Search

Your search keyword '"Bruno, Spire"' showing total 186 results
Start Over Author "Bruno, Spire" Topic medicine.medical_specialty
186 results on '"Bruno, Spire"'

1. Combined Sexual Behavioral Profiles in HIV-Seronegative Men Who have Sex with Men in West Africa (CohMSM ANRS 12324-Expertise France)

Author

Pierre-Julien, Coulaud, Luis, Sagaon-Teyssier, Mohamed, Mimi, Bakridine, M'madi Mrenda, Gwenaëlle, Maradan, Marion, Mora, Michel, Bourrelly, Bintou Dembélé, Keita, Abdoul Aziz, Keita, Camille, Anoma, Stéphane-Alain, Babo Yoro, Ter Tiero Elias, Dah, Christian, Coulibaly, Ephrem, Mensah, Selom, Agbomadji, Adeline, Bernier, Clotilde, Couderc, Christian, Laurent, Bruno, Spire, Claver Anoumou Yaotsè, Dagnra, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), ARCAD-SIDA [Bamako, Mali], Espace Confiance [Abidjan, Côte d’Ivoire], Association African Solidarité [Ouagadougou, Burkina Faso], Centre Muraz [Bobo-Dioulasso, Burkina Faso], Espoir Vie Togo [Lomé, Togo], Coalition PLUS [Pantin, France], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), CohMSM Study Group: Clotilde Couderc, Bruno Granouillac, Suzanne Izard, Christian Laurent, Laura March, Martine Peeters, Laetitia Serrano, Cyril Berenger, Michel Bourrelly, Pierre-Julien Coulaud, Gwenaëlle Maradan, Bakri M'madi Mrenda, Marion Mora, Enzo Parisi, Luis Sagaon-Teyssier, Bruno Spire, Adeline Bernier, Paméla Palvadeau, Daniela Rojas Castro, Drissa Camara, Oumar Cisse, Alou Coulibaly, Bintou Dembele Keita, Fodié Diallo, Mahamadou Diarra, Mady Gadjigo, Abdoul Aziz Keita, Kader Maiga, Aly Ouologuem, Fodé Traore, Niamkey Thomas Aka, Camille Anoma, Stéphane-Alain Babo Yoro, Noufo Hamed Coulibaly, Rachelle Kotchi, Patrick Kouabenan, Malan Jean-Baptiste Kouame, Kpassou Julien Lokrou, Frédéric Dibi N'Guessan, Xavier Anglaret, Jean-Marie Masumbuko, Maxime Oga, Christian Coulibaly, Ter Tiero Elias Dah, Ousseni Ilboudo, Joseph Ouedraogo, Mamadou Ouedraogo, Elisabeth Thio, Juste Rodrigue Toure, Abdoulazziz Traore, Issa Traore, Fiffou Yougbare, Nicolas Meda, Kouakou Kokouvi Selom Agbomadji, Richard Mawuényégan Kouamivi Agboyibor, Messan Attiogbe, Aléda Mawuli Badjassim, Agbégnigan Lorette Ekon, Anouwarsadat Kokouba, Ephrem Mensah, Diimiln Joseph Strauss Tablissi, Kossi Jeff Yaka, Claver Anoumou Yaotsè Dagnra, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), and Dupuis, Christine

Subjects
Male, Sexual behavior, [SDV]Life Sciences [q-bio], HIV risk, Human immunodeficiency virus (HIV), HIV Infections, Human sexuality, medicine.disease_cause, West africa, Men who have sex with men, Cohort Studies, Sexual and Gender Minorities, 0302 clinical medicine, MESH: Sexual Partners, 030212 general & internal medicine, 10. No inequality, MESH: Cohort Studies, General Psychology, virus diseases, MESH: HIV Infections, 3. Good health, [SDV] Life Sciences [q-bio], MESH: Sexual and Gender Minorities, Africa, Western, Sexual Partners, MESH: Risk-Taking, MESH: Young Adult, Cohort, Sexual orientation, 0305 other medical science, Psychology, Adult, medicine.medical_specialty, MESH: Homosexuality, Male, Young Adult, 03 medical and health sciences, Risk-Taking, Arts and Humanities (miscellaneous), Identity, MESH: Africa, Western, West Africa, medicine, Humans, MSM, Homosexuality, Male, MESH: Humans, 030505 public health, Public health, MESH: Adult, MESH: Male, Demography
Abstract

International audience; Understanding the dynamics of HIV infection in men who have sex with men (MSM) can help improve efficiency in existing prevention strategies. We aimed to identify and describe the sexual behaviors of MSM most at risk of HIV infection in West Africa. HIV-negative MSM were provided a quarterly preventive follow-up package in the community-based cohort CohMSM. They completed face-to-face sociobehavioral questionnaires every 6 months. This sub-study on 520 participants used a baseline, 6-, 12- and 18-month data cluster analysis to categorize two profiles (high risk [HRE] and moderate risk [MRE] of exposure to HIV) based on three risky sexual practices over the previous 6 months. HRE-MSM (61%) were more engaged in receptive practices, had a higher proportion of inconsistent condom use during anal sex, and reported more sexual partners than MRE-MSM (39%). The proportion of HIV seroconversions observed during the first 18 months of follow-up using sexual behavioral profiles (92% are HRE-MSM) was higher than using the three risky sexual practices separately. Factors associated with the HRE-MSM profile were being younger (18-21 years), reporting stigma, and having had no female partner while being attracted only to men. Our findings suggest that in order to identify MSM most at risk of HIV infection, several risky sexual practices need to be evaluated in a combined approach. Prevention programs should pay particular attention to younger MSM, and implement activities addressing questions of MSM identity and stigma in order to reduce the dynamic of HIV infection in Western African MSM.

Published
2019
Full Text
View/download PDF

2. Risk factors for HIV infection among men who have sex with men in the ANRS IPERGAY PrEP trial

Author

Cécile Tremblay, F Raffi, Jean-Michel Molina, Eric Cua, Julie Chas, Guillemette Antoni, Isabelle Charreau, Bruno Spire, Laurence Meyer, Constance Delaugerre, Julien Gras, Christian Chidiac, Marine Pillet, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Génomes, biologie cellulaire et thérapeutiques (GenCellDi (U944 / UMR7212)), Collège de France (CdF (institution))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Institut de Recherche Saint-Louis - Hématologie Immunologie Oncologie (Département de recherche de l’UFR de médecine, ex- Institut Universitaire Hématologie-IUH) (IRSL), Université Paris Cité (UPCité), Essais Thérapeutiques et Maladies Infectieuses, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Nice (CHU Nice), Centre hospitalier universitaire de Nantes (CHU Nantes), Université de Lyon, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital du Sacré-Coeur de Montréal, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Malbec, Odile

Subjects
Male, medicine.medical_specialty, Anti-HIV Agents, Sexual Behavior, [SDV]Life Sciences [q-bio], Human immunodeficiency virus (HIV), Dermatology, medicine.disease_cause, Placebo, Men who have sex with men, Sexual and Gender Minorities, Pre-exposure prophylaxis, Internal medicine, medicine, Emtricitabine, Humans, risk factors, Homosexuality, Male, Hiv acquisition, Medical prescription, pre-exposure prophylaxis, Illicit Drugs, business.industry, sexual behaviour, [SDV] Life Sciences [q-bio], Infectious Diseases, Baseline characteristics, business, Anal sex, HIV infections
Abstract

ObjectivesWe aimed to assess among men who have sex with men (MSM) risk factors for HIV infection, to identify those who require urgent pre-exposure prophylaxis (PrEP) prescription.MethodsAll participants enrolled in the placebo arm of the ANRS IPERGAY trial, or infected between screening and day 0, were included. Baseline characteristics were described and HIV incidence rate ratios (RRs) were estimated with their 95% CIs.Results203 MSM were included with a median follow-up of 9 months. During the study period, 16 participants acquired HIV infection while not receiving tenofovir disoproxil and emtricitabin (TDF/FTC) over 212.4 person-years (PYs) of follow-up (incidence rate 7.5/100 PYs, 95% CI: 4.3 to 12.2). Being enrolled in Paris was associated with a significant increased risk of HIV infection (RR: 4.1; 95% CI: 1.1 to 28.3). A high number of sexual partners in prior 2 months (≥10 vs <5) and of condomless receptive anal sex episodes in prior 12 months (>5 vs ConclusionsMSM who have frequent condomless receptive anal sex and multiple partners, or use recreational drugs should be targeted in priority for PrEP prescription especially if they live in an area with a high prevalence of HIV infection.

