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Fernández Piñeiro N, Ayerdi Aguirrebengoa O, Orviz García E, González Pérez C, Vera García M, Puerta López T, Rodríguez Martín C, Lejarraga Cañas C, Perez García J, Baza Caraciolo B, González Polo M, Alcudia Pérez F, Ruiz Fernández M, Jerez Zamora N, Morales Irala D, López Centeno B, Alioto D, Martínez Sesmero JM, Estrada Pérez V, Benítez Gimenez MT, Romero Guerrero JD. Pre-exposure prophylaxis program in the Community of Madrid: Two years of experience. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00147-3. [PMID: 38897909 DOI: 10.1016/j.eimce.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) against the human immunodeficiency virus (HIV) is an effective and safe preventive measure. However, it has not reached all target users who could benefit from it. The study aimed to understand the sociodemographic, clinical and behavioral baseline characteristics of PrEP users. As a secondary objective, the use of concomitant medication and drug consumption were described. METHODOLOGY Observational, retrospective and descriptive study of the sociodemographic, clinical and behavioral characteristics of the users who were included in the PrEP program of the Community of Madrid during the first two years of experience. RESULTS Two thousand two hundred fifty-six PrEP users were included, 99.0% men, with a mean age of 36.9 years (SD 8.68). 33.1% presented a sexually transmitted infection (STI) on the first visit, highlighting chlamydiasis and rectal gonococci. 70.4% reported using drugs associated with sex, and 42.4% participated in chemsex sessions in the last 3 months. A high percentage of users with concomitant medication was observed (37.6%), highlighting drugs related to mental health and alopecia. CONCLUSIONS A multidisciplinary approach is required to cover all the needs of PrEP users, including mental health evaluation measures and addiction treatment with the clinical approach.
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Affiliation(s)
- Nuria Fernández Piñeiro
- Servicio de Farmacia, Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
| | | | - Eva Orviz García
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Cristina González Pérez
- Servicio de Farmacia, Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Mar Vera García
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Teresa Puerta López
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Jorge Perez García
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Diego Morales Irala
- Subdirección General de Farmacia y Productos Sanitarios, Consejería de Sanidad, Servicio Madrileño de Salud, Madrid, Spain
| | - Beatriz López Centeno
- Subdirección General de Farmacia y Productos Sanitarios, Consejería de Sanidad, Servicio Madrileño de Salud, Madrid, Spain
| | - Daniele Alioto
- Subdirección General de Farmacia y Productos Sanitarios, Consejería de Sanidad, Servicio Madrileño de Salud, Madrid, Spain
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Le Roux C, Tassi MF, Faussat C, Aumond C, Gras G, Stefic K, Grammatico-Guillon L. Factors Associated with PrEP Persistence and Loss of Follow-Up: A 5-Year Historic Cohort. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02862-0. [PMID: 38777921 DOI: 10.1007/s10508-024-02862-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 02/13/2024] [Accepted: 03/26/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE HIV Pre-Exposure Prophylaxis (PrEP) has been used in France since 2016. Its effectiveness is no longer to be demonstrated. However, follow-up and adherence remain the main pitfalls. The main objective of this study was to identify factors associated with persistence or loss of PrEP follow-up. DESIGN An historic cohort of PrEP users was compiled from the database of consultations in the Indre-et-Loire dedicated sexual health centers (CeGIDD) from June 2016 to June 2021. METHODS Kaplan-Meier curves were performed to compare the group of persistent PrEP users to the discontinuation group. Factors associated with PrEP discontinuation were identified using Cox modelling, considering time-dependent variables. Final variables included in the model were selected based on the Akaike Information Criterion (AIC) and clinical relevance. RESULTS Over the period, 568 PrEP users were included in the cohort. Median follow-up was 2.3 years. A quarter of users were lost to follow-up within 3 months after PrEP initiation. Sexual risk reduction AIDS community-based support (HR = 0.65[0.42;0.99]), being in a couple (HR = 0.51[0.38;0.68]), and history of syphilis (HR = 0.57[0.40;0.81]) were significantly associated with persistence of follow-up. Remote consultations (HR = 2.74[1.63;4.61]), chemsex practices (HR = 2.01[1.29;3.14]), and side effects (HR=1.72[1.03;2.88]) were significantly associated with a loss of follow-up. CONCLUSION These results suggest that more sexual risk reduction AIDS community-based counseling could be a key, necessary for supporting PrEP users in their follow-up pathway. Indeed, AIDS community-based support could be used to build a basis for developing safe pathways. Remote consultations could represent a response to the issue of access to PrEP. To create a significant impact on global HIV incidence, the PrEP offer must be extended, and at-risk PrEP users supported to maintain PrEP use.
