MID-TERM EVALUATION OF THE YA FOHI PROJECT

Côte d’Ivoire remains one of the countries most affected by the HIV/AIDS epidemic in West Africa, with an estimated prevalence rate of 1.82% (Spectrum 2023). The epidemic is concentrated among highly vulnerable populations (HVPs), particularly people who use drugs (PWUD), among whom prevalence reaches 6.60%. In Abidjan, prevalence stands at 5.4%, compared to 3.8% in Bouaké and San Pedro. 

The prevalence of tuberculosis (TB) is 50 times higher among PWUD than in the general population—9.8% versus 0.2%. TB treatment, which is long and demanding, is often poorly adhered to, leading to a high rate of loss to follow-up within this group. Women who use drugs face multiple vulnerabilities and heightened stigma and discrimination. Although they represent only 10% of the estimated PWUD population in Côte d’Ivoire, they account for 26.5% of HIV-positive cases, illustrating their disproportionate exposure to risk and barriers to accessing care. 

Founded in October 2004, Espace Confiance (EC) was created through the initiative of staff from the Clinique de Confiance (CdeC) and individuals engaged in the fight against HIV, including people directly affected by or stigmatized due to the epidemic. Since January 2015, EC has collaborated with Médecins du Monde (MdM) within the framework of a harm reduction (HR) project aimed at improving healthcare access for PWUD in Abidjan, notably through the introduction of opioid substitution therapy (OST). 

The initial project, Ya Pas Drap, launched in 2015 by MdM in partnership with EC, contributed to a significant reduction in HIV prevalence among PWUD in Abidjan—from 9.8% in 2014 to 3.4% in 2020. In its third phase (2021–2023), the project YA FOHI aimed not only to consolidate the achievements in Abidjan but also to expand activities to new cities in Côte d’Ivoire: Bouaké and San Pedro. 

At mid-term, the YA FOHI project has already achieved notable progress, while facing several ongoing challenges. In this context, the mid-term evaluation represents a strategic stage in the project’s lifecycle. It responds to a requirement for accountability to the main donor, L’Initiative, while offering an opportunity to guide and optimize the second phase of implementation. This evaluation also provides an opportunity for knowledge capitalization, collective learning, advocacy, and partnership strengthening, in a context of increasingly limited financial resources.