Published
2021
Full Text
View/download PDF

3. Rapid antiretroviral therapy initiation and its effect on treatment response in MSM in West Africa

Author

Paméla Palvadeau, Bintou Dembélé Keita, Camille Anoma, Marion Mora, Christian Laurent, Jean-Baptiste Malan Kouamé, Issa Traoré, Ephrem Mensah, Issifou Yaya, Alou Coulibaly, Bruno Spire, Ter Tiero Elias Dah, Association African Solidarité [Ouagadougou, Burkina Faso], Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Muraz [Bobo-Dioulasso, Burkina Faso], Espoir Vie Togo [Lomé, Togo], ARCAD Santé PLUS [Bamako, Mali], Espace Confiance [Abidjan, Côte d’Ivoire], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Coalition Internationale Sida [Pantin, France] (Programme Recherche Communautaire), CohMSM Study Group, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), and Malbec, Odile

Subjects
attrition, Male, medicine.medical_specialty, viral suppression, [SDV]Life Sciences [q-bio], Immunology, Population, antiretroviral, antiretroviral therapy, MEDLINE, men, HIV Infections, law.invention, Men who have sex with men, West africa, Sexual and Gender Minorities, Randomized controlled trial, law, Burkina Faso, West Africa, medicine, Immunology and Allergy, Humans, MSM, Prospective Studies, Homosexuality, Male, education, Editorial Comments, education.field_of_study, business.industry, HIV, Antiretroviral therapy, [SDV] Life Sciences [q-bio], Infectious Diseases, Family medicine, Africa, Observational study, business, Viral load
Abstract

Early antiretroviral therapy (ART) initiation reduces HIV-related morbidity and mortality, and contributes to HIV transmission prevention by rapidly suppressing HIV viral load [1–4]. It can also help to control the RNA reservoir when treatment is initiated during the acute HIV infection [5–7]. Since September 2015, the WHO has recommended ART for all adults and adolescents living with HIV, irrespective of WHO clinical stage and CD4+ cell count [8]. In July 2017, WHO updated its treatment guidelines by recommending rapid ART initiation – defined as commencing ART within 7 days of HIV diagnosis – for the above groups, including same-day initiation for people ready to start treatment [9,10]. A systematic review of seven randomized controlled trials in adults aged 18 years or older, showed that rapid ART initiation improved ART uptake, viral load suppression and retention in care at 12 months [11–18]. However, the authors concluded that pragmatic research is needed to validate the effects observed in trials when rapid ART initiation is implemented in health systems. In contrast to trials, recent observational studies in Southern Africa found that same-day ART initiation was associated with lower retention in care [19–21]. In West Africa, the HIV epidemic is concentrated in key populations – including MSM – which together with their sexual partners represented 69% of all new HIV infections in 2019 [22]. Unfortunately, access to and retention in HIV prevention and care services for West African MSM are particularly low [23,24], due in part to social and legal barriers (homophobia, stigmatization, discrimination, violence and criminalization of same-sex relationships) [25,26]. Therefore, studies on the effects of care strategies in this population are needed to improve their management by informing policy. In particular, data on rapid ART initiation and its effect on treatment outcomes are lacking. The CohMSM study was designed to assess the feasibility and benefit of implementing quarterly HIV prevention and care services for MSM in Burkina Faso, Cote d’Ivoire, Mali, and Togo. One of its features was to propose ART initiation to MSM as soon as possible after HIV diagnosis, irrespective of their clinical stage and CD4+ cell count. As the study began in June 2015, rapid ART initiation was not considered, as the latter practice was only recommended by the WHO in 2017. National guidelines in all four study countries adopted the universal treatment strategy in 2018–2019 but rapid ART initiation was included only in Mali's guidelines (the other countries did not specify a specific time for initiation) [27–30]. In the present analysis, we assessed the time from HIV diagnosis to ART initiation and the effect of rapid ART initiation on attrition and virologic and immunologic responses among MSM participating in CohMSM. In addition, we assessed the effect of same-day ART initiation on the same treatment outcomes.

Published
2021
Full Text
View/download PDF

4. Evolution of Condom Use Among a 5-Year Cohort of Female Sex Workers in Zambia

Author

Amanda Tichacek, Luis Sagaon-Teyssier, William Kilembe, Kalonde Malama, Kristin M. Wall, Tyronza Sharkey, Susan Allen, Bruno Spire, Mubiana Inambao, Matthew Price, Rachel Parker, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Rwanda-Zambia HIV Research Group, IAVI Global Headquarters [New-York, NY, USA], University of California [San Francisco] (UC San Francisco), University of California (UC), Emory University [Atlanta, GA], and Malbec, Odile

Subjects
medicine.medical_specialty, Social Psychology, [SDV]Life Sciences [q-bio], Sexual Behavior, Psychological intervention, Sexually Transmitted Diseases, Zambia, HIV Infections, Article, law.invention, Condoms, Condom, law, Medicine, Humans, Condom use, Female sex workers, Risk behaviour, Sex Workers, business.industry, Public health, Public Health, Environmental and Occupational Health, virus diseases, Female sex, [SDV] Life Sciences [q-bio], Health psychology, Infectious Diseases, Cohort, Female, Consistent condom, Cohort study, business, Demography
Abstract

International audience; Observing sexual behaviour change over time could help develop behavioural HIV prevention interventions for female sex workers in Zambia, where these interventions are lacking. We investigated the evolution of consistent condom use among female sex workers and their clients and steady partners. Participants were recruited into an HIV incidence cohort from 2012 to 2017. At each visit, women received HIV counselling and testing, screening for sexually transmitted infections (STIs) and free condoms. Our outcome was reported consistent (100%) condom use in the previous month with steady partners, repeat clients, and non-repeat clients. Consistent condom use at baseline was highest with non-repeat clients (36%) followed by repeat clients (27%) and steady partners (17%). Consistent condom use between baseline and Month 42 increased by 35% with steady partners, 39% with repeat clients and 41% with non-repeat clients. Access to condoms, HIV/STI counselling and testing promoted positive sexual behaviour change.

Published
2021
Full Text
View/download PDF

5. Becoming adherent to a preventive treatment for HIV: a qualitative approach

Author

Claire Pintado, Eric Cua, Julie Chas, Costanza Puppo, Bruno Spire, Marie Suzan-Monti, Vanessa Laguette, Jean-Michel Molina, Xavier Mabire, Daniela Rojas Castro, Marie Préau, Stéphane Morel, Hôpital l'Archet, Hopital Saint-Louis [AP-HP] (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), AIDES Association [France], Centre de Recherche en Psychologie : Cognition, Psychisme et Organisations - UR UPJV 7273 (CRP-CPO), Université de Picardie Jules Verne (UPJV), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Coalition PLUS [Pantin, France], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Universitaire de Nice (CHU Nice), Service de maladies infectieuses et tropicales [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], ANRS (France Recherche Nord & Sud Sida-HIV Hépatites) and funded by the ANRS and the Fonds de dotation Pierre Bergé pour la Prévention – SIDACTION, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], and HAL AMU, Administrateur

Subjects
Adult, Male, medicine.medical_specialty, Anti-HIV Agents, Human immunodeficiency virus (HIV), HIV Infections, coping strategies, medicine.disease_cause, Medication Adherence, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, prevention, stigmatization, On demand, medicine, Humans, adherence, 030212 general & internal medicine, PrEP intake, Qualitative Research, ComputingMilieux_MISCELLANEOUS, Applied Psychology, 030505 public health, business.industry, HIV, Focus Groups, 3. Good health, Clinical trial, Psychiatry and Mental health, Clinical Psychology, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, Pre-Exposure Prophylaxis, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 0305 other medical science, business, qualitative methods, Qualitative research
Abstract

The clinical trial ANRS-IPERGAY investigated the efficacy of sexual activity-based (i.e. on demand) HIV pre-exposure prophylaxis (PrEP). Using a qualitative method, we analysed the role of adherence as one of the main elements for PrEP effectiveness and its associated determinants. Data were collected in various French ANRS-IPERGAY sites during the double-blind (2012-2014) and open-label study (2015-2016) phases, through two individual interviews per participant, collective interviews and focus groups. A total of 83 participants participated in the present study. Our analysis included 32 individual interviews (with 16 participants), 13 collective interviews (

