Christopher C M Kyba

Sara B Pritchard

A Roger Ekirch

Adam Eldridge

Andreas Jechow

Christine Preiser

Dieter Kunz

Dietrich Henckel

Franz Hölker

John Barentine

Jørgen Berge

Josiane Meier

Luc Gwiazdzinski

Manuel Spitschan

Mirik Milan

Susanne Bach

Sibylle Schroer

Will 10 Straw

Night Matters-Why the Interdisciplinary Field of "Night Studies" Is Needed

Keywords: night, night science, night studies, nyctology, interdisciplinary studies

The night has historically been neglected in both disciplinary and interdisciplinary research. To some extent, this is not surprising, given the diurnal bias of human researchers and the difficulty of performing work at night. The night is, however, a critical element of biological, chemical, physical, and social systems on Earth. Moreover, research into social issues such as inequality, demographic changes, and the transition to a sustainable economy will be compromised if the night is not considered. Recent years, however, have seen a surge in research into the night. We argue that "night studies" is on the cusp of coming into its own as an interdisciplinary field, and that when it does, the field will consider questions that disciplinary researchers have not yet thought to ask.

Introduction

At any given moment, half of the Earth's surface experiences night (Figure 1). The night is not only a time, but in many respects a place: nocturnal environments are critical habitats for both humans and other forms of life. Over the past 150 years, the night has undergone a series of major transformations. Electrification, industrialization, and capitalism have altered humanity's experiences with night as both a time and place. Ecological studies demonstrate that these changes have also affected nonhuman species (e.g., [START_REF] Gaston | The biological impacts of artificial light at night: The research challenge[END_REF][START_REF] Rich | Ecological Consequences of Artificial Night Lighting[END_REF]). In 1978, Melbin's pioneering article, "Night as frontier" sought to outline a sociology of the night [START_REF] Melbin | Night as frontier[END_REF]. Otherwise, scholarship on the night has been limited until recently, and disciplinary boundaries have tended to hamper interdisciplinary analyses. We, therefore, still remain in the dark when it comes to our understanding of night, despite the night's importance to natural and social processes. [START_REF]Earth and Moon Viewer[END_REF]. The challenges facing our planet and humanity during this century often have direct and indirect connections to the night that must not be overlooked. There is, therefore, a pressing need for interdisciplinary research into the night to come of age, expanding into a recognized field, because the night matters.

The Night as an Interdisciplinary Research Challenge

We are a group of researchers and practitioners from diverse backgrounds in the natural and social sciences, humanities, and non-governmental organizations (NGOs), united by our common interest in the night (Table A1). There has historically been a lack of balance between investigations into processes that occur during night versus day, from disciplinary, and especially interdisciplinary perspectives. Humans are diurnal, and it is difficult to conduct research at night, regardless of disciplinary specialization [START_REF] Rich | Ecological Consequences of Artificial Night Lighting[END_REF]. Moreover, as most people (including scholars) sleep at night, nocturnal processes and issues are easily overlooked. There are also intellectual and institutional reasons for our limited knowledge about the night. Research on the night is generally fragmented and siloed. Disparate topics too often appear as "someone else's problem" or are considered only as a facet of another field, thereby making interdisciplinary inquiry fundamentally difficult. This fragmentation and the lack of the "professionalization" of night studies as a field to date hamper raising the appropriate questions, let alone finding solutions. In Donald Rumsfeld's famous framing [START_REF]Department of Defense News Briefing[END_REF], there remain many "unknown unknowns" with respect to the night. A pressing "nighttime" problem, for example, is growing concern over mismatches between social and biological time in humans. The 2017 Nobel Prize in Physiology and Medicine was awarded for the discovery of the molecular mechanisms in nearly all living organisms that govern circadian rhythms, ranging from activity patterns to blood pressure. The timing of many common human behaviors is often no longer aligned with these biological clocks, and there is ample concern that widespread insufficient or ineffective sleep [START_REF] Roenneberg | Chronobiology: The human sleep project[END_REF] is detrimental to health. Sleep, however, is not simply a medical issue that can be isolated from broader social, cultural, and economic change. There are complex causes of changes in human sleep patterns over the past 150 years [START_REF] Ekirch | The modernization of Western sleep: Or, does insomnia have a history?[END_REF]. The development and expansion of artificial light at night has played a central role, with most cities now brightly illuminated [START_REF] Kyba | Artificially lit surface of Earth at night increasing in radiance and extent[END_REF][START_REF] Nye | American Illuminations: Urban Lighting[END_REF]. Beyond lighting, factors such as incessant processes in industrial plants, connectivity across time zones, provision of 24/7 services including energy, security, and health care, and the possibility of constant technological connectivity in both professional and personal domains have expanded many human activities beyond previous temporal limits (e.g., [START_REF] Gwiazdzinski | The Urban Night: A Space Time for Innovation and Sustainable Development[END_REF]). Extending the hours of labor for non-essential services, to take but one example, both reflects and reinforces industrial capitalism [START_REF] Shaw | The Nocturnal City[END_REF]. Nighttime shifts that enable factories to raise profits for shareholders often pay more than equivalent day shifts. This financial incentive, in turn, often attracts workers who are economically marginal including many women, people of color, and immigrants. Despite increased compensation, the nighttime economy may end up worsening social and economic inequality and magnifying environmental injustice, for instance, if these groups end up suffering from higher rates of disease and poorer health. There are also social costs due to incongruities between the schedule of workers and those of their families. One may question whether night economies really raise local revenue, once sleep deficits and the healthcare costs of night shift workers are also considered. This example demonstrates how night is an "interdisciplinary object"; physical and social processes at nightcircadian rhythms, capitalism, education, race, gender, security, mobility, public lighting, and inequality-are entangled in complex and sometimes unexpected ways. Now-established interdisciplinary fields such as gender studies and environmental studies provide precedents for the kind of professionalization and institutionalization of research that we envision. Like the environment, the night is an especially broad topic that invites diverse perspectives. Furthermore, night studies scholars have already drawn from a wide range of humanities, social science, and natural science disciplines. Due to the complexity of the night, it is essential to establish deep collaboration among social scientists, natural scientists, and humanists that unites empirically-based understandings of physical or biological processes with similarly empirically-grounded understandings of cultural, social, and historical processes (c.f. [START_REF] Bach | Dark Nights, Bright Lights: Night, Darkness, and Illumination in Literature[END_REF]). Complex social problems are unlikely to be easily fixed by technoscientific "solutions".

For example, therapy based on applied understanding of the "night hormone" melatonin could not solve the sleep crisis on its own. Failing to consider the full interdisciplinary context of night has already affected real-world situations. Consider the recent replacement of outdoor lighting in Rome in 2017 [START_REF] Povoledo | Streetlight Fight in Rome: Golden Glow, vs.; Harsh LED[END_REF]. The city's lighting transition was undertaken within the frame of energy consumption and cost, and resulted in the replacement of existing warm color lamps with "colder" white LED lighting. Missing from consideration in the policy decision were public expectations and the cultural meaning of urban light, as well as the negative environmental side effects of broad spectrum (white) light [START_REF] Povoledo | Streetlight Fight in Rome: Golden Glow, vs.; Harsh LED[END_REF]. As a result, residents and tourists had strong negative reactions to the light, arguing that the ancient city should not be lit with cold, harsh white lighting [START_REF] Davies | Artificial light pollution: Are shifting spectral signatures changing the balance of species interactions?[END_REF]. In addition, in trying to address one environmental problem (climate change), Rome may have worsened another (light pollution) in the process. We suggest that an interdisciplinary approach to night governance that incorporates cultural, economic, environmental, and other concerns would yield solutions to nighttime problems that avoid public backlash, negative impact on tourism, and wasted budget due to reversal of policy (e.g., [START_REF] Hecht | The early-adopter blues[END_REF]). Given the broad changes that the night has experienced in recent decades, the quickly spreading recognition of the value of "night mayors" in cities including Amsterdam, London, and New York City [START_REF] Codrea-Rado | What Europe's 'Night Mayors' Can Teach New York[END_REF], and the growing concern over "loss of the night" caused by artificial illumination and shifting schedules, a multi-faceted approach to night as an integrated field of study will redound to the public welfare as well as deepen our knowledge of this critical realm of everyday existence. Organizations such as institutes, university departments, and research clusters have been established to bring interdisciplinary focus on places (e.g., oceans, polar areas, and area studies), topics (e.g., migration and transportation), and even times (e.g., history). It is, therefore, in some sense surprising that a similar organization has not yet been founded to address the night. Momentum seems to be building in this direction, however. For example, the Consortium for Dark Sky Studies recently established a new undergraduate minor in "dark sky studies" at the University of Utah. Gaston recently made a compelling case in The American Naturalist for why "nighttime ecology" must be established as a synthetic program of research in this scientific field [START_REF] Gaston | Nighttime Ecology: The "Nocturnal Problem" Revisited[END_REF], and Shaw has argued for "nightology", proposing an integrated approach to nocturnal urban research [START_REF] Shaw | The Nocturnal City[END_REF]. While these are exciting developments, we suggest that the emerging field of night studies must necessarily be much broader. Beyond advancing interdisciplinary knowledge of the night, we expect that night studies researchers will, in many cases, work closely with organizations on evolving challenges such as those related to night governance, sustainability, or a carbon-free economy. Ideally, knowledge transfer from night studies scholars to practitioners will help them address emerging challenges, rather than responding to them after the fact. An example of an interdisciplinary challenge for cities where night studies scholars could provide expertise is in the provision of public transit during the night. Night transit serves diverse publics, who surely have different expectations for service and perceptions of safety (e.g., a group of young men heading to a nightclub versus a female, first-generation immigrant nurse returning home alone after working an evening shift). Lobbies for late night transit often include the entertainment industry, while taxi companies, residents, and transit worker organizations are often against expanded night services (e.g., [START_REF] Papa | London Finally Gets its Night Tube-but is there a Dark Side to 24/7 Transport? Available online[END_REF]). From an economic perspective, night transit may provide benefits due to increased activity, but impose future costs due to the health impacts of sleep loss by those using the service. Furthermore, long commutes and lost sleep may increase overall social inequality within a region [START_REF] Williams | Sleep and Society: Sociological Ventures into the Un (known)[END_REF]. Without a full picture, governance of the night may therefore serve the interests of a select powerful group, rather than the community generally.

