Evaluation of HIV antiretroviral treatment adherence in 2019 using anonymized data from the French national health insurance claims data base: The COCOVIH study.

OBJECTIVE: Adherence to antiretroviral treatment (ART) plays a key role in achieving viral suppression in people living with HIV. We aimed to quantify ART adherence in the entire French HIV-infected population treated in 2019 and to determine factors of influence. METHODS: People living with HIV were identified using HIV diagnosis according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria, HIV-specific laboratory tests, and prescription of antiretrovirals in 2019. Adherence was measured using the medication possession ratio (MPR; actual divided by theoretical number of tablets). Variables of interest included sex, age, type of ART, relevant comorbidities, and receiving supplementary universal health coverage for low-income citizens (CMUc). RESULTS: Of the n = 211 124 people living with HIV identified between 2006 and 2019, we included n = 140 607 on ART with two or more prescription fills in 2019 in this analysis. In total, 87.5% of people living with HIV were receiving ART in 2019. Mean ± standard deviation MPR was 82.5 ± 22.7%; 57% of people living with HIV had an MPR ≥90%, and 12.7% had an MPR <50%. Those with an MPR ≥90% significantly differed between males and females (59.1% and 52.8%, respectively; p < 0.001), and between CMUc recipients and non recipients (54.1% and 57.6%, respectively; p < 0.001). MPR ≥90% rate was lower for those with chronic nephropathy (50.2%), renal failure (46.6%), and tuberculosis (50.1%), and for those using psychoactive substances (52.3%). Factors associated with MPR ≥90% in multivariable analysis were older age, male sex, not receiving CMUc, more recent HIV diagnosis, and triple (vs. dual) ART. CONCLUSION: In 2019, the average MPR in people living with HIV was 82.5% according to the comprehensive French health care database. Besides sociodemographic variables such as older age, male sex, and not being a CMUc recipient (i.e. of low socioeconomic status), more recent HIV diagnosis and triple therapy were independently associated with better adherence, possibly reflecting advances in ART tolerability and dosing.

DEPIVIH 2: Use of three HIV testing methods in French primary care settings - ELISA laboratory screening versus two rapid point-of-care HIV tests.

OBJECTIVE: The primary endpoint was to evaluate the use of HIV testing methods by French primary care providers: Elisa laboratory screening, instant result HIV diagnostic test and rapid result HIV diagnostic test. The secondary endpoints were the population screening rate of unknown HIV status consulting during the study period, reasons for screening and for choosing the specific screening method, the investigators' satisfaction with the rapid diagnostic test (RDT) and problems encountered. PATIENTS AND METHODS: National prospective interventional study with French family physicians (FP) from December 2013 to December 2014. FPs enrolled all consenting adults consulting for an HIV screening test during a 6-month period: the choice was an Elisa laboratory test or one of the two RDTs. RESULTS: During the study period, 43 FPs included 981 patients. HIV screening was performed for the first time for 31.6% of patients; 767 (78.2%) Elisa laboratory test prescriptions and 214 (21.8%) RDTs were performed, leading to a screening rate of 1.3%. For 120 (15.7%) of the Elisa laboratory tests, the result was not reported and six RDTs were not valid. Nine patients were diagnosed as HIV-infected (0.9%): five with Elisa laboratory test and four with RDT. Almost 90% of FPs were willing to keep on using RDTs in their daily practice. CONCLUSION: In general practice, RDTs may be an important additional tool to traditional HIV screening. They could account for one in five tests prescribed in this context.

Increase in sexually transmitted infections in a cohort of outpatient HIV-positive men who have sex with men in the Parisian region.

OBJECTIVE: To describe the increased incidence of sexually transmitted infections (STIs) in a cohort of HIV-infected men who have sex with men (MSM), followed in a tertiary hospital of the Île-de-France region. MATERIALS AND METHODS: We performed a monocentric, retrospective, and prospective study. We included symptomatic HIV-infected MSM patients who consulted for their annual consultation. RESULTS: One hundred and eighty patients were seen between 2008-2011 and 215 between 2012-2015. We observed an increased incidence of STIs between the two periods (14 and 29.3%, respectively). These STIs includes: syphilis, hepatitis C, urethritis, and proctitis due to Chlamydia trachomatis and Neisseria gonorrhea. CONCLUSION: A better management of symptomatic and asymptomatic STIs is needed for HIV-infected MSM patients.

Feasibility and acceptability of rapid HIV test screening (DEPIVIH) by French family physicians.

BACKGROUND: In France, around 50,000 people were unaware of their HIV positivity at the end of 2008. The latest guidelines recommend routine screening of all adults. Family physicians have been identified as key persons for this new policy. Rapid HIV tests (RHT) have been proposed as an alternative to conventional blood tests. OBJECTIVES: The authors assessed the feasibility and acceptability of RHT test based screening in French community practice. METHOD: We made a prospective interventional study of the BioMerieux VIKIA(®) HIV 1/2 RHT among French family physicians. Data on the RHT was posted in the physician's waiting room. RESULTS: Sixty-two French physicians, mostly family practitioners, included 383 patients with a mean age of 36.2 years, from June to October 2010. Twenty-two percent (83) of these patients had never been tested for HIV. The RHT was proposed and 382 tests were accepted and performed (acceptability rate of 99.7%). Sixty-five percent of the tests were made on the patient's request. The tested population represented 1.5% of consulting patients during the study period (feasibility rate). Patients were quite satisfied but physicians less so. Test steps and capillary blood sampling were the main source of difficulty mentioned. At the end of the study, 59% of physicians were ready to continue using RHT in their daily practice. CONCLUSION: Routine RHT screening in community practice is feasible and well accepted by patients. It was the first screening test for 22% of our patients. Its feasibility was limited by capillary blood sampling technique and time constraints during consultation.