Published
2019
Full Text
View/download PDF

6. Factors Associated with Virological Rebound in HIV-Positive Sub-Saharan Migrants Living in France After Traveling Back to Their Native Country: ANRS-VIHVO 2006–2009 Study

Author

Jean-Médard Kankou, Olivier Bouchaud, Maria Patrizia Carrieri, Sophie Abgrall, Bruno Spire, Nathalie Lele, Marguerite Guiguet, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Parcours santé systémique (P2S), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Service des maladies infectieuses et tropicales, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13), Université de Lyon, Université Paris 13 (UP13), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sorbonne Université (SU), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU), ORS PACA, Hôpital Antoine Béclère, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and Gestionnaire, Hal Sorbonne Université

Subjects
Adult, Male, medicine.medical_specialty, Sub saharan, Anti-HIV Agents, Epidemiology, [SDV]Life Sciences [q-bio], Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Logistic regression, Medication Adherence, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Health care, medicine, Humans, 030212 general & internal medicine, Structural barriers, Africa South of the Sahara, Travel, 030505 public health, Sub-Saharan Africa, business.industry, Public health, Public Health, Environmental and Occupational Health, HIV, Migrant, Middle Aged, Viral Load, Country of origin, Antiretroviral therapy, 3. Good health, [SDV] Life Sciences [q-bio], Regimen, Virological rebound, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, 0305 other medical science, business, Demography
Abstract

International audience; In France, around 25% of the estimated number of people living with HIV are migrants, of whom three quarters are from sub-Saharan Africa (SSA). Our objective was to determine factors associated with virological rebound (VR) at the occasion of a transient stay to the country of origin. HIV-positive migrants from SSA participating to the ANRS-VIHVO adherence study between 2006 and 2009, on effective ART with controlled pre-travel HIV-1 plasma viral load (VL), were included. Outcome was VR, defined as VL ≥ 50 copies/ml at the post-travel visit during the week following the return to France. Among 237 persons (61.6% female, median age 41 years (IQR, 35–47), median time on ART 4.2 years (IQR, 2.2–7.1), 27 (11.4%) experienced VR. The main purpose of the travel was to visit family and median time spent abroad was 5.3 weeks (IQR, 4.1–8.8). The travel was extended longer than anticipated by at least 1 week in 42 individuals (17.7%). In multivariable logistic model, risk factors for VR were male sex [adjusted OR (aOR) 5.1; 95% CI 1.6–16.2)], no employment in France (aOR 2.0; 1.2–3.5), self-reported non-adherence during the trip (aOR 14.9; 4.9–45.9) and PI-containing regimen (aOR 4.6; 1.2–17.6). In another analysis not including self-reported adherence, traveling during Ramadan while respecting the fast (aOR 3.3; 1.2–9.6) and extension of the stay (aOR 3.0; 1.1–7.8) were associated with VR. Virological rebound was partly explained by structural barriers to adherence such as extension of the travel and inadequate management of Ramadan fasting. Individuals’ journeys should be carefully planned with health care providers.

Published
2019
Full Text
View/download PDF

7. Individual and healthcare supply-related barriers to treatment initiation in HIV-positive patients enrolled in the Cameroonian antiretroviral treatment access programme

Author

M Ngo Tonye, R B Pallawo, Issiakou Adamou, I Wandji, P Momo, B Spire, E Mpoudi-Ngolé, N Manga, E Njom Nlend, J M Bob Oyono, E Kamto, G Touko, B Fangam Molu, D Eloundou, H Mossi, M Tsoungi Akoa, U Olinga, H Meli, G Maradan, Pierre-Julien Coulaud, Laurent Vidal, M Ndam, R Garcia, J D Ngan Bilong, A Guterrez, Boyer, Christopher Kuaban, E Delaporte, C Tong, A P Meledie Ndjong, Y Perfura, C Nouboue, A Mafuta, G Tchatchoua, J Dissongo, N Noumssi, S Omgnesseck, J J Ze, Christian Laurent, Bruno Spire, O Ossanga, F Chabrol, C Ewolo, A Ambani, S Boyer, E Belley Priso, M C Kuitcheu, M Fokoua, E Kouakam, L J G Buffeteau, H Essama Owona, Khadim Ndiaye, S Eymard-Duvernay, Sylvie Boyer, F Liégeois, C Tchimou, M Mora, J D Noah, S Beke, E Abeng Mbozo’o, L R Njock, L March, M J Gomez, J Djene, C Danwe, Camelia Protopopescu, S Ngwane, H Fokam, E Soh, C Ndjie Essaga, O Kouambo, C Laurent, G Temgoua, M T Mengue, Gwenaëlle Maradan, Maël Baudoin, A Simo Ndongo, D S.Maninzou, L Ndalle, B Taman, Ida Penda, M Mpoudi Ngole, C Biloa, Ngam Engonwei, E H Moby, J Meli, L J Bitang, M Mbangue, L Ayangma, P Thumerel, O Ndalle, B Mbatchou, M Suzan-Monti, M Mgantcha, A L Mawe, S Abia, J Hachu, H Nyemb, P J Fouda, L Sagaon-Teyssier, H Hadja, L Ngum, F Ndoumbe, Y Mapoure, H Abessolo, I Ngo, A Yeffou, C Bondze, J Lindou, A Malongue, C Kouanfack, M de Sèze, P Ateba, Z Nanga, B Takou, M Defo, E C Njitoyap Ndam, C Ejangue, A Nono Toche, I Seyep, Yoyo Ngongang, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Yaoundé I, EVOLCam Group: G Maradan, A Ambani, O Ndalle, P Momo, C Tong, S Boyer, V Boyer, L March, M Mora, L Sagaon-Teyssier, M de Sèze, B Spire, M Suzan-Monti, C Laurent, F Liégeois, E Delaporte, V Boyer, S Eymard-Duvernay, F Chabrol, E Kouakam, O Ossanga, H Essama Owona, C Biloa, M-T Mengue, E Mpoudi-Ngolé, P J Fouda, C Kouanfack, H Abessolo, N Noumssi, M Defo, H Meli, Z Nanga, Y Perfura, M Ngo Tonye, O Kouambo, U Olinga, E Soh, C Ejangue, E Njom Nlend, A Simo Ndongo, E Abeng Mbozo'o, M Mpoudi Ngole, N Manga, C Danwe, L Ayangma, B Taman, E C Njitoyap Ndam, B Fangam Molu, J Meli, H Hadja, J Lindou, J M Bob Oyono, S Beke, D Eloundou, G Touko, J J Ze, M Fokoua, L Ngum, C Ewolo, C Bondze, J D Ngan Bilong, D S Maninzou, A Nono Toche, M Tsoungi Akoa, P Ateba, S Abia, A Guterrez, R Garcia, P Thumerel, E Belley Priso, Y Mapoure, A Malongue, A P Meledie Ndjong, B Mbatchou, J Hachu, S Ngwane, J Dissongo, M Mbangue, Ida Penda, H Mossi, G Tchatchoua, Yoyo Ngongang, C Nouboue, I Wandji, L Ndalle, J Djene, M J Gomez, A Mafuta, M Mgantcha, E H Moby, M C Kuitcheu, A L Mawe, Ngam Engonwei, L J Bitang, M Ndam, R B Pallawo, Issiakou Adamou, G Temgoua, C Ndjie Essaga, C Tchimou, A Yeffou, I Ngo, H Fokam, H Nyemb, L R Njock, S Omgnesseck, E Kamto, B Takou, L J-G Buffeteau, F Ndoumbe, J-D Noah, I Seyep, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and Herrada, Anthony