Conclusions

The night has experienced major changes in recent decades, and the pace of change is unlikely to slow down. While research into the night has expanded greatly in recent years, we believe that further networking and institutionalization is urgently needed. In order to develop into a recognized interdisciplinary field, night studies will need to see the establishment of journals, conference series, dedicated funding lines, research institutes, and university departments offering programs of study. If the field develops as we hope it will, perhaps it may eventually become recognized by the Greek term "nyctology": the study of night matters.

Addendum

Note that another opinion on the "science of the night" with a different focus was recently published by Michele Acuto [START_REF] Acuto | We need a science of the night[END_REF]. We agree strongly with Michele Acuto, and encourage readers to also read his piece. This manuscript was drafted independently over a period of inperson and online meetings spanning from 2017-2019, without any correspondence with Michele Acuto.

Figure 1 .

 1 Figure 1. At any given moment, half of the Earth's surface experiences night. Data by NASA Blue Marble and Black Marble, via John Walker 's webtool "Earth and moon viewer" [4].The challenges facing our planet and humanity during this century often have direct and indirect connections to the night that must not be overlooked. There is, therefore, a pressing need for interdisciplinary research into the night to come of age, expanding into a recognized field, because the night matters.

Acknowledgments

We thank Dieter Lang from LEDVANCE for critical comments on early drafts of the manuscript. The publication of this article was funded by the Open Access Fund of the Leibniz Association.

Author Contributions

A.J., C.C.M.K., D.H., F.H., J.M., and S.S. initiated the project, and selected and invited the rest of the co-authors to contribute. All authors collaborated on developing the outline and choosing specific examples or case studies via electronic and in-person meetings. Multiple drafts of the opening paragraph were written by co-authors, and ranked by all authors to select an initial opening. S.B.P. wrote the first complete draft of the paper, and all authors critiqued this draft. A.J., A.E., C.C.M.K., C.P., D.H., F.H., J.M., and S.S. edited subsequent drafts. C.C.M.K coordinated the project and was the primary editor. All authors critiqued draft versions of the manuscript and approved the final version. All authors have read and agreed to the published version of the manuscript.

Conflicts of Interest

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.


Serge Niangoran

Maxime Inghels

Arsène Kra Kouassi

Anne Bekelynck

Séverine Carillon

Lazare Sika

Christine Danel

Mariatou Koné

Joseph Larmarange

Physicians' knowledge of Hepatitis B and C in Côte d'Ivoire : the emergency need to intensify the training of health worker in the context of a generalized epidemic

published or not. The documents may come

  Physicians' knowledge of Hepatitis B and C in Côte d'Ivoire : the emergency need to intensify the training of health worker in the context of a generalized epidemic Background : Viral hepatitis is a major public health problem in Côte d'Ivoire, with a prevalence of 8% to 10% for hepatitis B and 1% for hepatitis C. Research indicates that there is a lack of awareness of hepatitis in the general population; however, there remains little evidence concerning physician's knowledge of the virus. We, thus, investigate physician's knowledge on viral hepatitis B and C, which can be the first condition for screening and treatment. Materials and methods : In 2018, we conducted a cross-sectional Knowledge, Attitudes and Practices (KAP) telephone survey on a random sample of physicians working in health facilities in Côte d'Ivoire. Data collected included an assessment of knowledge about viral hepatitis B and C and their personal attitudes towards hepatitis screening and vaccination. We created a knowledge score based on 14 variables (screening test variables, HBV viral load variables, treatment indications variables, treatment availability and associated costs variables) and identified the associated factors using a multivariate Poisson model. Results : 1. Knowledge of the prevalence of viral hepatitis B and C and their screening: 83% of doctors say that the screening is done with the HBs antigen. 68% say the presence of anti-HBc antibodies means previous contact with HBV Prevalence of hepatitis B and C: Only a third has an exact idea of the level of national prevalence. 21% say they have never been tested for HBV (32% tested only once and 46% several times) 2. Knowledge of hepatitis B vaccination and vaccination coverage of physicians : 47% believe that a person who has been in contact with the virus does not need to be vaccinated compared to 43% who think the opposite. 51% indicate vaccination as a means of prevention against HBV Almost 18% of doctors say they are not vaccinated against HBV 3. Knowledge of the management of viral hepatitis B and C: 30% of doctors know that antivirals are not free for mono-infected people and 34% do not know that some ARVs are effective against HBV. 52% say they do not agree that a positive HBV viral load greater than 20,000 IU is an indication for antiviral treatment. 36% are unaware that an HBsAg positive patient does not necessarily require treatment. Strong heterogeneity in knowledge of modes of transmission and means of prevention: Only 27% spontaneously cite "saliva" as a mode of transmission of hepatitis B. 4. Associated factors with a "good" knowledge of viral hepatitis B and C: Factors associated with high knowledge of viral hepatitis B and C among physicians were: Having followed specific training on viral hepatitis outside of the academic course (RRa = 1.16 [1.03 -1.30]). Having previously screened for viral hepatitis (RRa = 1.16 [1.04 -1.29]). Proximity to viral hepatitis by having people with the pathology around them (RRa = 1.09 [1.00 -1.19]). Discussion and conclusion : This study showed that the overall knowledge about viral hepatitis among physicians was unsatisfactory, contrasting with the extent of the disease in the population. The fight against viral hepatitis in Côte d'Ivoire necessarily involves increased involvement of all doctors, and in particular through enhanced initial and continuing training in prevention and patient care. Screening followed by vaccination of health care practitioners should be routinely applied. Serge Niangoran 1 , Maxime Inghels 2 , Arsène Kra Kouassi 1 , Anne Bekelynck 1 , Séverine Carillon 2 , Sika Lazare 3 , Christine Danel 4 , Mariatou Koné 5 , Joseph Larmarange 2 for the ANRS 12323 DOD-CI group. ( 1 ) Programme PACCI, site ANRS, Abidjan, Côte d'Ivoire ( 2 ) Ceped UMR 196 (Paris Descartes-IRD) SageSud ERL INSERM 1244, IRD, Paris, France ( 3 ) E N S E A , A b i d j a n , C ô t e d 'I v o i r e  ( 4 ) I N S E R M, 1 2 1 9 , B o rd ea ux , F r a n c e  ( 5 ) Institut d'Ethno Sociologie (IES), Abidjan, Côte d'Ivoire


Marc D'elbée

Mohamed Metogara

Odette Traore

Sokhna Ky-Zerbo

Odé Kanku Boye

Arlette Simo Kabemba

Dolorès Fotso

Alice Pourette

Joseph Desclaux

Fern Larmarange

Terris-Prestholt

Can task shifting improve efficiency of HIV self-testing kits distribution? A case study in Mali

établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.


Keywords: Chronic hepatitis B, Nucleos(t)ide analogues, Long-lasting effect, Covalently-closed-circular DNA, HBV cure

In worldwide clinical settings, several nucleos(t)ide analogues (NAs), including tenofovir disoproxil fumarate (TDF), entecavir (ETV), and tenofovir alafenamide fumarate (TAF) are used to treat patients chronically infected with HBV. [START_REF]EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[END_REF][START_REF] Fanning | Therapeutic strategies for hepatitis B virus infection: towards a cure[END_REF] NAs are easily administrated orally and have favorable pharmacologic profiles. [START_REF] Chaudhuri | Innovation and trends in the development and approval of antiviral medicines: 1987-2017 and beyond[END_REF] Their use is generally preferred to that of the immune stimulator pegylated-interferon (Peg-IFN)-alpha, which induces more adverse effects (AEs) and less virological suppression (i.e. HBV DNA decline in serum), although it is associated with a higher rate of HBsAg loss. [START_REF]EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[END_REF][START_REF] Fanning | Therapeutic strategies for hepatitis B virus infection: towards a cure[END_REF][START_REF] Yeo | Factors associated with rates of HBsAg seroclearance in adults with chronic HBV infection: a systematic review and meta-analysis[END_REF] Treatment indications for these NAs have been clearly defined by international societies, including EASL. [START_REF]EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[END_REF] Their efficacy to suppress/reduce HBV viremia and overall safety have been properly assessed in randomized controlled phase III clinical trials (i.e. registration trials) and in long-term real-world studies. [START_REF]EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[END_REF][START_REF] Fanning | Therapeutic strategies for hepatitis B virus infection: towards a cure[END_REF][START_REF] Yeo | Factors associated with rates of HBsAg seroclearance in adults with chronic HBV infection: a systematic review and meta-analysis[END_REF] When "no virologic resistance" occurs, long-term treatments with 1 of the 3 most used NAs (TDF, ETV, TAF) are associated with a prolonged virologic responses (i.e. viremia below detection levels by qPCR) in most patients (>95%), normalized alanine aminotransferase levels, regression of fibrosis, and altogether with the prevention of disease progression, including hepatocellular carcinoma development (See Fig. 1). [START_REF]EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[END_REF] Q 2

Yet, currently, NAs are to be taken daily and long-term, as treatment cessation is quasi-universally associated with virological rebound, 2,5 except in selected patients for whom "NA stopping rules" have been applied with some success (note that this latter point will not be discussed here; please refer to the following references for recent discussions on this topic [START_REF] Lampertico | Less can be more: a finite treatment approach for HBeAg-negative chronic hepatitis B[END_REF] ). Moreover it is also well acknowledged that NAs generally have a limited impact on HBsAg levels [START_REF]EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[END_REF][START_REF] Fanning | Therapeutic strategies for hepatitis B virus infection: towards a cure[END_REF][START_REF] Yeo | Factors associated with rates of HBsAg seroclearance in adults with chronic HBV infection: a systematic review and meta-analysis[END_REF] and that very long-term therapies are needed to reduce covalently closed circular DNA (cccDNA) levels. [START_REF] Lai | Reduction of covalently closed circular DNA with long-term nucleos(t)ide analogue treatment in chronic hepatitis B[END_REF][START_REF] Werle-Lapostolle | Persistence of cccDNA during the natural history of chronic hepatitis B and decline during adefovir dipivoxil therapy[END_REF] As these viral parameters are instrumental to a proper HBV cure (at minima functional, and at maxima sterilizing), there is some room for improvement.