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Affiliation(s)
- Clément Le Roux
- Epidemiology Unit for Clinical Data in the Centre-Val de Loire (EpiDcliC), Public Health and Prevention Unit, University Hospital of Tours, 37000, Tours, France.
- Public Health Department, Medical School, University of Tours, Tours, France.
- Free Information, Screening and Diagnostic Center 37 (CeGIDD 37), University Hospital of Tours, Tours, France.
| | - Marc-Florent Tassi
- Epidemiology Unit for Clinical Data in the Centre-Val de Loire (EpiDcliC), Public Health and Prevention Unit, University Hospital of Tours, 37000, Tours, France
- Pharmacy School, University of Tours, Tours, France
- INSERM U1259, MAVIVH, University of Tours, Tours, France
| | - Cathie Faussat
- Public Health Department, Medical School, University of Tours, Tours, France
- Free Information, Screening and Diagnostic Center 37 (CeGIDD 37), University Hospital of Tours, Tours, France
- INSERM U1259, MAVIVH, University of Tours, Tours, France
| | - Catherine Aumond
- AIDES Association, Centre Val de Loire Region, Orléans, France
- Regional HIV Coordination Committee (COREVIH), Centre Val de Loire Region, Orléans, France
| | - Guillaume Gras
- Free Information, Screening and Diagnostic Center 37 (CeGIDD 37), University Hospital of Tours, Tours, France
- Department of Infectious Diseases, University Hospital of Tours, Tours, France
- Regional HIV Coordination Committee (COREVIH), Centre Val de Loire Region, Orléans, France
| | - Karl Stefic
- INSERM U1259, MAVIVH, University of Tours, Tours, France
- Department of Bacteriology, Virology and Hospital Hygiene, University Hospital of Tours, Tours, France
| | - Leslie Grammatico-Guillon
- Epidemiology Unit for Clinical Data in the Centre-Val de Loire (EpiDcliC), Public Health and Prevention Unit, University Hospital of Tours, 37000, Tours, France
- Public Health Department, Medical School, University of Tours, Tours, France
- INSERM U1259, MAVIVH, University of Tours, Tours, France
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Garofoli N, Siguier M, Robineau O, Valette M, Phung B, Bachelard A, Rioux C, Le Gac S, Digumber M, Pialoux G, Ghosn J, Champenois K. Incidence and factors associated with PrEP discontinuation in France. J Antimicrob Chemother 2024:dkae133. [PMID: 38758214 DOI: 10.1093/jac/dkae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/05/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES HIV pre-exposure prophylaxis (PrEP) is effective in preventing HIV, but some seroconversions occur due to poor adherence or PrEP discontinuation. Our objective was to estimate the incidence of PrEP discontinuation and describe the reasons and factors associated with discontinuations. METHODS A retrospective cohort was conducted in three French hospitals between January 2016 and June 2022. PrEP users who attended at least twice within 6 months during study period were included and followed up until December 2022. The incidence rate of PrEP discontinuation was estimated by censoring lost to follow up individuals. Factors associated with PrEP discontinuations were identified using a multivariate Cox model. RESULTS A total of 2785 PrEP users were included, with 94% men and 5% transgender people. Median age was 35 years. By December 2022, 653 users had stopped PrEP (24%). The incidence rate was 10.8 PrEP discontinuations for 100 person-years (PY). The main causes of discontinuation were being in a stable relationship (32%), and not judging the treatment useful anymore (12%). Individuals who discontinued PrEP were younger [<29, HR = 1.45 (1.17-1.80)], and more likely to be women [HR = 2.44 (1.50-3.96)] or sex workers [HR = 1.53 (0.96-2.44)]. They were more likely to report PrEP side effects [HR = 2.25 (1.83-2.77)] or ≥2 sexually transmitted infections [HR = 1.87 (1.53-2.27)] during the last year. CONCLUSION The incidence of PrEP discontinuations was quite low compared to rates observed in other cohorts. Users who stopped PrEP were sometimes still exposed to HIV, emphasizing the need for targeted interventions to prepare and support PrEP discontinuations and limit seroconversion risk.