Subjects
Adult, medicine.medical_specialty, Anti-HIV Agents, 030231 tropical medicine, HIV Infections, Disease, Disease cluster, 03 medical and health sciences, 0302 clinical medicine, healthcare supply-related factors, Interquartile range, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Health care, medicine, Humans, 030212 general & internal medicine, Cameroon, Proportional hazards model, business.industry, Health Policy, Hazard ratio, HIV, Hepatitis B, medicine.disease, 3. Good health, time to ART initiation, Cross-Sectional Studies, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Population study, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Delivery of Health Care, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Increasing demand for antiretroviral treatment (ART) together with a reduction in international funding during the last decade may jeopardize access to ART. Using data from a cross-sectional survey conducted in 2014 in 19 HIV services in the Centre and Littoral regions in Cameroon, we investigated the role of healthcare supply-related factors in time to ART initiation in HIV-positive patients eligible for ART at HIV diagnosis. HIV service profiles were built using cluster analysis. Factors associated with time to ART initiation were identified using a multilevel Cox model. The study population included 847 HIV-positive patients (women 72%, median age: 39 years). Median (interquartile range) time to ART initiation was 1.6 (0.5–4.3) months. Four HIV service profiles were identified: (1) small services with a limited staff practising partial task-shifting (n = 4); (2) experienced and well-equipped services practising task-shifting and involving HIV community-based organizations (n = 5); (3) small services with limited resources and activities (n = 6); (4) small services providing a large range of activities using task-shifting and involving HIV community-based organizations (n = 4). The multivariable model showed that HIV-positive patients over 39 years old [hazard ratio: 1.26 (95% confidence interval) (1.09–1.45), P = 0.002], those with disease symptoms [1.21 (1.04–1.41), P = 0.015] and those with hepatitis B co-infection [2.31 (1.15–4.66), P = 0.019] were all more likely to initiate ART early. However, patients in the first profile were less likely to initiate ART early [0.80 (0.65–0.99), P = 0.049] than those in the second profile, as were patients in the third profile [association only significant at the 10% level; 0.86 (0.72–1.02), P = 0.090]. Our findings provide a better understanding of the role played by healthcare supply-related factors in ART initiation. In HIV services with limited capacity, task-shifting and support from community-based organizations may improve treatment access. Additional funding is required to relieve healthcare supply-related barriers and achieve the goal of universal ART access.

Published
2021
Full Text
View/download PDF

8. Assessment of mental health outcomes and associated factors among workers in community-based HIV care centers in the early stage of the COVID-19 outbreak in Mali

Author

Bintou Dembélé Keita, Gwenaëlle Maradan, Michel Bourrelly, Luis Sagaon-Teyssier, Aliou Kamissoko, Mamadou Cisse, Fabrice Pouradier, Fodié Diallo, Rosemary M. Delabre, Bruno Spire, Adam Yattassaye, Laurent Vidal, Daniela Rojas Castro, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), ARCAD Santé PLUS [Bamako, Mali], Coalition PLUS [Pantin, France] (Community Research Laboratory Pantin), Hôpital Simone Veil [Eaubonne], Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), and Dupuis, Christine

Subjects
medicine.medical_specialty, [SDV]Life Sciences [q-bio], education, MEDLINE, Mali, Article, 03 medical and health sciences, 0302 clinical medicine, Health care, Medicine, Healthcare workers, 030212 general & internal medicine, Health policy, Depression (differential diagnoses), business.industry, Public health, Outbreak, COVID-19, HIV, Mental health, 3. Good health, [SDV] Life Sciences [q-bio], Family medicine, Anxiety, medicine.symptom, Public aspects of medicine, RA1-1270, business, 030217 neurology & neurosurgery
Abstract

International audience; Background and objectives: In Mali, the non-governmental association (NGO) ARCAD Santé PLUS launched the CovidPrev program in response to the COVID-19 outbreak to ensure continuity of HIV care-related activities. This study aimed to identify individual and structural factors associated with mental health disorders (MHD) in the NGO's healthcare workers (HCW) in the early stage of the outbreak.Methods: Data were collected between April 6 and 11, 2020 for 135 HCW in ARCAD Santé PLUS's 18 community-based HIV care centers. Outcomes corresponded to the PHQ-9, GAD-7 and ISI instruments for depression, anxiety and insomnia, respectively. A general mixture model with a negative binomial distribution was implemented.Results: Most HCW were men (60.7%) and median age was 40 years IQR[33-46]. Symptoms of depression, anxiety and insomnia were declared by 71.9, 73.3, and 77% participants, respectively. Women were at greater risk of MHD. A lack of personal protection equipment and human resources, especially nurses, was associated with a high risk of MHD.Conclusions: Health policy must place non-front line HCW, including those in NGOs, at the core of the healthcare system response to the COVID-19 outbreak, as they ensure continuity of care for many diseases including HIV. The efficacy of public health strategies depends on the capacity of HCW to fully with and competently perform their duties.

Published
2020
Full Text
View/download PDF

9. The COVID-19 response must integrate people living with HIV needs in Sub-Saharan Africa: the case of Mali

Author

Michel Bourrelly, Bintou Dembélé Keita, Adam Yattassaye, Bruno Spire, Luis Sagaon-Teyssier, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), ARCAD Santé PLUS [Bamako, Mali], and Dupuis, Christine

Subjects
medicine.medical_specialty, Economic growth, Sub saharan, lcsh:Arctic medicine. Tropical medicine, Coronavirus disease 2019 (COVID-19), lcsh:RC955-962, [SDV]Life Sciences [q-bio], 030231 tropical medicine, Human immunodeficiency virus (HIV), Context (language use), medicine.disease_cause, Mali, 03 medical and health sciences, 0302 clinical medicine, Political science, Health care, medicine, 030212 general & internal medicine, HIV continuum of care, Letter to the Editor, Public health, business.industry, Public Health, Environmental and Occupational Health, COVID-19 prevention, Outbreak, NGO, 3. Good health, [SDV] Life Sciences [q-bio], implication, Infectious Diseases, NGO implication, Continuity of care, business
Abstract

The first COVID-19 cases in Mali were reported almost 1 month after the first case in the African continent. However, the outbreak continues to spread faster there than in other countries which, along with Mali, successfully tackled the 2014 Ebola outbreak in Africa. Given this context, specific actions targeting people living with HIV (PLWH) are needed to reinforce prevention. Community-based involvement is crucial to ensure continuity of care and treatment for PLWH. Furthermore, the health of frontline healthcare workers must take priority in any actions taken. The long-established trustful relationship between NGOs and PLWH in Mali is indispensable to disseminate key messages about COVID-19.

Published
2020
Full Text
View/download PDF

10. Evaluation of Drug Abuse by Hair Analysis and Self-Reported Use Among MSM Under PrEP: Results From a French Substudy of the ANRS-IPERGAY Trial

Author

Jean-Michel Molina, Islam Amine Larabi, Laurent Cotte, Catherine Capitant, Eric Cua, Jean-Claude Alvarez, Julie Chas, François Raffi, Armelle Pasquet, Gilles Pialoux, Gilles Peytavin, Bruno Spire, Rebecca Bauer, Perrine Roux, Laurence Meyer, CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Raymond Poincaré [AP-HP], Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Service d'infectiologie [CHU Nice], Centre Hospitalier Universitaire de Nice (CHU Nice), Service de Maladies Infectieuses et Tropicales [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service des Maladies Infectieuses et Tropicales [Hôpital Gustave Dron, Tourcoing], Centre Hospitalier Gustave Dron [Tourcoing], Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)

Subjects
Drug, Adult, Male, medicine.medical_specialty, Anti-HIV Agents, Substance-Related Disorders, media_common.quotation_subject, Sexual Behavior, Ecstasy, Sexually Transmitted Diseases, HIV Infections, 030312 virology, Men who have sex with men, Drug detection, 03 medical and health sciences, Sexual and Gender Minorities, Internal medicine, Surveys and Questionnaires, Prevalence, Medicine, Humans, Pharmacology (medical), Homosexuality, Male, Sida, media_common, 0303 health sciences, Harm reduction, biology, Unsafe Sex, business.industry, Hair analysis, medicine.disease, biology.organism_classification, Substance abuse, Infectious Diseases, Sexual Partners, Hair Analysis, Pre-Exposure Prophylaxis, Self Report, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

BACKGROUND We used the Agence nationale de Recherches sur le sida et les hepatites virales (ANRS)-IPERGAY trial to qualitatively and quantitatively measure drug use among men who have sex with men under preexposure prophylaxis using 2 different methods, to better understand and collectively respond to risky practices. METHOD We included 69 volunteers of the ANRS-IPERGAY trial. We measured drug use by 2 methods: (1) drug detection by hair analysis and (2) reported drug use by self-reported drug consumption. RESULTS New psychoactive substances (NPS) and conventional drugs were detected in 53 of the 69 (77%) volunteers by hair analysis and in 39 of the 69 (57%) volunteers by questionnaires. On the 219 hair segments analyzed, the most commonly used drugs were cocaine in 47 of the 69 (68%), 3,4-methylenedioxymethamphetamine/ecstasy in 31 of the 69 (45%), and NPS in 27 of the 69 (39%). On the 1061 collected questionnaires, the most commonly used drugs were cocaine in 31 of the 69 (45%), 3,4-methylenedioxymethamphetamine/ecstasy in 29 of the 69 (42%), and NPS in 16 of the 69 (23%). Hair analysis detects more conventional drugs and/or NPS use (P < 0.05). Drug use identified by hair was significantly associated with a higher number of sexual partners in the past 2 months (P ≤ 0.001), more often casual partners (P ≤ 0.001), condomless anal sex (P ≤ 0.005), hardcore sexual practices (P ≤ 0.001), a higher number of sexually transmitted infections, and chemsex (P ≤ 0.05). CONCLUSIONS Self-report drug use by questionnaires remains the reference tool for harm reduction at the individual level because of its feasibility and low cost. However, hair analysis is more sensitive, objectively assessing consumption, and interesting to understand uses and to be able to collectively respond to risky practices with adapted messages.