Improvements to currently used NAs? First, even if some of the NAs are very potent at inhibiting HBV polymerase (Pol) activity and neo-synthesis of encapsidated relaxed circular DNA (rcDNA, i.e. viral genome within nucleocapsid), which is then used to either produce secreted infectious viral particles (i.e. maintenance of viremia) or to maintain the level of cccDNA following recycling of rcDNA to the nucleus, [START_REF] Seeger | Hepadnaviruses[END_REF] careful/close monitoring of viremia using very potent qPCR technology has demonstrated partial virologic responses in longterm NA-treated patients, with viremia varying between "non detectable" and very low levels. [START_REF] Mak | HBV RNA profiles in chronic hepatitis B patients under different disease phases and antiviral therapy[END_REF] This indicates that the blockade of HBV Pol activity is not 100%. This also has consequences for cccDNA levels, as residual HBV Pol activity might be sufficient to maintain the cccDNA pool. More potent NAs that further block cccDNA replenishment and accelerate decay would be required for HBV cure.

Second, pure potency (EC 50 value) is not everything. Indeed to be potent, a NA needs to be efficiently matured by host-cell enzymes to its triphosphorylated (TP) (or equivalent form) [START_REF] Deville-Bonne | Human and viral nucleoside/nucleotide kinases involved in antiviral drug activation: structural and catalytic properties[END_REF] and to be delivered/distributed at the right place (i.e. hepatocytes, when HBV is concerned). In other words, this means that potency is also highly dependent on adequate subcellular biodistribution and biologic activation of NAs only (or mainly) within hepatocytes. The latter also has implications for toxicity and safety. Third, a better toxicity profile is also important. The toxicity of NAs comes mainly from off-target activity (i.e. non-HBV Pol). Indeed, many NAs inhibit mitochondrial polymerases leading to side effects in the long term. [START_REF]LiverTox: Clinical and Research Information on Drug-Induced Liver Injury[END_REF][START_REF] Fung | Extrahepatic effects of nucleoside and nucleotide analogues in chronic hepatitis B treatment[END_REF][START_REF] Wang | Phosphorylation of the anti-hepatitis B nucleoside analog 1-(2'-deoxy-2'-fluoro-1-beta-D-arabinofuranosyl)-5-iodouracil (FIAU) by human cytosolic and mitochondrial thymidine kinase and implications for cytotoxicity[END_REF] For instance, renal and bone toxicity was observed with long-term administration of TDF; this problem was, at least partially, addressed by the research and development of TAF. [START_REF] Agarwal | 96 weeks treatment of tenofovir alafenamide vs. tenofovir disoproxil fumarate for hepatitis B virus infection[END_REF] Even though such toxicity was not evident with ETV, toxicity remains a general issue in the case of systemic activity of a given medication. A way to further reduce toxicity would therefore be to strictly deliver and/or activate the NA in the target cell type (hepatocytes in the case of HBV). [START_REF] Pierra Rouviere | HBV replication inhibitors[END_REF] In the current issue of Journal of Hepatology, Higashi-Kuwata and colleagues [START_REF] Higashi-Kuwata | Identification of a novel long-acting 4'-modified nucleoside reverse transcriptase inhibitor against HBV[END_REF] cyclo-pentane-1-carbonitrile), is a guanosine analogue derived from 4'-cyano-methylene-carbocyclic-2'-deoxyguanosine (CMCdG) and has a structure similar to ETV. Two enantiomers (E-CFCP and Z-CFCP) were initially synthesized, but E was further developed because it was far more active. E-CFCP was shown to be more potent, with a lower EC 50 in various cell culture models and virtually 100% inhibition at the highest dose tested, as well as less toxic than ETV and TAF in side-by-side in vitro comparisons. Moreover E-CFCP was still active against ETV-(L180M/S202G/ M204V) [START_REF] Yim | Evolution of multidrug resistant hepatitis B virus during sequential therapy[END_REF] and adefovir-(A181T/N236T) [START_REF] Villet | Impact of hepatitis B virus rtA181V/T mutants on hepatitis B treatment failure[END_REF] resistant strains. Very interestingly, a longer antiviral activity off-treatment was found with E-CFCP compared to ETV and TAF, suggesting that less frequent administration could be possible. The overall higher potency and longer off-treatment efficacy of E-CFCP over ETV is likely due to both a better uptake by hepatic cells, leading to higher intracellular concentrations, and a stronger conversion into the active TP form, as well as a longer intracellular half-life.

Altogether E-CFCP presented a very favourable pharmacologic profile (bioavailability at 70% in mice), with excellent resistance to extremely low pH, which allowed a per os preclinical evaluation in a liver-humanized mouse model. In this model, E-CFCP (at 0.02 mg/kg/day) was more efficient than ETV (at 0.02 mg/kg/ day) at reducing HBV viremia, while rebound after treatment cessation was further delayed in the E-CFCP arm; this strong antiviral activity was obtained in the absence of any toxicity over a period of 14 days of dosing. E-CFCP (at 0.2 mg/kg/day) was also capable of potently inhibiting replication of an ETV-resistant strain, in sharp contrast to ETV itself (and TAF), thus confirming in vitro data on this improved activity against possible circulating mutant strains in patients with CHB. In silico analysis indicated that the addition of the E-positioned fluorine and 4'cyano moities could allow E-CFCP-TP to retain important binding interactions with the mutated catalytic pocket in HBV pol, unlike ETV.

Therefore, E-CFCP seems to fulfil many of the aforementioned expectations for improved NAs. Yet caution must be exercised in the absence of data on efficacy and safety in patients with CHB. We must keep in mind that despite demonstrating higher potency and an improved pharmacologic profile in preclinical and early clinical studies, TAF failed to demonstrate superiority to TDF in phase III trials. [START_REF] Agarwal | 96 weeks treatment of tenofovir alafenamide vs. tenofovir disoproxil fumarate for hepatitis B virus infection[END_REF] Pharmacologic data in humans needs to be obtained, as fast as possible, for E-CFCP to be genuinely compared to ETV, which is an excellent NA in this respect. The intrinsic toxicologic properties of ETV-related NAs are better than the tenofovir derivatives, particularly regarding mitochondrial toxicity, [START_REF]LiverTox: Clinical and Research Information on Drug-Induced Liver Injury[END_REF] but again the safety profile of E-CFCP is yet to be properly established in humans and compared to ETV. [START_REF] Yan | Entecavir pharmacokinetics, safety, and tolerability after multiple ascending doses in healthy subjects[END_REF] To minimize further toxicity, by preventing off-target activity on host polymerases in too many cell types, it would be nice to have NAs that are either only biodistributed to hepatocytes (using a specific hepatocyte delivery strategy) or only activated (into TP form) within hepatocytes by using novel/original pro-drugging strategies. In the case of E-CFCP, we are told that it is a poor inhibitor of HIV polymerase, Fig. 1. Schematic representation of the effect of current and "ideal" NAs on various viral parameters. Treatment of patients with CHB using approved NAs generally leads to a strong effect on viremia (virosuppression) and a weaker effect on cccDNA and HBsAg levels even after years of implementation (plain lines).

Yet in many patients a close monitoring with improved qPCR technology has demonstrated partial responses to current NAs, with measurable, often intermittent, very-low-level viremia. This reflects the fact that current NAs do not inhibit HBV polymerase at maximal efficacy (virtually 100%). Whether this is improved, while keeping or increasing the safety profile, could lead to stronger and faster decline of all viral parameters, including cccDNA (dotted lines). Current standards to monitor viremia could also be improved upon in terms of sensitivity and frequency of monitoring to better reflect the improved/sustained efficacy of novel NAs. cccDNA, covalently closed circular DNA; CHB, chronic hepatitis B; LOD, level of detection; NA, nucleos(t)ide analogues. In other words, one should aim at an optimal hepatic extraction ratio for a NA with anti-HBV activity, with virtually no effect on HIV because of a lack of bio-distribution/activation in cells replicating HIV.

