Katia Giguère

Bio: Katia Giguère is an academic researcher from McGill University. The author has contributed to research in topics: Population & Men who have sex with men. The author has an hindex of 3, co-authored 5 publications receiving 28 citations. Previous affiliations of Katia Giguère include Laval University.

Trends in knowledge of HIV status and efficiency of HIV testing services in sub-Saharan Africa (2000-2020): a modelling study of survey and HIV testing program data

Abstract: Background Knowledge of HIV status (KOS) among people living with HIV (PLHIV) is essential for an effective national HIV response. This study estimates progress and gaps in reaching the UNAIDS 2020 target of 90% KOS, and the efficiency of HIV testing services (HTS) in sub-Saharan Africa (SSA), where two thirds of all PLHIV live. Methods We used data from 183 population-based surveys (N=2.7 million participants) and national HTS programs (N=315 country-years) from 40 countries as inputs into a mathematical model to examine trends in KOS among PLHIV, median time from HIV infection to diagnosis, HIV testing positivity, and proportion of new diagnoses among all positive tests, adjusting for retesting. Findings Across SSA, KOS steadily increased from 6% (95% credible interval [95%CrI]: 5% to 7%) in 2000 to 84% (95%CrI: 82% to 86%) in 2020. Twelve countries and one region, Southern Africa, reached the 90% target. In 2020, KOS was lower among men (79%) than women (87%) across SSA. PLHIV aged 15-24 years were the least likely to know their status (65%), but the largest gap in terms of absolute numbers was among men aged 35-49 years, with over 700,000 left undiagnosed. As KOS increased from 2000 to 2020, the median time to diagnosis decreased from 10 to 3 years, HIV testing positivity declined from 9% to 3%, and the proportion of first-time diagnoses among all positive tests dropped from 89% to 42%. Interpretation On the path towards the next UNAIDS target of 95% diagnostic coverage by 2030, and in a context of declining positivity and yield of first-time diagnoses, we need to focus on addressing disparities in KOS. Increasing KOS and treatment coverage among older men could be critical to reduce HIV incidence among women in SSA, and by extension, reducing mother-to-child transmission.

PrEP Use Among Female Sex Workers: No Evidence for Risk Compensation.

Abstract: Background:Little is known about risk compensation among female sex workers (FSW) on HIV pre-exposure prophylaxis (PrEP), and self-report of sexual behaviors is subject to bias.Setting:Prospective observational PrEP demonstration study conducted among FSW in Cotonou, Benin.Methods:Over a period of 2

Under-Reporting of Known HIV-Positive Status Among People Living with HIV: A Systematic Review and Meta-analysis

Abstract: Monitoring progress towards the UNAIDS ‘first 90’ target requires accurate estimates of levels of diagnosis among people living with HIV (PLHIV), which is often estimated using self-report. We conducted a systematic review and meta-analysis quantifying under-reporting of known HIV-positive status using objective knowledge proxies. Databases were searched for studies providing self-reported and biological/clinical markers of prior knowledge of HIV-positive status among PLHIV. Random-effects models were used to derive pooled estimates of levels of under-reporting. Thirty-two estimates from 26 studies were included (41,465 PLHIV). The pooled proportion under-reporting known HIV-positive status was 20% (95% confidence interval 13–26%, I2 = 99%). In sub-group analysis, under-reporting was higher among men who have sex with men (32%, number of estimates [Ne] = 10) compared to the general population (9%, Ne = 10) and among Black (18%, Ne = 5) than non-Black (3%, Ne = 3) individuals. Supplementing self-reported data with biological/clinical proxies may improve the validity of the ‘first 90’ estimates.

Under-Reporting of Known HIV-Positive Status Among People Living with HIV: A Systematic Review and Meta-Analysis