Published
2020
Full Text
View/download PDF

11. Characterization of Physicians That Might Be Reluctant to Propose HIV Cure-Related Clinical Trials with Treatment Interruption to Their Patients? The ANRS-APSEC Study

Author

Marie Suzan-Monti, Laurence Meyer, Lisa Fressard, Christel Protière, Marion Mora, Bruno Spire, Marie Préau, Jean-Daniel Lelièvre, Olivier Lambotte, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Immunologie des maladies virales, auto-immunes, hématologiques et bactériennes (IMVA-HB), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Service de Médecine Interne - Immunologie Clinique [AP-HP Bicêtre], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Infectious Diseases Models for Innovative Therapies (IDMIT), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Institut des Maladies Emergentes et des Thérapies Innovantes (IMETI), The Apsec Study Group, and Dupuis, Christine

Subjects
0301 basic medicine, medicine.medical_specialty, physicians, principal component analysis, [SDV]Life Sciences [q-bio], Immunology, Human immunodeficiency virus (HIV), HIV cure-related clinical trials, lcsh:Medicine, Scientific literature, medicine.disease_cause, Article, analytical treatment interruption studies, 03 medical and health sciences, 0302 clinical medicine, Drug Discovery, medicine, Antiretroviral treatment, Pharmacology (medical), 030212 general & internal medicine, Hiv transmission, Pharmacology, business.industry, lcsh:R, Viewpoints, Continuous training, 3. Good health, HIV cure research, [SDV] Life Sciences [q-bio], Clinical trial, 030104 developmental biology, Infectious Diseases, Treatment interruption, Family medicine, multivariable linear regression, business, viewpoints
Abstract

International audience; HIV cure-related clinical trials (HCRCT) with analytical antiretroviral treatment interruptions (ATIs) have become unavoidable. However, the limited benefits for participants and the risk of HIV transmission during ATI might negatively impact physicians' motivations to propose HCRCT to patients. Between October 2016 and March 2017, 164 French HIV physicians were asked about their level of agreement with four viewpoints regarding HCRCT. A reluctance score was derived from their answers and factors associated with reluctance identified. Results showed the highest reluctance to propose HCRCT was among physicians with a less research-orientated professional activity, those not informing themselves about cure trials through scientific literature, and those who participated in trials because their department head asked them. Physicians' perceptions of the impact of HIV on their patients' lives were also associated with their motivation to propose HCRCT: those who considered that living with HIV means living with a secret were more motivated, while those worrying about the negative impact on person living with HIV's professional lives were more reluctant. Our study highlighted the need to design a HCRCT that minimizes constraints for participants and for continuous training programs to help physicians keep up-to-date with recent advances in HIV cure research.

Published
2020
Full Text
View/download PDF

12. Who are the persons living with HIV who might refuse to participate in HIV cure-related clinical trials with treatment interruption?

Author

Marie Préau, Jean-Daniel Lelièvre, Olivier Lambotte, Abdourahmane Sow, Bruno Spire, Lisa Fressard, Marion Mora, Marie Suzan-Monti, Christel Protière, Marion Fiorentino, and Laurence Meyer

Subjects
0301 basic medicine, medicine.medical_specialty, Biomedical Research, Anti-HIV Agents, Immunology, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Immunology and Allergy, Medicine, Humans, In patient, 030212 general & internal medicine, Intensive care medicine, Clinical Trials as Topic, business.industry, Therapeutic Human Experimentation, 3. Good health, Clinical trial, 030104 developmental biology, Infectious Diseases, Treatment interruption, Patient Participation, business
Abstract

Achieving a HIV cure has become a research priority. As any improvement of knowledge, which could help scientists design new HIV cure-related clinical trials (HCRCT) depends on the risks potential participants are willing to accept, it is important to understand who will agree or refuse to participate and in which proportions. By providing insights into factors associated with reluctance toward HCRCT participation, our results may help clinicians in patient recruitment.

Published
2020

13. How PrEP users constitute a community in the MSM population through their specific experience and management of stigmatization. The example of the French ANRS-PREVENIR study

Author

J. Ghosn, Stéphane Morel, Dominique Costagliola, Xavier Mabire, Costanza Puppo, Marie Préau, Bruno Spire, M. Genin, D Rojas Castro, Lydie Beniguel, Jean-Michel Molina, Dupuis, Christine, Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), AIDES [Pantin, France], Coalition PLUS [Pantin, France] (Community Research Laboratory Pantin), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Service de maladies infectieuses et tropicales [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP)

Subjects
Male, Safe Sex, MESH: Sexual Behavior, Health (social science), [SDV]Life Sciences [q-bio], Social Stigma, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, 0302 clinical medicine, Social Norms, MESH: Sexual Partners, 030212 general & internal medicine, Prospective Studies, MESH: Anti-HIV Agents, Prospective cohort study, MESH: Qualitative Research, Qualitative Research, education.field_of_study, virus diseases, MESH: HIV Infections, Group dynamic, Focus Groups, MESH: Social Norms, PrEP, [SDV] Life Sciences [q-bio], Sexual Partners, MESH: Risk-Taking, community, France, 0305 other medical science, MESH: Social Stigma, Adult, medicine.medical_specialty, Social Psychology, Anti-HIV Agents, Sexual Behavior, Population, MESH: Stereotyping, Stigma (botany), MESH: Safe Sex, MESH: Homosexuality, Male, 03 medical and health sciences, Risk-Taking, medicine, Humans, Homosexuality, Male, education, Stereotyping, 030505 public health, MESH: Humans, business.industry, Public Health, Environmental and Occupational Health, HIV, MESH: Adult, MESH: Male, MESH: Prospective Studies, MESH: France, stigma, Family medicine, group dynamics, Pre-Exposure Prophylaxis, MESH: Focus Groups, business, Qualitative research, qualitative methods, MESH: Pre-Exposure Prophylaxis
Abstract

International audience; The ANRS-PREVENIR (2017-2020) prospective cohort study aims to reduce the number of new HIV infections in the "Ile-de-France" region in France, by enrolling individuals at high risk of HIV infection and proposing daily and on-demand pre-exposure prophylaxis (PrEP). The qualitative component of the ANRS-PREVENIR study aimed to investigate social and relational evolutions associated with PrEP use in men who have sex with men (MSM). In 2018, 12 focus groups with MSM (n = 68) were conducted by a social sciences researcher in Paris. A thematic analysis was performed. Results showed that stigma concerning PrEP use is a complex issue, with various kinds of stigmatization being practiced, sometimes even by the wider MSM population and PrEP users themselves. All types of stigma identified were expressed in forms of verbal abuse which made PrEP use taboo. Inside the wider MSM population a PrEP-user "community" was identified which shared a certain complicity in terms of values and a positive attitude towards PrEP. The emergence of new intragroup and intergroup social norms should be taken into account by policy makers to promote a more positive image of PrEP users.