Even if the potency of E-CFCP is confirmed in patients with CHB, including those infected with ETV-resistant strains, which represent a real clinical burden, it is crucial to determine whether this potentially improved efficacy on viremia would translate into a faster decline of cccDNA. Because, after all, this is one of the most important features required to improve the current functional cure rate of NAs. So far, long-term data indicate that NAs induce a (very) slow cccDNA decline in patients with CHB. [START_REF] Lai | Reduction of covalently closed circular DNA with long-term nucleos(t)ide analogue treatment in chronic hepatitis B[END_REF][START_REF] Werle-Lapostolle | Persistence of cccDNA during the natural history of chronic hepatitis B and decline during adefovir dipivoxil therapy[END_REF] Yet, a near 100% inhibition of encapsidated rcDNA production and the prevention of recycling to the nucleus to replenish the cccDNA pool should lead to a faster decline of cccDNA in infected cells, irrespective of immune action and/or cell division (e.g. micro-regeneration). Unfortunately, there is no preclinical model available to evaluate this before entering clinical trials, meaning that such data will not be available soon for E-CFCP. When it comes to the rate of HBsAg loss, which is the newly defined clinical endpoint, [START_REF] Cornberg | guidance for design and endpoints of clinical trials in chronic hepatitis B -Report from the 2019 EASL-AASLD HBV Treatment Endpoints Conference( ‡)[END_REF] the best documented approach is to combine NAs with Peg-IFN-alpha, [START_REF] Janssen | Pegylated interferon alfa-2b alone or in combination with lamivudine for HBeAg-positive chronic hepatitis B: a randomised trial[END_REF][START_REF] Lau | Peginterferon Alfa-2a, lamivudine, and the combination for HBeAgpositive chronic hepatitis B[END_REF][START_REF] Marcellin | Combination of tenofovir disoproxil fumarate and peginterferon a-2a increases loss of hepatitis B surface antigen in patients with chronic hepatitis B[END_REF][START_REF] Marcellin | Peginterferon alfa-2a alone, lamivudine alone, and the two in combination in patients with HBeAg-negative chronic hepatitis B[END_REF] as NAs alone have little effect on HBsAg decline [START_REF] Yeo | Factors associated with rates of HBsAg seroclearance in adults with chronic HBV infection: a systematic review and meta-analysis[END_REF] ; this would have to be considered for the potential clinical R&D of E-CFCP. Finally, there are still debates around the capacity of some NAs to be more active than others to prevent disease progression and hepatocellular carcinoma occurrence. [START_REF] Hsu | Inhibitory effect of nucleos(t)ide analogs on telomerase activity and risk of hepatocellular carcinoma in patients with chronic hepatitis B[END_REF][START_REF] Hsu | Tenofovir versus entecavir for hepatocellular carcinoma prevention in an international consortium of chronic hepatitis B[END_REF][START_REF] Papatheodoridis | Similar risk of hepatocellular carcinoma during long-term entecavir or tenofovir therapy in Caucasian patients with chronic hepatitis B[END_REF] It is too early to say whether E-CFCP will be more efficient at reducing these residual risks in patients with CHB on long-term treatment.

The authors argue that this long-acting compound could be clinically useful to reduce the risk of resistance and to improve compliance to treatment. However, the 10-year risk of drug resistance in naïve patients treated with current NAs, such as ETV or TDF/TAF, is negligible and the efficacy of TDF or TAF, as rescue therapies for NA-resistant patients, is excellent. [START_REF]EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection[END_REF] In general, compliance to long-term NA administration is already very good in most clinical centres and the management of NA therapy, e.g. visits and monitoring, is not very demanding with check-ups being performed every 6 months in most patients. Whether a long-acting anti-HBV drug would help the scale-up of anti-HBV treatment in "low to middle" income countries, remains an open issue, although one of the top priorities in these countries is the identification and diagnosis of these patients in order to start a cost-effective treatment.

To conclude, one can envision the identification, R&D and clinical development of novel NAs to better fight HBV infection. Indeed, NAs are "good value" and usually the best backbone for combination treatment. In particular, a NA with an "ideal" toxicity profile (i.e. no side effect whatsoever in a dream scenario) and an improved impact on cccDNA decay could open the door to more universal treatment schedules with NAs, as many identified and diagnosed patients with CHB do not receive any treatment.

Financial support

I Q 1 s 7 Q 6 David

 176 there any need for new, long-acting nucleos(t)ide analogues for the treatment of hepatitis B infection? Q Durantel 1, *, Cyril B. Dousson 2,3 , Pietro Lampertico 4, * 1 INSERM, U1111, International Center for Infectiology Research (CIRI), CNRS UMR_5308, University of Lyon (UCBL1), Lyon, France; 2 Ai-biopharma, Medicinal Chemistry Department, Montpellier, France; 3 Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy; 4 Department of Pathophysiology and Transplantation, CRC "A. M. and A. Migliavacca" Center for Liver Disease, University of Milan, Milan, Italy

  describe a novel nucleoside analogue with very potent and long-lasting anti-HBV activity. This NA, called E-CFCP (chemical name: (1S,3S,5S,E)-3-(2-amino-6-oxo-1,6-dihydro-9Hpurin-9-yl)-2-(fluoromethylene)-5-hydroxy-1-(hydro-xymethyl)

  Plain lines: effect with current NAs on various parameters Dotted lines: improved effect with more potent and long-lasting NAs print & web 4C=FPO

  DD was funded by annual endowment/core grants from INSERM (Institut National de la Santé et de la Rehcerche Médicale) and by ANRS (Agence Nationale de Recherche sur le Sida et les hépatites virale) grants (several from CSS12 and ANR 16-IFEC-0005-01).

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	46 Journal of Hepatology 2021 vol. -j 1-4

Acknowledgments

DD is Director of Research at INSERM and is mainly supported in his activity by INSERM, ANRS, and other public funding bodies. PL is Professor of Gastroenterology at University of Milan and runs clinical investigations with both public and private support.

Conflict of interest

DD has received research grants from: Janssen, Gilead Sciences, Roche,

Q 3

Sanofi; CBD is an employee of Ai-biopharma, a SME with interest in HBV drug discovery; PL served as member of the Advisory Board or Speaker Bureau for: BMS, Roche, Gilead Sciences, GSK, Abbvie, MSD, Arrowhead, Alnylam, Janssen, Spring Bank, MYR Pharmaceuticals, Eiger.

Please refer to the accompanying ICMJE disclosure forms for further details.

Authors' contributions

All authors contributed equally.

Supplementary data

Supplementary data to this article can be found online at https:// doi.org/10.1016/j.jhep.2021.01.038.


Apprendre par les tiers-lieux Tiers-lieux et configurations apprenantes

Le lab des tiers lieux, 28 avril 2022

Luc Gwiazdzinski, Benjamin Gentils et Benjamin Chow-Petit

Si les tiers-lieux permettent l'appréhension de sujets complexes et l'engagement dans des transformations sociétales et politiques parfois radicales, c'est notamment parce que des configurations apprenantes peuvent y prendre forme.

L'avenir est la seule chose qui m'intéresse, car je compte bien y passer les prochaines années.

Woody Allen

La réflexion sur l'apprentissage par les tiers-lieux s'inscrit dans un contexte de montée des incertitudes, d'augmentation de la complexité et de transformation des modes de vie. L'article explore de manière indisciplinaire la notion de tiers-lieux en s'interrogeant sur les configurations apprenantes qui peuvent y prendre forme. Cet art des tiers-lieux est conçu comme un objet de médiation, une forme de diplomatie par l'apprentissage collectif et individuel, un moyen de redonner du pouvoir d'agir aux citoyens en se rapprochant de l'agir par les communs 1 .