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Affiliation(s)
- Nina Garofoli
- Department of Infectious Diseases and Sexual Health Clinic, Assistance Publique-Hopitaux de Paris Nord, Bichat-Claude Bernard Hospital, Paris, France
| | - Martin Siguier
- Department of Infectious Diseases, Assistance Publique-Hopitaux de Paris, Tenon Hospital, Paris, France
- Department of Infectious Diseases, Université Sorbonne Paris Nord, Paris, France
| | - Olivier Robineau
- Hospital Center of Tourcoing, Universitary Service of Infectious Diseases and Travel Medicine, Tourcoing, France
| | - Michel Valette
- Hospital Center of Tourcoing, Universitary Service of Infectious Diseases and Travel Medicine, Tourcoing, France
| | - Bao Phung
- Department of Infectious Diseases and Sexual Health Clinic, Assistance Publique-Hopitaux de Paris Nord, Bichat-Claude Bernard Hospital, Paris, France
| | - Antoine Bachelard
- Department of Infectious Diseases and Sexual Health Clinic, Assistance Publique-Hopitaux de Paris Nord, Bichat-Claude Bernard Hospital, Paris, France
| | - Christophe Rioux
- Department of Infectious Diseases and Sexual Health Clinic, Assistance Publique-Hopitaux de Paris Nord, Bichat-Claude Bernard Hospital, Paris, France
| | - Sylvie Le Gac
- Department of Research (Coordinator), COREVIH Ile-de-France Nord, Paris, France
| | - Marc Digumber
- Department of Research (Coordinator), COREVIH Ile-de-France Nord, Paris, France
| | - Gilles Pialoux
- Department of Infectious Diseases, Assistance Publique-Hopitaux de Paris, Tenon Hospital, Paris, France
| | - Jade Ghosn
- Department of Infectious Diseases and Sexual Health Clinic, Assistance Publique-Hopitaux de Paris Nord, Bichat-Claude Bernard Hospital, Paris, France
- Department of Research (Coordinator), COREVIH Ile-de-France Nord, Paris, France
- Inserm UMR1137, Université Paris Cité and Université Sorbonne Paris Nord, IAME, Paris, F-75018, France
| | - Karen Champenois
- Inserm UMR1137, Université Paris Cité and Université Sorbonne Paris Nord, IAME, Paris, F-75018, France
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Tassi MF, Stéfic K, Faussat C, Aumond C, Roux CL, Gras G, Grammatico-Guillon L. On the risk of using raw regional data on new HIV infections in France. J Int AIDS Soc 2024; 27:e26205. [PMID: 38194425 PMCID: PMC10776023 DOI: 10.1002/jia2.26205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/23/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
| | - Karl Stéfic
- INSERM U1259 MAVIVH, Université de Tours, Tours, France
- Laboratoire de virologie et CNR VIH-Laboratoire associé, CHRU de Tours, Tours, France
| | - Cathie Faussat
- Pôle santé publique et prévention, CHRU de Tours, Tours, France
| | - Catherine Aumond
- Délégation régionale AIDES Centre-Val de Loire, Tours, France
- Coordination Régionale de la lutte contre le VIH, CHRU de Tours, Tours, France
| | - Clément Le Roux
- Pôle santé publique et prévention, CHRU de Tours, Tours, France
| | - Guillaume Gras
- Coordination Régionale de la lutte contre le VIH, CHRU de Tours, Tours, France
- Centre gratuit d'information, de dépistage et de diagnostic, CHRU de Tours, Tours, France
| | - Leslie Grammatico-Guillon
- INSERM U1259 MAVIVH, Université de Tours, Tours, France
- Pôle santé publique et prévention, CHRU de Tours, Tours, France
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Unigwe IF, Cook RL, Janelle JW, Park H. Trends in Recommended Screening and Monitoring Tests for Users of HIV Pre-Exposure Prophylaxis Before and During the COVID-19 Pandemic. AJPM FOCUS 2023; 2:100134. [PMID: 37790950 PMCID: PMC10546544 DOI: 10.1016/j.focus.2023.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction To ensure the health and safety of persons taking pre-exposure prophylaxis to prevent HIV infection, the 2017 Centers for Disease Control and Prevention guidelines recommended initial and follow-up laboratory testing. We assessed the trends in adherence rates to recommended laboratory testing among pre-exposure prophylaxis users and identified factors associated with HIV testing among pre-exposure prophylaxis users from 2016 to 2020 and also examined rate changes during the COVID-19 pandemic in 2020. Methods We conducted a retrospective cohort study assessing the rates and trends of recommended laboratory testing among commercially insured pre-exposure prophylaxis users from 2016 to 2020, using the MarketScan database. We examined the proportion of pre-exposure prophylaxis users adhering to the following initial and follow-up laboratory testing: (1) HIV, creatinine clearance, hepatitis B virus, hepatitis C virus, and sexually transmitted infections (chlamydia/gonorrhea and syphilis) within 7 days before pre-exposure prophylaxis initiation; (2) HIV 90 days after initiation; and (3) HIV, creatinine clearance, and sexually transmitted infections 180 days after pre-exposure prophylaxis initiation. We used general linear models to examine trends and multivariable logistic regression