Published
2020
Full Text
View/download PDF

14. Reaching a Different Population of MSM in West Africa With the Integration of PrEP Into a Comprehensive Prevention Package (CohMSM-PrEP ANRS 12369—Expertise France)

Author

Camille Anoma, Daniela Rojas Castro, Luis Sagaon-Teyssier, Gwenaëlle Maradan, Bintou Dembélé Keita, Michel Bourrelly, August Eubanks, Marion Mora, Ephrem Mensah, Issifou Yaya, Ter Tiero Elias Dah, Bruno Spire, Christian Laurent, Lucas Riegel, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), ARCAD-SIDA [Bamako, Mali], Espace Confiance [Abidjan, Côte d’Ivoire], Association African Solidarité [Ouagadougou, Burkina Faso], Centre Muraz [Bobo-Dioulasso, Burkina Faso], Espoir Vie Togo [Lomé, Togo], Coalition PLUS [Pantin, France] (Community Research Laboratory Pantin), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), CohMSM-PrEP Study Group, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), and Dupuis, Christine

Subjects
Male, medicine.medical_specialty, Anti-HIV Agents, media_common.quotation_subject, [SDV]Life Sciences [q-bio], Population, Psychological intervention, HIV Infections, 030312 virology, Men who have sex with men, 03 medical and health sciences, Pre-exposure prophylaxis, Risk Factors, Odds Ratio, Medicine, Humans, Pharmacology (medical), Homosexuality, Homosexuality, Male, 10. No inequality, education, media_common, 0303 health sciences, education.field_of_study, Unsafe Sex, business.industry, 1. No poverty, virus diseases, 16. Peace & justice, 3. Good health, [SDV] Life Sciences [q-bio], Outreach, Africa, Western, Infectious Diseases, Family medicine, Cohort, Pre-Exposure Prophylaxis, business, Peer education
Abstract

International audience; Background: In West Africa, few HIV services target men who have sex with men (MSM). In 2015, the interventional cohort CohMSM started offering a community-based prevention package for MSM. Participants expressed interest in pre-exposure prophylaxis (PrEP) and their eligibility was demonstrated. In 2017, PrEP was added to services already offered as part of a new program, CohMSM-PrEP, which recruited CohMSM participants and new participants. We aimed to determine whether the introduction of PrEP as an additional prevention tool influenced the type of participant signing up for CohMSM-PrEP.Methods: CohMSM-PrEP recruited HIV-negative MSM in community-based clinics in Mali, Cote d'Ivoire, Burkina Faso, and Togo. Quarterly follow-up included free clinical examinations, PrEP, HIV/sexually transmitted infection screening, peer education, condoms, and lubricants. Sociobehavioral data were collected every 3 months using face-to-face questionnaires. Our outcome was participant type: new participants vs CohMSM participants. Logistic regression was performed to identify the factors associated with being a new participant.Results: Of the 524 MSM included in CohMSM-PrEP, 41% were new participants. After adjustment, multivariate analysis showed they were more socioeconomically disadvantaged with financial insecurity, social isolation-including isolation within the MSM community-and riskier sexual practices.Conclusion: The introduction of PrEP as an additional prevention tool and the use of peer-based outreach services over time influenced the type of participant signing up for a community-based HIV prevention cohort in West Africa. Adding these elements to existing interventions in Sub-Saharan Africa could be the key to reaching MSM marginalized from HIV prevention and care programs.

Published
2020
Full Text
View/download PDF

15. Does Quality of Life and Sexual Quality of Life in HIV Patients Differ Between Non-treated HIV Controllers and Treated Patients in the French ANRS VESPA 2 National Survey?

Author

Marion Mora, Laurence Meyer, Costanza Puppo, Olivier Lambotte, Luis Sagaon-Teyssier, Marie Préau, Vanessa Laguette, Faroudy Boufassa, Bruno Spire, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Laboratoire de Psychologie Sociale (LPS), Aix Marseille Université (AMU), Epidemiology and Population Health, Epidemiology of HIV and STI Team (U1018 Inserm ), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Essais Thérapeutiques et Maladies Infectieuses, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Immunologie des Maladies Virales et Autoimmunes (IMVA - U1184), Université Paris-Sud - Paris 11 (UP11)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM), service de Médecine Interne et d'Immunologie Clinique [AP-HP Hôpital Bicêtre], Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris (AP-HP), French Aids National Research Agencies (Grant Number 2012-2), Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and Lissalde, Claire

Subjects
Quality of life, Adult, Male, Gerontology, medicine.medical_specialty, [SDV.IMM] Life Sciences [q-bio]/Immunology, Social Psychology, Sexual Behavior, media_common.quotation_subject, Social Stigma, Stigma (botany), HIV Infections, Cohort Studies, Social group, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, medicine, Humans, 030212 general & internal medicine, 10. No inequality, Normality, media_common, 030505 public health, business.industry, Public health, Public Health, Environmental and Occupational Health, HIV controllers, virus diseases, Middle Aged, Sexual quality of life, humanities, 3. Good health, Health psychology, Infectious Diseases, Anti-Retroviral Agents, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Quality of Life, [SDV.IMM]Life Sciences [q-bio]/Immunology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, Sexual Health, 0305 other medical science, business, Psychosocial, Cohort study
Abstract

International audience; People living with HIV who spontaneously control the virus without antiretroviral treatment are called HIV Controllers and their status places them at the limits of bio-clinical normality. The objective of this study was to investigate an unexplored field: HIV Controllers' quality of life (QOL). Using quantitative methods, we compared the QOL of untreated (by definition) HIV Controllers in the ANRS CO18 HIV Controller cohort study, with the QOL of treated patients in the French national survey ANRS VESPA 2. In particular, the physical, social, mental and sexual dimensions of QOL were examined. Results highlight that perceiving oneself to be ill or healthy is linked to stigma and to a lack of self-identification with a social group. Some components of the QOL were significantly impaired in HIV controllers. This study is the first to investigate this field.

Published
2018
Full Text
View/download PDF

16. Assessement of Awareness of, Concerns and Attitudes Towards HIV-Related Court-Case Sentences in France in a Representative Sample of People Living with HIV (ANRS VESPA2 Survey)

