Advantages and limits of remote consultations for HIV pre-exposure prophylaxis health pathway: ePrEP qualitative study.

OBJECTIVE: Because of a high rate of HIV diagnosis and restricted medical access in the Centre-Val de Loire region in France , remote consultations (RC) with a community-based approach has been implemented to promote access to healthcare. Our study aimed to determine whether RC could improve access to pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) as part of the healthcare pathway associated with PrEP. MATERIALS AND METHODS: A qualitative approach involving semi-structured interviews with 17 MSM and 3 physicians from specialized sexual health centres was performed, with a mean duration of interview over one hour. The research focused on the health pathway associated with PrEP, from initial awareness to ongoing prescription and follow-up. RESULTS: Transitioning PrEP consultations to RC is feasible, but concerns about a potential decline in care quality compared to traditional sexual health centres follow-ups were noted. Both MSM and physicians recognized that RC could complement face-to-face approaches, especially in terms of organizational benefits. In rural areas, access to specialists through RC was seen as a partial solution, though it could be hindered by barriers in accessing laboratory testing and pharmacy services, like fear of stigmatization. More generally, distrust of medication and the difficulty of discussing sexuality with a GP were highlighted, which could limit the uptake of PrEP without access to specialists. CONCLUSIONS: The initiation and uptake of PrEP among MSM are more effectively influenced by initiatives that provide information, reassurance, and facilitate initial procedures, rather than solely through RC. A strategy combining digital and community-based approaches, along with medical expertise, is recommended to increase PrEP utilization among MSM.

Étude qualitative de l'acceptabilité de la téléconsultation pour le traitement préventif du VIH.

Introduction : In France, the incidence of HIV infections remains at 6,000 infections a year. Pre-Exposure Prophylaxis (PrEP) could reduce this number. Despite available reimbursement since 2016 to exposed populations, the recipients remain mostly men who have sex with men (MSM) living in large cities. In Center-Val de Loire, where newly HIV diagnoses and difficulties of access to care are tremendous, community tele-support and dedicated teleconsultations have been launched to promote access, particularly in rural areas. This study aimed to identify the interests and limits of these teleconsultations for PreP users.Purpose of research : E-PrEP qualitative study conducted by semi-structured interviews with MSM PrEP users allowing the thematic analysis of eight interviews lasting an average of one hour, conducted with MSM taking at least one teleconsultation.Results : The teleconsultation met user expectations with good acceptability. It integrated naturally into the associated preventive care pathway where applicable. The description of a more impersonal face-to–face exchange is balanced by establishing a trusting relationship. Teleconsultation has sometimes eased talking about sexuality. An enhanced confidentiality could represent a specific motif to choose teleconsultation. Access to the specialist seems to be an asset compared to a GP follow-up hardly chosen for this type of consultation. Fears of lack of discretion or judgmental behavior from these unspecialized healthcare professionals were pronounced..Conclusions : The deployment of teleconsultations can be encouraged to facilitate access to PrEP with vigilance on the associated health path.

Inégalités face à la COVID-19 ­ Profils de territoire.

INTRODUCTION: In the midst of the COVID-19 health crisis, the Regional Health Observatories (RHO) and the National Federation of RHOs have chosen to make available their expertise regarding development and production of health indicators to support local and national public policies available, in order to plan for the lifting of population lockdown measures. PURPOSE OF RESEARCH: To characterize as finely as possible the geographical territories, including overseas territories, using indicators to describe both the population potentially at risk of presenting serious forms of COVID-19 and the demographic and social situations that could favor the circulation of the Sars-Cov-2 virus. RESULTS: 1,250 profile sheets, one for each public establishment of intermunicipal cooperation in the French departments (excluding Mayotte) presenting 34 indicators were produced. A national synthesis including a typology of these territories in seven classes was also produced. CONCLUSION: This work shows the possibility of describing a series of indicators linked to a specific theme systematically and at fine geographical scales. Along with a typology of territories, this tool can contribute with others to the management of a health crisis.

Factors influencing the decision to practise obstetrics among Québec medical students: a survey.

OBJECTIVE: The objectives of this study were to track changes in medical students' interest in obstetrics from the beginning of their studies in medicine to the end of their pre-clinical clerkships and to identify factors that influenced this interest. METHODS: This was a cohort study of all Québec medical students who, in 2003, were about to begin their clerkships (n = 500). A questionnaire was administered at this time (T1) and at the end of the clerkship (T2). The main outcome variables were an intention to provide prenatal care without deliveries and an intention to deliver infants in future practice. Logistic regression analysis was used to assess relationships between the various determinants and the decision to practise obstetrics. RESULTS: A total of 353 students, or 70.6% of the cohort, completed both questionnaires. At the end of their clerkships, 32 students (9.1%) were definitely planning to include complete obstetrical care in their future practices, and 45 (12.7%) said that they probably would. Between the beginning and the end of their clerkships, only 8% of students had changed their minds in favour of an obstetrical career, and 20% had decided against it. An intention to deliver infants is associated with the following factors: considering the practice of obstetrics gratifying (odds ratio [OR] 6.73; 95% confidence intervals [CI] 3.30-13.70); having been exposed to obstetrical care outside the clerkship in obstetrics and gynaecology (OR 4.4; 95% CI 1.6-10.26); having completed university studies before studying medicine (OR 4.08; 95% CI 1.11-15.3); and having had a decisive, positive experience with obstetrics (OR 2.86; 95% CI 0.96-8.50). Students who believed that specialists had played a key role in their decision and that obstetrics is a demanding practice were less likely to plan a career that included delivering infants (OR 0.43; 95% CI 0.23-0.69 and OR 0.35; 95% CI 0.21-0.59, respectively). CONCLUSION: This study shows that an interest in practising obstetrics emerges very early in medical training. However, a student's learning experiences during an obstetrical rotation affect this decision. Departments of family medicine and obstetrics and gynaecology may be able to work together to create more positive role models.