to identify predictors of ≥1 HIV test within 180 days after index pre-exposure prophylaxis. Results We identified 19,581 new pre-exposure prophylaxis users. Most were male (96%) and aged 18-34 years (55%). Adherence rates to recommended testing increased from 2016 through 2019 (e.g., 9.0%-13.6% for all initial screening tests 7 days before initiation, 42.1%-44.6% for HIV testing 90 days after initiation, 33.8%-40.6% for all follow-up tests within 180 days after initiation), but all rates decreased during the COVID-19 pandemic (12.4%, 33.6%, and 31.6%, respectively). Younger age (aged 13-17 years: AOR=0.44, 95% CI=0.28, 0.71) and ages 18-34 years (AOR=0.80, 95% CI=0.74, 0.86) were associated with a significantly lower likelihood of getting an HIV test within 180 days after initiation than ages 35-44 years, and female sex (AOR=0.64, 95% CI=0.55, 0.74) were associated with a significantly lower likelihood than male sex. Pre-exposure prophylaxis users with a history of sexually transmitted infections had a higher likelihood (AOR=1.27, 95% CI=1.16, 1.40) of getting tested than those without. Conclusions Initial screening and follow-up testing rates were lower than those recommended by the Centers for Disease Control and Prevention. Public health efforts are needed to ensure that patients have access to needed laboratory testing during pandemics or natural disasters and to educate patients and clinicians about the importance of screening and monitoring tests to ensure the safety and health of pre-exposure prophylaxis users.
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Affiliation(s)
- Ikenna F. Unigwe
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida
| | - Jennifer W. Janelle
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Haesuk Park
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida
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Gökengin D, Noori T, Alemany A, Bienkowski C, Liegon G, İnkaya AÇ, Carrillo J, Stary G, Knapp K, Mitja O, Molina JM. Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100738. [PMID: 37927439 PMCID: PMC10625023 DOI: 10.1016/j.lanepe.2023.100738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023]
Abstract
The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.
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Affiliation(s)
- Deniz Gökengin
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Ege University, Izmir, Turkiye
- Ege University HIV/AIDS Practice and Research Center, Izmir, Turkiye
| | - Teymur Noori
- European Centre for Disease Prevention and Control STI, Blood-Borne Viruses and TB DPR, Stockholm, Sweden
| | - Andrea Alemany
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Carlo Bienkowski
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Poland and Hospital for Infectious Diseases in Warsaw, Poland
| | - Geoffroy Liegon
- Section of Infectious Diseases and Global Health University of Chicago Medicine Chicago, Illinois, United States
| | - Ahmet Çağkan İnkaya
- Hacettepe University Faculty of Medicine Department of Infectious Diseases Ankara, Turkey
| | - Jorge Carrillo
- IrsiCaixa AIDS Research Institute, Campus Can Ruti, Badalona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Badalona, Spain
- CIBERINFEC, Instituto de Salud Carlos IIII, Madrid, Spain
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Katja Knapp
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Oriol Mitja
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Jean-Michel Molina
- University of Paris Cité and Department of Infectious Diseases Saint-Louis and Lariboisiére Hospitals, APHP, Paris, France
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Grangeiro A, do Santos LA, Estevam DL, Munhoz R, Arruda É, de Moraes RA, de Quadros Winkler L, Neves LADS, Santos JCV, Kruppa M, Zucchi EM, Escuder MM, Leal AF, Koyama MAH, Peres MFT, Couto MT, Neto JE. Telehealth effectiveness for pre-exposure prophylaxis delivery in Brazilian public services: the Combine! Study. J Int AIDS Soc 2023; 26:e26173. [PMID: 37766486 PMCID: PMC10534058 DOI: 10.1002/jia2.26173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) delivery based on user needs can enhance PrEP access and impact. We examined whether telehealth for daily oral PrEP delivery could change the indicators of care related to prophylactic use in five Brazilian public HIV clinics (testing centres, outpatient clinics and infectious disease hospitals). METHODS Between July 2019 and December 2020, clients on PrEP for at least 6 months could transition to telehealth or stay with in-person follow-up. Clients were clinically monitored until June 2021. A desktop or mobile application was developed, comprising three asynchronous consultations and one annual in-person consultation visit. Predictors influencing telehealth preference and care outcomes were examined. The analysis encompassed intent-to-treat (first choice) and adjustments for sexual practices, schooling, age, duration of PrEP use and