Author

Marie Suzan-Monti, Bruno Spire, Antoine Vilotitch, Rosemary Dray-Spira, Patrick Yeni, Michel Celse, Baptiste Demoulin, Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Conseil national du sida et des hépatites virales [Paris, France], Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Université Paris Diderot - Paris 7 (UPD7), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), The VESPA2 survey was sponsored and funded by the French National Agency for Research on Aids and Viral Hepatitis (ANRS), Grant No. 2010-176., ANRS VESPA2 study group : Lert F, Spire B, Carrieri P, Dray-Spira R, Hamelin C, Lorente N, Préau M, Suzan-Monti M, Mora M, Le Strat Y, Cuzin L, Meyer L, Rojas-Castro D, Fischer H, Allègre T, Mours P, Riou JM, Sordage M, Chennebault JM, Fialaire P, Rabier V, Froidure M, Huguet D, Leduc D, Pichancourt G, Wajsbrot A, Bourdeaux C, Foltzer A, Hoen B, Hustache-Mathieu L, Abgrall S, Barruet R, Bouchaud O, Chabrol A, Mattioni S, Mechai F, Jeantils V, Bernard N, Bonnet F, Hessamfar M, Lacoste D, Malvy D, Mercié P, Morlat P, Paccalin F, Pertusa MC, Pistone T, Receveur MC, Vandenhende MA, Dupont C, Freire Maresca A, Leporrier J, Rouveix E, Dargere S, de la Blanchardière A, Martin A, Noyon V, Verdon R, Rogeaux O, Beytout J, Gourdon F, Laurichesse H, Meier F, Mortier E, Simonpoli AM, Cordier F, Delacroix I, Garrait V, Elharrar B, Dominguez S, Lascaux AS, Lelièvre JD, Levy Y, Melica G, Buisson M, Piroth L, Waldner A, Gruat N, Leprêtre A, de Truchis P, Le Du D, Melchior JC, Sehouane R, Troisvallets D, Blanc M, Boccon-Gibod I, Bosseray A, Brion JP, Durand F, Leclercq P, Marion F, Pavese P, Brottier-Mancini E, Faba L, Roncato-Saberan M, Bollengier-Stragier O, Esnault JL, Leautez-Nainville S, Perré P, Froguel E, Nguessan M, Simon P, Colardelle P, Doll J, Godin-Collet C, Roussin-Bretagne S, Delfraissy JF, Duracinsky M, Goujard C, Peretti D, Quertainmont Y, Marionneau J, Aissi E, Van Grunderbeeck N, Denes E, Ducroix-Roubertou S, Genet C, Weinbreck P, Augustin-Normand C, Boibieux A, Cotte L, Ferry T, Koffi J, Miailhes P, Perpoint T, Peyramond D, Schlienger I, Brunel JM, Carbonnel E, Chiarello P, Livrozet JM, Makhloufi D, Dhiver C, Husson H, Madrid A, Ravaux I, de Severac ML, Thierry Mieg M, Tomei C, Hakoun S, Moreau J, Mokhtari S, Soavi MJ, Faucher O, Ménard A, Orticoni M, Poizot-Martin I, Atoui N, Baillat V, Faucherre V, Favier C, Jacquet JM, Le Moing V, Makinson A, Mansouri R, Merle C, Elforzli N, Allavena C, Aubry O, Besnier M, Billaud E, Bonnet B, Bouchez S, Boutoille D, Brunet C, Feuillebois N, Lefebvre M, Morineau-Le Houssine P, Mounoury O, Point P, Raffi F, Reliquet V, Talarmin JP, Ceppi C, Cua E, Dellamonica P, De Salvador-Guillouet F, Durant J, Ferrando S, Mondain-Miton V, Perbost I, Pillet S, Prouvost-Keller B, Pradier C, Pugliese P, Rahelinirina V, Roger PM, Rosenthal E, Sanderson F, Hocqueloux L, Niang M, Prazuck T, Arsac P, Barrault-Anstett MF, Ahouanto M, Bouvet E, Castanedo G, Charlois-Ou C, Dia Kotuba A, Eid-Antoun Z, Jestin C, Jidar K, Joly V, Khuong-Josses MA, Landgraf N, Landman R, Lariven S, L'hériteau F, Machado M, Matheron S, Michard F, Morau G, Pahlavan G, Phung BC, Prévot MH, Rioux C, Yéni P, Bani-Sadr F, Calboreanu A, Chakvetadze E, Salmon D, Silbermann B, Batisse D, Beumont M, Castiel P, Derouineau J, Eliaszewicz M, Gonzalez G, Jayle D, Karmochkine M, Kousignian P, Pavie J, Pierre I, Weiss L, Badsi E, Bendenoun M, Cervoni J, Diemer M, Durel A, Rami A, Sellier P, Ait-Mohand H, Amirat N, Bonmarchand M, Bourdillon F, Breton G, Caby F, Grivois JP, Katlama C, Kirstetter M, Paris L, Pichon F, Roudière L, Schneider L, Samba MC, Seang S, Simon A, Stitou H, Tubiana R, Valantin MA, Bollens D, Bottero J, Bui E, Campa P, Fonquernie L, Fournier S, Girard PM, Goetschel A, Guyon HF, Lacombe K, Lallemand F, Lefebvre B, Maynard JL, Meyohas MC, Ouazene Z, Pacanowski J, Picard O, Raguin G, Roussard P, Tourneur M, Tredup J, Valin N, Balkan S, Clavel F, de Verdière NC, De Castro N, de Lastours V, Ferret S, Gallien S, Gérard L, Goguel J, Lafaurie M, Lascoux-Combe C, Molina JM, Oksenhendler E, Pintado C, Ponscarme D, Rozenbaum W, Scemla A, Bonnard P, Lassel L, Lebrette MG, Lyavanc T, Mariot P, Missonnier R, Ohayon M, Pialoux G, Treilhou MP, Vincensini JP, Gilquin J, Hadacek B, Nait-Ighil L, Nguyen TH, Sobel A, Viard JP, Zak Dit Zbar O, Aumaître H, Eden A, Ferreyra M, Lopez F, Medus M, Neuville S, Saada M, Blum L, Perfezou P, Arvieux C, Chapplain JM, Revest M, Souala F, Tattevin P, Bord S, Borsa-Lebas F, Caron F, Chapuzet C, Debab Y, Gueit I, Etienne M, Fartoukh C, Feltgen K, Joly C, Robaday-Voisin S, Suel P, Khuong MA, Krausse J, Poupard M, Tran Van G, Cazorla C, Daoud F, Fascia P, Frésard A, Guglielminotti C, Lucht F, Bernard-Henry C, Cheneau C, Lang JM, de Mautort E, Partisani M, Priester M, Rey D, Majerholc C, Zucman D, Assi A, Lafeuillade A, de Jaureguiberry JP, Gisserot O, Aquilina C, du Clary FP, Alvarez M, Chauveau M, Delobel P, Garipuy D, Labau E, Marchou B, Massip P, Mularczyk M, Obadia M, Ajana F, Allienne C, Baclet V, de la Tribonnière X, Huleux T, Melliez H, Meybeck A, Riff B, Valette M, Viget N, Bastides F, Bernard L, Gras G, Guadagnin P, May T, Rabaud C, Dos Santos A, Poinsignon Y, Derradji O, Escaut L, Teicher E, Vittecoq D, Bantsima J, Caraux-Paz P, Patey O., Lissalde, Claire, and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Social Psychology, Social stigma, Cross-sectional study, Social Stigma, Stigma (botany), HIV Infections, 03 medical and health sciences, Discrimination, Psychological, 0302 clinical medicine, Criminalization, 5. Gender equality, Criminal Law, Surveys and Questionnaires, medicine, Humans, 030212 general & internal medicine, 10. No inequality, Psychiatry, Prejudice (legal term), Transients and Migrants, Depressive Disorder, Major, Stereotyping, 030505 public health, Public health, Public Health, Environmental and Occupational Health, HIV, Awareness, Middle Aged, 16. Peace & justice, Health psychology, Cross-Sectional Studies, Sexual Partners, Infectious Diseases, Attitude, Socioeconomic Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Criminal law, Female, Key population, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, 0305 other medical science, Psychology, Prejudice
Abstract

International audience; Some of the 12 criminal trials and sentences in France for HIV transmission in 1998-2011 attracted substantial public attention , with a possible negative impact on people living with HIV (PLWH) through reinforced stigma and discrimination. This analysis aimed to characterize PLWH enrolled in the representative ANRS-VESPA2 survey, aware of and concerned about convictions for HIV transmission. Being a migrant from Sub-Saharan Africa, having difficult socioeconomic conditions, having unprotected sex with one's main partner and concealing one's HIV status were all factors statistically associated with concern about the sentences. Participants tempted to press charges against someone for infecting them were more likely to be younger, women, not living in a couple, unemployed, and to report a major depressive disorder. Concern about HIV-related criminal proceedings among the most vulnerable PLWH do not reflect the actual risk of prosecution they are exposed to. Resumen En Francia, algunos de los 12 juicios y sentencias relacionados con la contaminación del VIH en 1998-2011 suscitaron con-siderablemente el interés público. Esto pudo impactar negativamente las personas viviendo con VIH (PVVIH) aumentando su estigmatización y discriminación. Este análisis busca caracterizar las PVVIH, de la encuesta ANRS-VESPA2, informadas acerca de esos juicios e inquietos por la posibilidad de implicación en uno de ellos. Ser inmigrante subsahariano, las con-diciones socio-económicas desfavorables, las relaciones sexuales no protegidas con la pareja principal, y ocultar el VIH, están asociados a la posibilidad de ser implicados en un juicio. Por otro lado, aquellos que han intentado presentar cargos por contaminación del VIH fueron mayoritariamente jóvenes, mujeres, personas viviendo solas, desempleados, y personas en depresión. Los juicios por contaminación del VIH entre las PVVIH más vulnerables no reflejan el riesgo de acusación al que están expuestos.

