclosure from partners before sex: results from an online survey of chinese men who have sex with men","volume":"22","author":"Tang","year":"2018","journal-title":"AIDS Behav."},{"key":"B40","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1080\/09540120020018224","article-title":"Living with HIV: women's experience in Burkina Faso, West Africa","volume":"13","author":"Issiaka","year":"2001","journal-title":"AIDS Care."},{"key":"B41","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1097\/OLQ.0000000000001084","article-title":"Cascade of provider-initiated human immunodeficiency virus testing and counselling at specific life events (pregnancy, sexually transmitted infections, marriage) in C\u00f4te d'Ivoire","volume":"47","author":"Inghels","year":"2020","journal-title":"Sex Transm Dis"},{"key":"B42","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1186\/1471-2458-10-197","article-title":"Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study","volume":"10","author":"Orne-Gliemann","year":"2010","journal-title":"BMC Public Health."},{"key":"B43","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/S0968-8080(08)32407-0","article-title":"Couple-centred testing and counselling for HIV serodiscordant heterosexual couples in sub-Saharan Africa","volume":"16","author":"Desgr\u00e9es-du-Lo\u00fb","year":"2008","journal-title":"Reprod Health Matters."},{"key":"B44","unstructured":"Resources, Agency, Achievements: Reflections on the Measurement of Women's Empowerment\n            KabeerN\n          GSDRC"},{"key":"B45","unstructured":"Can task shifting improve efficiency of HIV self-testing kits distribution?\n            D'Elb\u00e9eM\n            BadianeK\n            Ky-ZerboO\n            BoyeS\n            KabembaOK\n            TraoreMM\n          2020"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.653543\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,19]],"date-time":"2021-05-19T04:40:50Z","timestamp":1621399250000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.653543\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,19]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2021.653543"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.653543","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,19]]},"article-number":"653543"}}