PrEP status during the choice period. RESULTS Of 470 users, 52% chose telehealth, with the adjusted odds ratio (aOR) increasing over time for PrEP use (aOR for 25-months of use: 4.90; 95% CI: 1.32-18.25), having discontinued PrEP at the time of the choice (aOR: 2.91; 95% CI: 1.40-6.06) and having health insurance (aOR: 1.91; 95% CI: 1.24-2.94) and decreasing for those who reported higher-risk behaviour (aOR for unprotected anal sex: 0.51; 95% CI: 0.29-0.88). After an average follow-up period of 1.6 years (95% CI: 1.5-1.7), the risk of discontinuing PrEP (not having the medication for more than 90 days) was 34% lower with telehealth (adjusted hazard ratio: 0.66; 95% CI: 0.45-0.97). When adjusted by mixed linear regression, no differences in adherence (measured by mean medication possession rate) were found between in-person and telehealth (p = 0.486) or at pre- and post-telehealth follow-ups (p = 0.245). Sexually transmitted infections increased between the pre-follow-up and post-follow-up choices and were not associated with in-person or telehealth (p = 0.528). No HIV infections were observed. CONCLUSIONS Our findings indicate that telehealth for PrEP delivery can enhance service rationalization and reinforce the prevention cascade. This approach reduces prophylaxis interruptions and is mainly preferred by individuals with lower demands for healthcare services.
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Affiliation(s)
| | | | | | | | - Érico Arruda
- Hospital São José de Doenças InfecciosasFortalezaBrazil
| | | | | | | | | | | | - Eliana Miura Zucchi
- Programa de Pós‐Graduação em Saúde ColetivaUniversidade Catolica de SantosSantosSão PauloBrazil
| | | | - Andréa Fachel Leal
- Instituto de Filosofia e Ciências HumanasUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | | | | | | | - José Eluf Neto
- Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
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Wang H, Molina JM, Dray-Spira R, Schmidt AJ, Hickson F, van de Vijver D, Jonas KJ. Spatio-temporal changes in pre-exposure prophylaxis uptake among MSM in mainland France between 2016 and 2021: a Bayesian small area approach with MSM population estimation. J Int AIDS Soc 2023; 26:e26089. [PMID: 37221971 PMCID: PMC10206410 DOI: 10.1002/jia2.26089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION In France, oral pre-exposure prophylaxis (PrEP) for HIV prevention has been publicly available since 2016, mainly targeting at men who have sex with men (MSM). Reliable and robust estimations of the actual PrEP uptake among MSM on a localized level can provide additional insights to identify and better reach marginalized MSM within current HIV prevention service provision. This study used national pharmaco-epidemiology surveillance data and regional MSM population estimations to model the spatio-temporal distribution of PrEP uptake among MSM in France 2016-2021 to identify marginalized MSM at risk for HIV and increase their PrEP uptake. METHODS We first applied Bayesian spatial analyses with survey-surveillance-based HIV incidence data as a spatial proxy to estimate the size of (1) regional HIV-negative MSM populations and (2) MSM who could be eligible for PrEP use according to French PrEP guidelines. We then applied Bayesian spatio-temporal ecological regression modelling to estimate the regional prevalence and relative probability of the overall- and new-PrEP uptake from 2016 to 2021 across France. RESULTS HIV-negative and PrEP-eligible MSM populations vary regionally across France. Île-de-France was estimated to have the highest MSM density compared to other French regions. According to the final spatio-temporal model, the relative probability of overall PrEP uptake was heterogeneous across France but remained stable over time. Urban areas have higher-than-average probabilities of PrEP uptake. The prevalence of PrEP use increased steadily (ranging from 8.8% [95% credible interval 8.5%;9.0%] in Nouvelle-Aquitaine to 38.2% [36.5%;39.9%] in Centre-Val-de-Loire in 2021). CONCLUSIONS Our results show that using Bayesian spatial analysis as a novel methodology to estimate the localized HIV-negative MSM population is feasible and applicable. Spatio-temporal models showed that despite the increasing prevalence of PrEP use in all regions, geographical disparities and inequalities of PrEP uptake continued to exist over time. We identified regions that would benefit from greater tailoring and delivery efforts. Based on our findings, public health policies and HIV prevention strategies could be adjusted to better combat HIV infections and to accelerate ending the HIV epidemic.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
- Viroscience Department, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jean-Michel Molina
- Department of Infectious Diseases, Hôpital Saint-Louis, University of Paris Cité, Paris, France
| | - Rosemary Dray-Spira
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