De l'importance d'être dans une situation apprenante

La réflexion proposée s'inscrit dans un contexte d'incertitude

  La liberté, l'auto-détermination et l'émancipation n'ont de sens que si nous nous dotons de la capacité de comprendre notre environnement, si nous réussissons à acquérir les savoir-être et les savoir-faire qui nous permettent de choisir nos vies. Avoir accès à des configurations apprenantes est donc consubstantiel des droits fondamentaux. La liberté de faire ce que nous voulons sans les pratiques, les savoir-faire et savoir-être ne suffit pas. Ce droit d'apprentissage est un droit humain qui détermine non seulement notre capacité individuelle, mais aussi notre capacité collective de comprendre et d'agir sur le monde. Hier dans l'éducation populaire Autre exemple d'actualité avec le conflit armé en Ukraine qui s'est invité à l'école. Il a suscité questions et inquiétudes de la part des élèves. Pour tenter d'y répondre, les enseignants se sont organisés en configuration apprenante, faisant preuve d'une créativité inouïe et esquissant une histoire pédagogique du retour de la guerre en Europe. Du primaire à l'université, ils créent, s'approprient et partagent des ressources : articles, cartes, revues, vidéos, coupures de presse en lien avec l'histoire-géographie, l'éducation aux médias et à l'information, l'anglais, etc. En parallèle, en Savoie, à Paris, à Saint-Aunès près de Montpellier, en Alsace… Des élèves qui ont fui la guerre sont accueillis dans les classes.Les articles de blog avec des ressources pédagogiques et les rencontres dans les écoles se multiplient pour apprendre ensemble à accueillir des élèves ayant connu la guerre. De la même façon que la richesse de l'apprentissage est parfois réduite à un diplôme, le génie du (faire) tiers-lieu ne peut être réduit à des réponses à appels à projet et à une politique de gestion administrative, caractéristique des politiques publiques de soutien à l'innovation 9 . La richesse des configurations apprenantes et des tiers-lieux ne tient pas dans une technique. Il s'agit d'un être en situation, dans le faire, le partage et la transmission voire d'un collectif en résistance. La philosophie du tiers-lieu est celle d'un savoir ouvert, à disposition. Il n'est pas un territoire clos, mais un "lieu infini" 10 où l'on grandit et s'enrichit en permanence, sans limites. On peut parler d'organisations apprenantes dans le sens où elles permettent d'apprendre en permanence des actions de leurs membres et de celles des autres, dans une logique de réciprocité. Cette approche peut s'ouvrir à l'ensemble de la société autour de l'idée d'une connaissance vivante, qui circule et s'enrichit au contact de la réalité. Par ailleurs, l'apprentissage ne concerne pas que l'éducation des enfants, la formation professionnelle, mais intègre tous les temps de la vie. Confrontée à la complexité, toute la société a besoin de configurations apprenantes, de lieux et de moments d'hybridation et de croisement. La posture apprenante qui a fait ses preuves dans les urgences dramatiques (guerres, marées noires, solidarité lors du premier confinement en mars 2020, etc.) doit pouvoir se déployer dans nos quotidiens au service de tous.Dès 2013, le manifeste des Tiers-Lieux, oeuvre collective à l'initiative de Yoann Duriaux et Antoine Burret, est publié avec pour intention originelle d'améliorer la compréhension de ce qui se fait (ou révèle) dans les tiers-lieux. On y pose les bases d'un dispositif favorisant les apprentissages et reposant sur des rencontres, de l'inattendu, de la surprise et de la sérendipité12 . Dans les tiers-lieux pratiqués et explorés depuis, on retrouve quelques principes importants parmi lesquels : une acculturation collective par les échanges et par le faire ; une absence de hiérarchie qui n'exclut pas des dynamiques d'entraînement ; un respect mutuel ; du croisement entre des personnes venues d'horizons différents ; un confort sans jugement ; une responsabilisation de chacun et chacune ; une confiance en soi et dans la capacité à apprendre de ses erreurs ; la confiance dans les autres ; la mise à l'épreuve du faire des savoirs acquis ; la documentation sous licence ouverte des connaissances produites, la possibilité de bifurquer ("Fork"). Les possibilités d'apprentissage par les tiers-lieux et les liens avec l'éducation formelle, l'éducation non formelle et les apprentissages informels ont été particulièrement bien décrits par Jean-Baptiste Labrune 13 dans sa contribution au rapport « Faire Ensemble pour Mieux Vivre Ensemble » du CGET, devenue ANCT. Interrogés sur leur engagement, les participants à ces aventures collectives y trouvent généralement : l'acquisition de savoirs et de connaissances, un droit à l'erreur et à l'expérimentation, un réseau personnel et professionnel de soutien, une socialisation, des flux d'information qualifiés, des échanges et interactions, une réduction de la distance sociale. Beaucoup parlent de plaisir, de convivialité et même de joie, dans une curiosité toujours renouvelée. Le tiers-lieu apparaît à la fois comme une communauté apprenante et d'entraide. Quand les chemins de vie changent, quand les acteurs finissent par lâcher, il reste une expérience marquante qui permet de prendre et reprendre une place entre le je et le nous 14 . Ces approches se déclinent à l'envie, des ronds-points des gilets jaunes aux fablabs mobilisés pendant la crise de la Covid-19 en passant par des dispositifs de formation apprenants.Tiers-lieux et configurations apprenantes ne sont pas des recettes miracles, des potions magiques territoriales, à peine des clés d'entrée, des invitations à l'aventure. Apprentissage silencieux et culturel, le tiers-lieu apprenant est « désir d'agir avec les autres pour ouvrir le champ du possible et interrompre la répétition immuable du temps et de la servitude » 15 et possibilité de mondes. La réflexion autour des tiers-lieux et des configurations apprenantes est un appel à la rencontre, à la confiance et au faire ensemble, un appel à agir à partir des liens et des lieux. C'est une interpellation et une mise en lien avec les institutions existantes -éducation nationale, associations d'enseignants, acteurs de l'éducation populaire -avec lesquelles coconstruire, et un appel à celles et ceux qui sont hors cadre et qui peuvent trouver là matière à engagement et accomplissement.A différentes échelles et dans différents territoires, on a pu mesurer l'impact positif de ces approches comme l'inventivité nouvelle des professeurs, la fabrication de savoirs, savoir-être et savoir-faire pour répondre à des situations complexes et inédites. Dans les tiers-lieux on peut apprendre de manière informelle et traiter de tous les sujets. Cependant, malgré la joie et la confiance, ils sont aussi des réceptacles des douleurs de la société, des lieux d'exacerbation de ces tensions. Cela impose de prendre soin des personnes qui sont là et d'éviter de participer au discours managérial sur l'adaptation et la flexibilité. Attention également à ne pas vouloir l'imposer. Tiers-lieu ? Configuration apprenante ? Si je le veux… Commun, Essai sur la révolution au XXIe siècle, Dardot P., Laval C., Paris, La Découverte (2015) 2 La montée des incertitudes.Travail, protections, statut de l'individu, Castel R., Paris, Seuil (2009) 3 Agir dans un monde incertain, essai sur la démocratie technique, Callon M., Lascoumes P.,Barthes Y., Paris, Le Seuil (2001) 4 Surveiller et punir. Naissance de la prison, Foucault M.,Paris, Gallimard (1975) 5 Territoires apprenants. Un processus d'apprentissage émergent à l'épreuve du réel, Cholat F., Gwiazdzinski L., Grenoble, Elya (2021) 6 Manifeste peuple et culture, 1945

	idéologique qui réduit la capacité d'action et nous extrait de la réalité. Nous recherchons une
	meilleure connexion entre les imaginaires que l'on découvre et que l'on confronte, et le fait de
	les vivre concrètement. Nous croyons à l'importance des lieux d'interactions et de
	synchronisation des actions et souhaitons exister au sens du philosophe Henri Maldiney : "être L'hypothèse de la fabrique de dispositifs apprenants
	au devant de soi dans la rencontre". Pour nous, l'apprentissage est une manière de comprendre
	et d'agir sur le monde individuellement et collectivement. S'organiser en tiers-lieux est l'une des pistes permettant de déployer une configuration
	apprenante. La notion, attribuée à Ray Oldenburg 7 a pris une dimension particulière en France.
	Pour un accès à des configurations apprenantes Antoine Burret 8 l'envisage comme une "configuration sociale particulière où se produit une
	rencontre entre des entités individuées qui s'engagent intentionnellement à la conception d'une
	représentation commune", c'est-à-dire à responsabilité partagée. Du soin plutôt que des potions magiques
	Notes :
	1
	Lieux d'interactions et de synchronisation des actions
	Citoyens, chercheurs, acteurs engagés voire activistes, nous ne sommes pas là par hasard. Nous
	croyons que le futur se construit et nous souhaitons y prendre part par l'observation, l'analyse
	mais aussi par la pratique, le faire, in vivo et in situ. Nous nous inscrivons dans une approche
	de la "transmodernité" où il ne s'agit pas de dire ce que sera le futur, mais de mettre en place
	les moyens et les dispositifs collectifs pour le faire advenir. Les tiers-lieux font partie de ces
	dispositifs au sein desquels des choses peuvent émerger. Nous souhaitons dépasser l'anxiété de
	nos sociétés pour garder de la nuance et croiser des convictions, évitant ainsi l'enfermement

2 3 dans un monde complexe qui rend nécessaire les croisements des personnes, des cultures et des savoirs. Au-delà de la sidération face à des situations qui nous dépassent (conséquences du réchauffement climatiques, pandémies, conflits armés, etc.), il est possible d'imaginer des configurations apprenantes par la rencontre, l'être et le faire ensemble, à travers des "dispositifs" -au sens d'« un ensemble hétérogène constitué de discours, d'institutions, d'aménagements architecturaux, de règles et de lois, etc. » 4 -adaptés. En ce sens, la notion encore non stabilisée d'organisation apprenante -où l'on favorise l'apprentissage in situ et in vivo, hors les murs des institutions, en associant d'autres acteurs de l'environnement. Processus situationnel dans lequel le partage de la connaissance par le faire devient une fonction fondamentale pour déployer un imaginaire, créer des visions et des politiques participatives pour le développement croisé des individus, des organisations et des territoires et le bien-être de tous" 5 -constitue une piste intéressante d'engagement et de fabrique des possibles, dépassant les temporalités de l'urgence. 6 comme aujourd'hui à l'école les configurations apprenantes, nous avons là des possibilités pédagogiques permettant aux citoyens de se doter de capacités d'agir sur leurs mondes.

L'école hors-les-murs et l'école qui accueille, deux exemples pour une école qui fait tierslieu

Après plusieurs confinements et périodes d'enseignement à distance, par le numérique, dans un contexte de sédentarisation croissante des enfants, de déconnexion d'avec la nature, un mouvement de pratique régulière de la classe dehors s'est accru au sein de l'école publique. Cette pratique n'est ni nouvelle, ni spécifiquement française. Néanmoins, pour que les enseignants acquièrent la liberté de pouvoir enseigner à l'extérieur, il est impératif de mettre en place des configurations apprenantes locales qui mobilisent les académies, les collectivités, les associations d'éducation populaire et d'éducation à l'environnement. Comment un enseignant peut-il s'octroyer la liberté d'aller dehors, sans travail préalable de séquençage pédagogique ? Comment mener à bien ce travail exigeant, en plus de la charge quotidienne, sans soutien de ceux qui détiennent une part d'expérience utile comme les éducateurs à l'environnement ? Comment accéder à un parc en milieu urbain dont les pelouses sont "en repos" l'hiver sans concertation préalable avec les services des espaces verts des mairies ? Comment dépasser les préjugés qui subsistent parfois au sein de la hiérarchie académique, sur cette pratique dont les valeurs pédagogiques sont pourtant reconnues par la recherche comme par le ministère de l'éducation nationale ? C'est la question de l'hospitalité à l'école qui se joue. Là encore, des savoirs s'échangent et des solidarités se créent avec les parents, le personnel et les élèves. Des webinaires s'organisent pour permettre à des enseignants ayant déjà accueilli des élèves allophones, parfois victimes de traumatismes, de partager leur expérience.