Abstract: Background: Monitoring progress towards the UNAIDS ‘first 90’ target requires accurate estimates of levels of diagnosis among people living with HIV (PLHIV). Knowledge of HIV-positive status is often estimated using self-report, potentially leading to information bias. We aimed to systematically review the evidence and quantify levels of under-reporting of knowledge of HIV-positive status among PLHIV using objective proxies of knowledge of status. Methods: Databases were searched for studies providing self-reported and biological/clinical markers of prior knowledge of HIV-positive status among laboratory-confirmed PLHIV. PLHIV with antiretroviral drugs detected, viral load suppression, or prior diagnosis in medical records, but not reporting being HIV-positive, were classified as under-reporting known HIV-positive status. Random-effects models were used to derive pooled estimates of the proportion under-reporting known HIV-positive status. Possible sources of heterogeneity were investigated using sub-group analyses. Findings: Thirty-two independent estimates from 26 studies including 41,465 PLHIV were included. Most studies were conducted in North America (number of estimates [Ne]=12) or Africa [Ne=14], in the general population [Ne=10] or among men who have sex with men [MSM; Ne=10]). The pooled proportion under-reporting known HIV-positive status among all PLHIV was 20% (95% confidence interval: 13%–26%, I2=99%). In sub-group analysis, under-reporting was higher among MSM (32%, Ne=10) compared to the general population (9%, Ne=10). In the subset of North American studies with data stratified by race, under-reporting was higher among Black (18%, Ne=5) than non-Black (3%, Ne=3; p=0.026) individuals. Interestingly, the absolute magnitude of under-reporting was not associated with the level of self-reporting (slope 0.12, p=0.168). Interpretation: Substantial under-reporting of knowledge of HIV-positive status was found, particularly among MSM, and among Black PLHIV in North America. Supplementing self-reported data with biological/clinical proxies where possible may improve the validity of the ‘first 90’ estimates. Funding Statement: NS, KMM, MCB and DD are supported by the HPTN Modelling Centre which is funded by the US National Institutes of Health (www.nih.gov/; grant number UM1AI068617) through the HPTN Statistical and Data Management Center. NS, KMM and MCB acknowledge the MRC Centre for Global Infectious Disease Analysis which is jointly funded by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and is also part of the EDCTP2 programme supported by the European Union (grant number MR/R015600/1). KG was supported by a Postdoctoral Fellowship from the Fonds de recherche du Quebec – Sante. SHE was supported by the HPTN Laboratory Center (grant number UM1AI068613). Declaration of Interests: KMM has received an honorarium from Gilead for speaking. All remaining authors have no competing interests to declare.

The revolving door of HIV care: Revising the service delivery cascade to achieve the UNAIDS 95-95-95 goals.

Abstract: Peter Ehrenkranz and co-authors present a cyclical cascade of care for people with HIV infection, aiming to facilitate assessment of outcomes.

HIV pre-exposure prophylaxis for female sex workers: ensuring women's family planning needs are not left behind.

Abstract: Introduction Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre-exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. Discussion FSWs have high unmet need for effective contraception and unintended pregnancy is common in low- and middle-income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk-taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single-focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real-life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two-fold increase in condomless sex among FSWs on PrEP, which, given low use of non-barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW-focused community-based HIV services is likely to be the most effective model for improving access to non-barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. Conclusions As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women's rights.

Achieving the 95 95 95 targets for all: A pathway to ending AIDS

Abstract: In December 2020, UNAIDS released a new set of ambitious targets calling for 95% of all people living with HIV to know their HIV status, 95% of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and 95% of all people receiving antiretroviral therapy to have viral suppression by 2025. Adopted by United Nations Member states in June 2021 as part of the new Political Declaration on HIV and AIDS, these targets, combined with ambitious primary prevention targets and focused attention to supporting enablers, aim to bridge inequalities in treatment coverage and outcomes and accelerate HIV incidence reductions by focusing on progress in all sub-populations, age groups and geographic settings. Here we summarise the evidence and decisions underpinning the new global targets.

Accuracy of self-reported HIV-testing history and awareness of HIV-positive status in four sub-Saharan African countries.

Abstract: BACKGROUND In many countries in sub-Saharan Africa, self-reported HIV testing history and awareness of HIV-positive status from household surveys are used to estimate the percentage of people living with HIV (PLHIV) who know their HIV status. Despite widespread use, there is limited empirical information on the sensitivity of those self-reports, which can be affected by nondisclosure. METHODS Bayesian latent class models were used to estimate the sensitivity of self-reported HIV-testing history and awareness of HIV-positive status in four Population-based HIV Impact Assessment surveys in Eswatini, Malawi, Tanzania, and Zambia. Antiretroviral (ARV) metabolite biomarkers were used to identify persons on treatment who did not accurately report their status. For those without ARV biomarkers, we used a pooled estimate of nondisclosure among untreated persons that was 1.48 higher than those on treatment. RESULTS Among PLHIV, the model-estimated sensitivity of self-reported HIV-testing history ranged from 96% to 99% across surveys. The model-estimated sensitivity of self-reported awareness of HIV status varied from 91% to 97%. Nondisclosure was generally higher among men and those aged 15-24 years. Adjustments for imperfect sensitivity did not substantially influence estimates of PLHIV ever tested (difference <4%) but the proportion of PLHIV aware of their HIV-positive status was higher than the unadjusted proportion (difference <8%). CONCLUSION Self-reported HIV-testing histories in four Eastern and Southern African countries are generally robust although adjustment for nondisclosure increases estimated awareness of status. These findings can contribute to further refinements in methods for monitoring progress along the HIV testing and treatment cascade.