Dépistage du VIH hors les murs en Côte d'Ivoire : des prestataires communautaires sous pression

Background - Outreach HIV testing strategies have significantly contributed to the increase in the number of people knowing their HIV status in sub-Saharan Africa. This article analyzes the articulation of donor and field constraints on the implementation of outreach HIV testing strategies in Côte d’Ivoire. Methods - Qualitative research was conducted in three health districts (Man, Cocody-Bingerville and Aboisso) in Côte d’Ivoire in 2015-2016, through in-depth interviews with community providers, local leaders and people tested and through observation of outreach HIV testing activities. Results - Implementing organizations feel “under pressure” to meet donors’ objectives that are deemed unattainable, as well as the lack of training and funding. As a result, providers do not observe systematically the rules of the “three Cs” (counselling, informed consent, confidentiality), and propose testing to individuals who are “off-target” (in terms of locations and populations). Discussion - Implementing NGOs experience two types of constraints those resulting from the functioning of international aid (inadequate funding compared to actual costs, objectives too high, the important chain of intermediaries) and those related to the local context (spaces not adapted to guarantee confidentiality and the professional activity of target populations). Conclusion - The pressure that is exerted at different levels on implementing NGOs is detrimental to the quality of HIV testing. It is now essential to develop a more qualitative approach in defining strategies and evaluation criteria.