L'apport des tiers-lieux à l'apprentissage (cultures, pratiques, outils) à l'épreuve du faire

Dans les tiers-lieux, nous pouvons trouver refuge, bricoler et improviser 11 . Au-delà de ce que nous apprenons concrètement, nous nous enrichissons aussi des autres, de leur histoire, de leurs mots, de leurs pratiques et de leur vision du monde. Dans cet apprentissage silencieux des cultures de chacun, nous finissons par comprendre les autres, y compris ceux avec qui nous serions à priori incompatibles, opposés. Nous pouvons parler d'éducation populaire.

7

The Great Good Place,

Oldenburg, R., Paragon House (1989)

Tiers lieux : et plus si affinités, Burret A., Limoges, FYP (2015)

Reforms in the French Industrial Ecosystem, Berger S., Ministère de l'Enseignement Supérieur, de la Recherche etde l'innovation (2016)


Luc Gwiazdzinski

Recomposing the Nights of the Pendemic and Night-Time Avenues of Under-Tourism in French Cities From Overtourism to Undertourism Sustainable scenarios in post-pandemic times

Introduction

The night is a dimension that has long been forgotten by the city, economics, tourism and even by academic research, yet it has gradually become part of current events [START_REF] Gwiazdzinski | The Urban Night: A Space Time for Innovation and Sustainable Development[END_REF]. Colonized by light and daytime activities, urban nightlife has recently become a coveted market, a field of innovation for public policy, a special lifestyle, a tourist sector in its own right, and an indicator of the vitality of cities and communities [START_REF] Gwiazdzinski | The Urban Night: A Space Time for Innovation and Sustainable Development[END_REF]. In France, the COVID-19 public health emergency and the lock-down measures and curfews enforced by the authorities have had a particularly marked impact on night-time economic and cultural actors, who have been obliged to halt their activities, as well as on a nightlife sector that reportedly generates 100,000 jobs and a turn-over of €2 billion1 . Movement between areas and between countries has been severely restricted, which has ended up destroying night activities and night tourism, thereby silencing our cities. Based on work conducted during this past, unusual year 2 , I examine some of the strategies and tactics deployed by nightlife actors to adapt to the conditions and restrictions imposed by public health authorities, and point out some apparent paradoxes. In Chinese, the word "crisis" is composed of two characters. While the first means "danger", the second points to an opportunity. After identifying the problems and risks for the tourist sector, the city, and society, which are inherent in the current situation, I situate my reflection on the night and tourism within a dimension of "ad-venture", in [START_REF] Jankelevitch | L'aventure, l'ennui, le sérieux (Adventure, bore-dom, seriousness)[END_REF] sense of "what we live and hope for": "the emergence of the future". Following on tourism's previous excessive exploitation of the night, the time is ripe to explore underground, nocturnal avenues of sub-tourism.

A progressive structuring

Prior to the public health emergency, the nightlife industry had been gradually self-organizing, and had made significant progress in terms of structuring and governance. Beyond the regulation of conflicts between the city that works, the city that has fun, and the city that sleeps, the economic and cultural actors had come togeth-er to make their presence felt in the debate by highlighting their economic weight and the number of jobs they provide. Colonized by daytime activities, the night is now a central time-space, a societal issue that has earned a place in scientific journals, popular newspapers, and the regional press.

The night is an economic sector in its own right, which is developing and striving to selfstructure. Nightlife has become a criterion of attractiveness and a key resource [START_REF] Guibert | Festival Hellfest de Clisson. Les retombées économiques de la musique metal plus fortes que sa stigmatization[END_REF] for local communities. In only a few years, it has also become part of the public policy agenda, with a dual logic of control and development, and frequently with an emphasis on improving the quality of life of both residents and visitors. In the face of pressures and tensions, authorities are trying both to maintain control over the night (regulating raves, imposing curfews, enacting municipal by-laws limiting traffic, etc.) and to make urban nights more accessible and hospitable via a variety of initiatives (lighting, free events, transport, shelters, etc.). At the same time, in many cities (Paris, Sydney, Berlin, etc.), studies and diagnoses have proliferated in an attempt to "shed light" on the night. "Assemblies" have been held, and "night councils" set up in Paris, Nantes, and Geneva. In some fifty cities around the world, "night mayors" have been appointed to deal with this cross-cutting issue. As a sign of the times, an interdisciplinary field of research is gradually taking shape around Night Studies [START_REF] Gwiazdzinski | Geographies of the night. From geographical object to Night 8 Studies[END_REF], drawing together historians, geographers, urban planners, sociologists, economists, anthropologists, ethnologists, philosophers, biologists, culture and communication specialists, political scientists, and architects. All over the Recomposing the nights of the pandemic 101 world, symposiums, seminars, studies, theses and exhibitions are multiplying around the Nighttime Economy, with operational relays and numerous international forums3 . Night tourism meanwhile has gradually established itself with in the domain of public policy. Over the last ten years, we have witnessed the advance of "urban night tourism" [START_REF] Gwiazdzinski | Pour une mise en tourisme des nuits urbaines (turning nightlife as a relevant tourism activity)[END_REF] and the "touristification of nightlife" [START_REF] Giordano | La touristification de la vie nocturne: une nouvelle frontière pour la 11 recherche sur la nuit urbaine[END_REF]. Night tourism has become a driving force and a metropolitan laboratory (Gwiazdzinski, 2013). As a sign of this evolution, in France, the importance of nightlife in urban tourism has recently been recognized at the ministerial level. A "centre of excellence" has been set up to unite nightlife players and tourism professionals in a drive to develop offerings and promote them effectively to a foreign tourist clientele, with a precise roadmap and "22 measures to turn nightlife into an international tourist asset"4 . This recognition stands in contrast with the fate reserved for the urban night in recent months. Indeed, by closing businesses, limiting the right to move around, and imposing the obligation to keep others at a distance, COVID-19 measures endanger the economy, the culture, and our ways of life. This scenario of constraint is paradoxical and counterintuitive in cities as densely populated areas, which are places for gathering and "maximizing [the very] interactions" [START_REF] Claval | La logique des villes. Essai d'urbanologie[END_REF] that are currently being restricted. It is all the more paradoxical for night-time and party organizing actors, whose job is to "arrange opportunities for meeting" -but are prevented from doing so -, and for the night itself, as a time when distances and barriers generally lapse. This threefold challenge puts cities, nights, and their actors and inhabitants under pressure. The future of tourism and of our cities depends in part on the solutions that they will be able to develop in conjunction with all the stakeholders.

A particularly hard-hit space-time

Just take a walk in any city after 6 p.m. to get the measure of the situation.

The night, or rather night actors, have been the hardest hit by the lockdown and have been forgotten during it. In France, professionals in this industry have angrily pointed out that the government "made many commitments in favour of different economic segments, without even acknowledging the nightlife sector"5 . Yet the crisis has weakened these economic and cultural actors and is threatening the night dynamic, at the expense of tourism but also of urbanity, or our capacity to live together in cities. On examining the chronology of this disaster, we find that prior to the public health emergency, tensions were already coming to bear on urban nightlife and concerns were being expressed about overly strict supervision [START_REF] Straw | Nightlife is the soul of cities -and 'night mayors' are its keepers in this coronavirus 16 pandemic[END_REF] or, on the contrary, about excessive noise and light pollution. Now, the pandemic has dealt a severe blow to this nightlife dynamic and night tourism. The crisis has particularly impacted the night-time economy and its various public and private actors. In France, the first shutdowns an-nounced affected the drinking establishments sector (bars, cafés, clubs, etc.), that is to say, some 45,000 establishments; plus, the 170,000 restaurants and 1,800 festivals that play a major role in both local everyday dynamics and tourism/nightlife. Cinemas and theatres were closed, shows and festivals cancelled, and the entire breadth of the musical and cultural scene was impacted. The same thing has been happening in most countries. Inter-nationally and nationally, traffic restrictions have prohibited the influx of tourists. Locally, as always, the first freedoms to be tak-en away in the event of a crisis have been those related to moving around at night. In France, as of March 25 2020, in addition to national lockdown measures, 112 cities -home to over 2 million French people -were subjected to a night-time curfew6 . In the Alpes-Maritimes region, the préfecture issued an order imposing a curfew from 10 pm to 5 am in all coastal towns and other cities of over 10,000 inhabitants. This was intended to stop "unessential" outings and thereby the spread of COVID-19, thus subjecting the night to the "dicta" of the day and attributing a singular character to the former. Furthermore, some of the potential nightlife actors