| | - Axel J Schmidt
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ford Hickson
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
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Abstract
Preexposure prophylaxis (PrEP) is increasingly implemented in national HIV prevention programmes through routine care. Monitoring will be vital to understand whether programmes succeed in engaging people into using PrEP appropriately, and in reducing the HIV epidemic. Yet, it is currently unclear which indicators are most suited to monitor PrEP programmes' performance. We therefore aimed to identify and map indicators that are currently used or suggested for monitoring PrEP programmes. We conducted a scoping review based on the framework by Arksey and O'Malley. We combined a systematic search in the peer-reviewed literature with hand-searching grey literature documents describing indicators and strategies that are used or suggested for PrEP monitoring. Only literature published after 2012 was included. No geographical restrictions were set. We charted data on indicator definitions, data sources used, reported experiences with monitoring and any relevant contextual factors. Ultimately, 35 peer-reviewed and 14 grey literature records were included. We identified indicators related to preuptake stages of PrEP, uptake and coverage, and programme impact. The indicators most commonly suggested for national-level monitoring were the number of new and current PrEP users, the number of HIV seroconversions among PrEP users and some variably defined indicators related to continuation and discontinuation of PrEP. Despite its perceived high relevance, studies reported several challenges to routinely monitor the population in need of PrEP and track prevention-effective PrEP use. In conclusion, a variety of indicators is currently used or suggested for monitoring PrEP programmes. Implementing proxy measures that track different aspects of PrEP use over time, and making synergies with research more explicit, could be used as strategies to obtain more granular insights into trends revealed by routine monitoring.
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Roll-out of HIV pre-exposure prophylaxis use in France: A nationwide observational study from 2016 to 2021. Lancet Reg Health Eur 2022; 22:100486. [PMID: 35990255 PMCID: PMC9386455 DOI: 10.1016/j.lanepe.2022.100486] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Oral HIV pre-exposure prophylaxis (PrEP) has been available and fully reimbursed for people at high risk of sexually acquired HIV infection in France since January 2016. Its dissemination has been widely promoted to reduce HIV incidence in high-risk populations. This study aimed to assess the roll-out of PrEP use in France from its implementation until mid-2021. Methods Using the French National Health Data System (SNDS) covering 99% of people residing in France, all PrEP users defined as individuals aged 15 years or older who received at least one dispensing of PrEP between 1 January 2016 and 30 June 2021 were identified. PrEP users number and their socio-demographic and PrEP use characteristics were assessed over time. Findings As of 30 June 2021, a total of 42 159 individuals had initiated PrEP in France. Monthly PrEP initiations increased steadily up to 1027 in February 2020, and then slowed down sharply from the onset of the COVID-19 epidemic until a recovery in the first half of 2021. PrEP users were overwhelmingly men (97·5%, 41 126/42 159), aged 36 years on average, living in a large metropolitan area (73·8%, 31 096/42 159), and among whom a minority (7·0%, 2966/42 159) were socio-economically disadvantaged. Throughout the study period, 80-90% of users renewed PrEP from one semester to another, suggesting a good level of maintenance among those engaged in treatment. Nevertheless, for 20·1% (7148/35 549) of new PrEP users no prescription renewal was recorded in the first six months after initiation, suggesting a substantial proportion of early treatment discontinuation. Private practitioners accounted for a minority (21·3%, 77 885/366 399) of PrEP renewal prescriptions. Interpretation PrEP roll-out has been markedly impacted by the COVID-19 pandemic in France. Although PrEP deployment has been substantial among men who have sex with men, further action is needed to expand access to PrEP to all other population groups who could benefit from it and to promote adherence to treatment. Funding This research was carried out within EPI-PHARE without external funding.
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Jourdain H, de Gage SB, Desplas D, Dray-Spira R. Real-world effectiveness of pre-exposure prophylaxis in men at high risk of HIV infection in France: a nested case-control study. THE LANCET PUBLIC HEALTH 2022; 7:e529-e536. [DOI: 10.1016/s2468-2667(22)00106-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 12/20/2022] Open
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