Recomposing the nights of the pandemic 103 were absent, especially students, who often went back to live in their home towns. After the summer lifting of the lockdown, the 14 December 2020 decree enforced a curfew between 8 p.m. and 6 a.m. As of 8 p.m. on Tuesday, December 15, daytime and inter-re-gional travel was allowed, but travel was prohibited from 8 pm to 6 am, except for valid work, family, and health reasons, missions of general interest, or walking a pet, all upon presentation of a travel certificate. The rationale invoked was saving time in an attempt to avoid overwhelming the healthcare system while averting a full lockdown. Better yet, in early January 2021, a 6pm curfew was in-troduced. As I write these lines in mid-March, the curfew is still in place. Why such relentless attacks on the night? Why are authorities invariably afraid of the night, of parties, and of young people? Why are they unwilling to trust responsible and experienced professionals, thus prompting the organization of clandestine parties, with their attendant excesses and stigma-tization? Why drive the population to rush about in stores and on public transport networks between 5pm and 6 pm despite the risks pointed up by various studies? As early as January 2021, re-searchers from the Toulouse University Hospital virology labora-tory demonstrated that in the Toulouse urban area, the curfew had led to "an increase in the number of people testing positive". The regulatory approach also seems to have taken precedence over ac-knowledgement of local dynamics. Measures introduced abruptly from the top down are often based on a lack of knowledge about nightlife, night partying and its actors, and the night's increasing prominence in terms of economic value, employment, attractive-ness, creativity, culture, and as a key component of our lifestyles and well-being. For many expert figures, such ignorance often goes hand in hand with a lack of recognition, or even contempt, for particular artistic forms and venues such as the electro, rap or metal scenes. Such a negative approach to the night, which is invariably treated in terms of problems, difficulties, and fear, is highly questionable. For a long time, the night was poorly studied and little understood, to the point that we might even coin the phrase a "night of data" -so lacking was the information. And the night time is still often stigmatized. it partly deprives them of their vision, hu-mans fear the night. This particular moment in time is dreaded, while daylight is perceived positively: something is said to "shed light on" or "highlight" a given matter. Until recently, city officials, technicians, urban planners, and researchers saw the city as a daily 16-hour period, glossing over the eight hours of the night or simply trying to keep them under control. During the first lockdown, the archipelago configuration of the night was extended to the day. The emergency response to the virus staked out a new urban geography (Gwiazdzinski, Straw, Maggioli, 2019), that of the "lockdown archipelago" [START_REF] Gwiazdzinski | Petite lecture rythmique de l'archipel du confine-ment[END_REF]. As new islanders, under house arrest, entire populations strove to 19 organize themselves from home, while seeking exchanges with the outside world by means of digital information technologies. Delivery staff, who remained exposed to the disease, ensured ur-ban coastal movement, as it were, between these islands. For many urbanites, the street became a space seen from afar, from a window or a balcony. Not just discotheques and nightclubs, but the entire nocturnal world has been left floundering, and with it, a part of our social life. The night is a special time for partying and a key moment for social interaction in our cities, neighbourhoods, and villages. When the curfew kicks off, when partying becomes impossible, when venues close, when events are cancelled, when those whose occupation re-volves around the promotion of conviviality, pleasure, and encounters are forbidden to do their job, then, a key economic and employment sector, but also a culture, an art of living, the whole universe of the night, and our mental health come directly under threat. It is vital to meet, share, and marvel together. What will happen if 30% of night establishments close down? And what will our cities turn into then, with their empty, wasteland nights? According to the Chambre syndicale des lieux musicaux, festifs et nocturnes (employers' federation for musical, festival, and nightlife venues), over 300 companies accounting for 30% of the industry have al-ready filed for bankruptcy. Before the public health emergency, pop and electronic music yielded some €930 million in annual revenue, eighty percent of which was generated by the clubs, discotheques, and festivals airing these musical genres.

Adaptations and paradoxes

The emergency constraints have not prevented the actors of the night from trying to adapt, innovate, and develop a forward-looking analysis. Some users, on the other hand, have been prompted to take "side roads", to deceive and hide, thus restoring a transgressive flavour to nights that had sometimes been somewhat too well-behaved. In the outdoors, "essential" workers have continued their risky night activities during the lockdowns, while the homeless have been left to fend for themselves. Restaurants and Michelinstarred chefs have offered take-outs and delivered their dishes to custom-ers locked in their homes. Specialty companies have also delivered home decoration supplies. Chat and video conferencing apps have become all the rage as a way to organize parties. Free apps have been used for entertainment purposes: to play games remotely, or to arrange quizzes and music "blind tests". Some have opted to throw a Netflix or Disney+ party. For the time being, partying has moved inside our homes or takes place on balconies connected to the world. As for professionally organized nightlife, this gig has also migrated to social networks, where concerts have multiplied -such as "Saturday Night Lockdown" in Paris -along with parties and remote aperitifs or "digital aperitifs" as widely publicized in the media7 . Drive-in cinema has been brought back, with a national tour due to start at the Quinconces in Bordeaux on 16 May 2021. Many parties been held in parking lots. After much grumbling, party organizers and other night-life actors have multiplied their initiatives, attempting to "make do" between outdoor events in public spaces and online offerings. They have displayed responsibility, creativity, and innovation in imagining virtuous new arrangements between establishments of various sizes and kinds spanning the public and private sectors. From the very first lockdown, they have sought to cooperate with local authorities, displaying a future-oriented perspective by asking ques-tions about partying ethics and sustainability and proposing the implementation of nightlife ecosystems at the neighbourhood scale with the participation of residents8 . Meanwhile, residents have launched movements of their own such as "Droit au sommeil Paris" (Right to sleep Paris), which conducted a survey among "victims of nocturnal noise pollution in Paris", highlighting the problems caused by ephemeral [temporary, pop-up] night-time terraces, alleged to have "undermined efforts and progress" in relation to sound pollution.

In a push for the right to enjoy the night and to party, nightlife actors have rallied around conferences such as "Dancer Demain" (Dancing Tomorrow) organized by the Technopol collective in May 2020, symposia such as the "États généraux de la fête" (General Assembly of the Party Organization Sector) convened in December 2020 by the bars association, or networking on an international scale through the Global Nighttime Recovery Plan. These forums have allowed actors to exchange views, weigh up the situation, and even propose tools and actions for responding to the impacts of the COVID-19 emergency, including via the design of appropriate health protection measures. By bringing together actors from the cultural, nightlife, and risk prevention/mitigation sectors, along with political representatives, technical representatives of public authorities, and academics, this set of assemblies, workshops, debates, and encounters has helped all those involved to take stock of a world that has been weakened by the emergency but is resisting and reorganizing. The sector, therefore, is in the process of restructuring itself, innovating, exploring critical issues, seeking recognition, and proposing paths forward, in the context of a new and unprecedented dialogue between the local and the global, between actors in the field and public authorities. These initiatives have often been documented in official reports such as the white paper of the États généraux de la fête, along with proposals that go beyond a mere cataloguing of the sector's demands to bring into the open the "right to celebrate". Further-more, this cross-cutting set of reflections (spanning health, culture, economics, security, public peace, urbanism, sustainable develop-ment, the digital, solidarity, mobility...) and collective approaches have reminded decision-makers of the need for a "public policy of the night" for cities, districts, rural and periurban areas, as well as at the national level. Practical proposals have included the forma-tion of "night councils" throughout the country, but also the creation of an "inter-ministerial committee", or even a "national night council" that would draw together empirical, technical, scientific, and political approaches. Many actors have flagged the need to work with nightlife professionals rather than incurring the risks associated with clandestine gatherings. The COVID-19 emergency has brought to the fore the social dimensions of the night, people's need to meet, and the importance of all the public and private activities that enliven nocturnal life in the city. We have all become aware of the value of late night stores, bars, restaurant, cinemas, shows, festivals and all mundane night-Recomposing the nights of the pandemic 107 time activities: collective rituals, which we thought would last for-ever. There is now shared acknowledgment of both their worth and their fragility. Some have even wished that they could once again hear the noise pollution they used to resent. Despite the sector's inventiveness, remote parties, concerts, and events have displayed their limitations, pointing up the obvious: the importance of the body, the senses, physical experience, and meeting in person in generating togetherness and celebration. During the pandemic, nocturnal activity in the city has thus been confined to a small number of clandestine sites (secret bars whose addresses were circulated covertly), private homes where we could gather with our "loved ones", that is to say, with those who were locked down with us, and exchanges between one balcony and another. Transgressions such as illegal New Year's Day gatherings, including a highly publicized one in Lieuron, Ille-et-Vilaine attended by 2,500 people -and a growing number of others -sparked relentless media backlash and a flow of insults on social media networks attacking young people and celebrations. In March 2021, an "unauthorized carnival" organized in Marseille was attended by over 6,000 people. Photos of the crowd and of participants without masks were widely shared on the Internet. The media and authorities condemned this gathering and the participants' recklessness, while overlooking the fact that the earlier mass celebration in Brittany had not resulted in any "outbreaks". The prosecution of some of the participants led to suspended pris-on sentences, community service, and acquittals. Nevertheless, the collective awareness generated by these events can usefully inform the dynamics of tomorrow's cities.

Hypotheses for the future At the time of writing (March 2021), no precise date has yet been set for the reopening of nighttime amenities. Questions arise surrounding people's need to spend time together after the lockdowns. If nightclubs do not reopen, issues of concern will include: increased pressure on public spaces in the evening time, the great-er difficulty of complying with regulations at night, a possible shift to private venues, and an increase in wild, clandestine parties, all of which bear greater risk of conflict, alcohol abuse, or violence, in the absence of expert supervision and prevention strategies. More broadly, and depending on how the epidemic evolves, as well as on the relaxation of public health measures, it is plausible to hypothe-size that both daytime and night-time tourism may acquire a more "local" or "regional" focus going forward, with the development of specific offerings within a "season-themed" (Gwiazdzinski, 2013) framework. Indeed, tourism as classically defined -or "the activity of a per-son who travels for pleasure, visits a region, a country, a conti-nent other than his own, to quench their curiosity, their taste for adventure and discovery, their desire to enrich their experiences and cultures" -has currently disappeared. If the consumption of images from elsewhere, remote dialogues with distant interlocu-tors, virtual visits to museums, and attendance at online concerts and parties is to be called "tourism", then we may hypothesize the emergence of a new form ofspecifically nocturnal -tourism that no longer necessarily includes a geographical journey. This would represent the umpteenth adaptation to a changing environment of the concept of tourism [START_REF] Gwiazdzinski | Tourisme(s) et adaptation(s)[END_REF], the tourism sector, and its practices. Such a prospect was already on the horizon before the public health emergency, in the context of climate change and transition, but it has been further reinforced by the lockdown. Nevertheless, for nightlife and tourism, the future remains un-certain. The closure of nightclubs makes a rapid return to nightlife and tourism in its usual forms seem unlikely. In terms of the out-look for the movement of people between countries, there appears to be little hope of a speedy resumption of international flights, with obvious implications. Economic and cultural nightlife actors are deeply concerned, even though the government and local com-munities have rallied to support them. Many establishments do not have sufficient liquid assets to tide them over. Owners have not stopped collecting rents. Insurance clauses do not provide for reimbursement and the insurance sector is reluctant to make a great-er show of "solidarity". If the crisis continues, we can only expect bankruptcies, and city centres are thus at risk of being transformed into night-time wastelands. Young people have been under the radar for a long time, although they have been hit hard by the public health measures. They are now making themselves heard and participating in the debate on opening up and celebrating via numerous events such as the "State of Emergency for Youth" 9 .

Recomposing the nights of the pandemic 109

The night may in any case be revisited, in a few favoured directions emerging from current research 10 and reflections across a range of expert circles 11 . With regard to the de-lockdown process and the need for space, one of the keys will again be occupying public space and the outdoors. Constrained by physical distancing regulations, establishments will see their surface area divided by a factor of two, three, or even four, thus putting their viability at risk. If authorities were to be more flexible, we could, for example, imagine more extensive terraces and a broader appropriation of squares, parks, and pedestrian streets. Temporary arrangements may be viewed as contributing to a form of "chrono-urbanism" [START_REF] Gwiazdzinski | Pour se réinventer, les villes devraient prendre la clé des temps[END_REF], as is already the case for the cycle paths that have been deployed in many cities. And where "ephemeral" facilities are concerned, night actors possess valuable experience and knowhow. In terms of usage, we might hypothesize the return to a localized practice of the night, a sort of "short night circuit" within one's own neighbourhood, as we were invited to practice last summer when we went exploring France. In terms of urban planning, the need for space prompts us to imagine a de-saturation of urban nights, a deconcentration and a wider spreading out of night-time activity across the city and towards the suburbs, but also the organization of tailored events. With discotheques closed, the summer of 2020 -a lull in the epidemic -was marked in Paris by illegal parties in the Bois de Vincennes. Faced with this risk, the city council would prefer to ensure a "legal and organized offering, with satisfactory sanitary conditions" and believes that it will be possible to organize "50 events for 1,000 people" 12 . In any case, nightlife actors will have to re-invent and experiment, engaging all stakeholders in the process: estab-lishments, residents, and end-users. Discussions underway in cit-ies such as Paris and Nantes, for example, confirm the importance of open air settings and public spaces, which currently appear to be the lifeline of the city, of the night, and of "reinvented tourism". The government's announcements in mid-March 2021, on the theme of "slowing down without locking down", reflected the be-ginnings of a shift in this direction, despite maintaining the curfew at the slightly later time of 7 p.m.

The debates and consultations held during the pandemic with the mobilized nightlife actors show that they too wish to increase their ethical engagement and move towards enhanced social and environmental responsibility. The time has come for them to strengthen their relationship with their environment, contribute to the emergence of night-time ecosystems and clusters, and serve on "night councils" where these exist. The current challenges make it 11 Cycle of virtual roundtables: "Danser Demain", Teccnopol, 9 May 2020 possible to imagine a greater harmonizing of the night, a more sus-tainable coexistence, and the quest for a subtle balance and "night thinking": without lights, there can be no urban night, yet too much lighting kills the night. In view of the public health emergency and curfews prohibiting movement, many municipalities have decided to switch off public lighting. Researchers with in-depth knowledge of the night have much to say about the day. We may expect the next few months to be enriching. For those involved in the nightlife and tourism sectors, who are called to adapt to a new situation, this will prove a difficult period, but rewarding in terms of experience to be gained. Given the unprecedented situation, political leaders and their adminis-trations will need to leave room for experimentation. Our cities' futures and our own lifestyles also depend on the success or other-wise of the process, the leeway allowed by public authorities, and collective remedial efforts. Herein lies the ultimate paradox of the present forbidden and stolen nights: for both users and scholars of the night, the curfew has brought a sultry and transgressive edge to nights that had sometimes become a little too well-behaved or overly commercial. Tourism will manage to benefit from this. That is the only certainty we have. Following the excesses of "over-tour-ism", the "sub-tourism" approach may well require the under-ground and the night.

9

  23 March 2021, Youth Assembly. De l'urgence du lien social: Culture et lieux de convivialité. 10 10 Ongoing research-action workshops. Laboratoire Pacte et Plateforme nationale de la vie nocturne, 2020.

"La nuit doit revoir le jour" (Night must see the day again), Sneg & cie, 7 May

2 ANR Smartnights, enquêtes avec la plateforme nationale de la vie nocturne (ANR Smartnights, surveys with the national nightlife platform)'.

"Tbilisi International Night Time Economy Forum" in December 2018 in Tbilissi (Georgia) or "ANZ Night Time Economy Forum", with an evocative subtitle "Creating Vibrant Cities After Dark" in June 2019.

Pôles d'excellence touristique. 22 mesures pour faire de la vie nocturne un facteur touristique à l'international 13 (Poles of tourist excellence. 22 meas-ures to turn nightlife into an international tourist asset), 2015, Foreign and International development Ministry.

"La nuit doit revoir le jour", Sneg & cie, 7 May 2020.

France Inter radio station, 24 March 2020.

7 https://www.lepoint.fr/societe/coronavirus-comment-reussir-son-ape-ro-a-distance-23-03-2020-2368384_23.php.

8 8 Action research workshops "La nuit à l'épreuve du cononavirus", Labora-toire Pacte et Plateforme nationale de la vie nocturne, 2020.


Marc D'elbée

Mohamed Métogara

Kéba Traore

Anthony Badiane

Arlette Simo Vautier

Fotso

Kanku Odé

Nicolas Kabemba

Peter Rouveau

Mathieu Godfrey-Faussett

Marie-Claude Maheu-Giroux

Boily

Métogara Mohamed Traore

Kéba Badiane

Anthony Vautier

Arlette Simo Fotso

Odé Kanku Kabemba

Nicolas Rouveau

Peter Godfrey-Faussett

Mathieu Maheu-Giroux

Marie-Claude Boily

Graham Francis Medley

Joseph Larmarange

Fern Terris-Prestholt

Costs and scale-up costs of integrating HIV self-testing into civil society organisation-led

come

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METHODS

From June 2018 to September 2020, the deployment strategy identified three sequential intervention phases: 1) development phase (June 2018 -March 2019); 2) start-up phase (April 2019 -July 2019 (Senegal / Mali), -October 2019 (Côte d'Ivoire)); and 3) early implementation phase (until September 2020) (Figure 1). The costing teams followed the guidelines of the Global Health Cost Consortium to estimate the economic costs of HIVST kits provision.

We analysed IPO and CSO financial reports capturing all costs spent, ensuring high comparability of analyses between CSO and between countries (top-down costing). We conducted field observations to estimate the economic costs (donations of goods and services) as well as identifying and collecting allocation factors between delivery channels (bottom-up costing). We also conducted a time and motion study, observing dispensing agents for the allocation of field personnel costs. We then categorised costs as central, development/start-up, field and HIVST kit costs. Scale up modelling used an accounting cost function and identified fixed costs and variable costs assumed to vary linearly with the scale.

RESULTS

Monitoring and evaluation data analysis

Between 2018-2020, 51,028, 14,472, and 34,353 HIVST kits were distributed in Côte d'Ivoire, Senegal and Mali through a total of 161, 48, and 191 peers educators, respectively. The average number of HIVST kits distributed was 7,290 per CSO in Côte d'Ivoire, 3,618 in Senegal and 6,871 in Mali. Across countries, 64%-80% of HIVST kits were distributed to FSW, 20%-31% to MSM, and 5%-8% to PWUD.

Costs data analysis

Average

CONCLUSION

In all countries, CSO-led HIVST kit provision to KP showed relatively high costs during the study period related to the progressive integration of the programme to CSO activities and contextual challenges (COVID-19 pandemic, country safety concerns). In transition to scale-up and integration of the HIVST programme into CSO activities, this model shows large potential for substantial economies of scale. Further research will assess the overall cost-effectiveness of this model.

  Costs and scale-up costs of integrating HIV self-testing into civil society organisation-led programmes for key populations in Côte d'Ivoire, Senegal, and Mali INTRODUCTION The ATLAS project, coordinated by the international partner organisation Solthis (IPO), introduced HIV self-testing (HIVST) into civil society organisations (CSO) programmes offering community-based HIV testing services for key populations (KP), namely female sex workers (FSW), men who have sex with men (MSM), and people who use drugs (PWUD). In this study, we estimate the costs of implementing HIVST through twenty-three CSO-led models for KP in Côte d'Ivoire (N=7), Senegal (N=11), and Mali (N=5). We modelled costs for programme transition (2021) and early scale-up (2022-2023) to guide national scale-up, propose costed operational plans and inform about the sustainability of this distribution model.

Figure 1 .

 1 Figure 1. Description of the ATLAS project's three HIV self-testing (HIVST) deployment phases in Côte d'Ivoire, Senegal, and Mali over 2018-2020

  costs per HIVST kit distributed were $15 for FSW (Côte d'Ivoire: $13, Senegal: $17, Mali: $15), $23 for MSM (Côte d'Ivoire: $15, Senegal: $27, Mali: $27), and $80 for PWUD (Côte d'Ivoire: $16, Senegal: $143), driven by personnel costs (47%-78% of total costs), and HIVST kits costs (2%-20%).

Figure 2 .

 2 Figure 2. HIVST average costs and cost composition: observed (2018-2020), in transition (2021), and early scale-up (2022-2023) -Côte d'Ivoire, Senegal, Mali