Published
2018
Full Text
View/download PDF

17. Efficacy and safety of varenicline for smoking cessation in people living with HIV in France (ANRS 144 Inter-ACTIV): a randomised controlled phase 3 clinical trial

Author

Patrick Mercié, Julie Arsandaux, Christine Katlama, Samuel Ferret, Aurélie Beuscart, Christian Spadone, Claudine Duvivier, Jacques Reynes, Nathalie Wirth, Laetitia Moinot, Antoine Bénard, David Zucman, Xavier Duval, Jean-Michel Molina, Bruno Spire, Catherine Fagard, Geneviève Chêne, Hélène Allaguy-Salachy, Henri-Jean Aubin, Claudine Bernard-Henry, Claude Beuscart, Anne Borgne, Olivier Bouchaud, Charles Brahmy, Dominique Breilh, André Cabié, Claude Cateland, Antoine Cheret, Sandrine Couffin-Cadiergues, Marie-Dominique Dautzenberg, Pierre Dellamonica, Pascale Denis-Kandel, Christine Denis-Vatant, Michel Detilleux, Michel Dupon, Brigitte El Harrar, Marie Christine Fagnen Sylvaire, Simone Guillermet, Christine Jacomet, Vincent Jeantils, Marek Korzek, Estibaliz Lazaro, Béatrice Le Maitre, Frédéric Lucht, Marianne Maquet, Audrey Mathieu, Thierry May, Sonia Merigeaud, Philippe Morlat, Alissa Naqvi, Didier Neau, Jean Perriot, Sandrine Pierre-François, Isabelle Poizot-Martin, Elisabeth Quoix, Matthieu Rebillard, Caroline Roussillon, Eric Rosenthal, Thierry Sainte-Marie, Dominique Salmon-Céron, Luminita Schneider, Anne Simon, Malika Soussi, Albert Sotto, Anne-Marie Taburet, Elina Teicher, Monique Termote, Valery Trosini-Desert, Renaud Verdon, Jean-Paul Viard, Daniel Vittecoq, Muriel Vray, David Youssi, Service de Médecine Interne et Immunologie Clinique [CHU Bordeaux] (Pôle Médecine Interne), CHU Bordeaux [Bordeaux], Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC Bordeaux, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses et tropicales [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de maladies infectieuses et tropicales [Saint-Louis], Université Paris Diderot - Paris 7 (UPD7)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection à VIH, réservoirs, diversité génétique et résistance aux antirétroviraux (ARV) (EA 7327), Université Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Département Maladies Infectieuses et Tropicales, Hôpital Universitaire, Montpellier, France, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service d’information Médicale [CHU de Bordeaux] (Pôle de Santé Publique), Service de Médecine Interne [Hôpital Foch, Suresnes] (SMI), Hôpital Foch [Suresnes], CIC Bichat [AP-HP, Hôpital Bichat-Claude-Bernard] (CIC 1425 Inserm), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Service des Maladies Infectieuses et Tropicales [CHU Saint Louis], Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Génétique et Ecologie des Virus, Génétique des Virus et Pathogénèse des Maladies Virales, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), ANRS 144 Inter-ACTIV study group : Allaguy-Salachy H, Arsandaux J, Aubin HJ, Bénard A, Bernard-Henry C, Beuscart A, Beuscart C, Borgne A, Bouchaud O, Brahmy C, Breilh D, Cabié A, Cateland C, Chêne G, Cheret A, Couffin-Cadiergues S, Dautzenberg MD, Dellamonica P, Denis-Kandel P, Denis-Vatant C, Detilleux M, Dupon M, Duval X, Duvivier C, El Harrar B, Fagard C, Fagnen Sylvaire MC, Ferret S, Guillermet S, Jacomet C, Jeantils V, Katlama C, Korzek M, Lazaro E, Le Maitre B, Lucht F, Maquet M, Mathieu A, May T, Mercié P, Merigeaud S, Moinot L, Molina JM, Morlat P, Naqvi A, Neau D, Perriot J, Pierre-François S, Poizot-Martin I, Quoix E, Rebillard M, Reynes J, Roussillon C, Rosenthal E, Sainte-Marie T, Salmon-Céron D, Schneider L, Simon A, Soussi M, Sotto A, Spadone C, Spire B, Taburet AM, Teicher E, Termote M, Trosini-Desert V, Verdon R, Viard JP, Vittecoq D, Vray M, Wirth N, Youssi D, Zucman D., Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Centre Médical de l'Institut Pasteur (CMIP), Institut Pasteur [Paris] (IP), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Maladies Infectieuses et Tropicales [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Dupuis, Christine

Subjects
Adult, Counseling, Male, medicine.medical_specialty, Epidemiology, medicine.medical_treatment, Immunology, Population, HIV Infections, Placebo, Drug Administration Schedule, law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Double-Blind Method, Randomized controlled trial, law, Virology, Internal medicine, medicine, Humans, Nicotinic Agonists, 030212 general & internal medicine, education, Varenicline, education.field_of_study, 030505 public health, business.industry, Incidence (epidemiology), Smoking, Odds ratio, Middle Aged, 3. Good health, Clinical trial, Treatment Outcome, Infectious Diseases, chemistry, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Smoking cessation, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, 0305 other medical science, business
Abstract

International audience; BACKGROUND:Tobacco smoking is common in people living with HIV, but high-quality evidence on interventions for smoking cessation is not available in this population. We aimed to assess the efficacy and safety of varenicline with counselling to aid smoking cessation in people living with HIV.METHODS:The ANRS 144 Inter-ACTIV randomised, parallel, double-blind, multicentre, placebo-controlled phase 3 trial was done at 30 clinical hospital sites in France. People living with HIV who had smoked at least ten cigarettes per day for 1 year or longer, were motivated to stop smoking, were not dependent on another psychoactive substance, and had no history of depression or suicide attempt were eligible. Using a computer-generated randomisation sequence, we allocated (1:1) the patients to receive either varenicline titrated to two 0·5 mg doses twice daily or placebo twice daily for 12 weeks, plus face-to-face counselling. Patients and investigators were masked to treatment group allocation. Patients who were not abstinent at week 24 were offered open-label varenicline for 12 additional weeks. The primary outcome was the proportion of smokers continuously abstinent from week 9 to week 48. Smoking status was confirmed by carbon monoxide in exhaled air. Primary analyses were done in both the intention-to-treat (ITT) population and modified ITT (mITT) population, which comprised all patients who took at least one tablet of their assigned study treatment. The safety analyses were done in the mITT population. The trial is registered at ClinicalTrials.gov, number NCT00918307. The trial status is complete.FINDINGS:From Oct 26, 2009, to Dec 20, 2012, of 303 patients assessed for eligibility, 248 patients were randomly assigned to the varenicline group (n=123) or the placebo group (n=125). After randomisation, one participant initially assigned to the placebo group was excluded from the ITT analysis for a regulatory reason (no French health-care coverage). 102 patients in the varenicline group and 111 patients in the placebo group received at least one dose of their assigned treatment and were included in the mITT analysis. In the ITT analysis, varenicline was associated with a higher proportion of patients achieving continuous abstinence over the study period (week 9-48): 18 (15%, 95% CI 8-21) of 123 in the varenicline group versus eight (6%, 2-11) of 124 in the placebo group, adjusted odds ratio (OR) 2·5 (95% CI 1·0-6·1; p=0·041). In the mITT analysis, varenicline was also associated with higher continuous abstinence: 18 (18%, 95% CI 10-25) of 102 versus eight (7%, 2-12) of 111 in the placebo group (adjusted OR 2·7, 95% CI 1·1-6·5; p=0·029). The incidence of depression was 2·4 per 100 person-years (95% CI 0·6-9·5; two [2%] of 102) in the varenicline group and 12·4 per 100 person-years (95% CI 6·9-22·5; 11 [10%] of 111) in the placebo group. 14 (7%) of 213 participants had 18 cardiovascular events: six (6%) of 102 people in the varenicline group and eight (7%) of 111 people in the placebo group.INTERPRETATION:Varenicline is safe and efficacious for smoking cessation in people living with HIV and should be recommended as the standard of care.FUNDING:The French National Institute for Health and Medical Research (INSERM)-French National Agency for Research on AIDS and Viral Hepatitis (ANRS) and Pfizer.

Published
2018
Full Text
View/download PDF

18. Protective effect of coffee consumption on all-cause mortality of French HIV-HCV co-infected patients

Author

Eric Rosenthal, Silvia Rosellini, Linda Wittkop, Dominique Salmon-Ceron, Isabelle Poizot-Martin, Laure Esterle, François Raffi, Bruno Spire, Maria Patrizia Carrieri, David Zucman, Fabienne Marcellin, Camelia Protopopescu, and François Dabis

Subjects
Adult, Male, medicine.medical_specialty, Population, HIV Infections, Coffee, 03 medical and health sciences, 0302 clinical medicine, Cause of Death, Internal medicine, Humans, Medicine, Prospective Studies, 030212 general & internal medicine, education, Prospective cohort study, Aged, Proportional Hazards Models, Cause of death, education.field_of_study, Hepatology, Coinfection, business.industry, Mortality rate, Hazard ratio, Hepatitis C, Middle Aged, medicine.disease, Surgery, Cohort, Female, 030211 gastroenterology & hepatology, business
Abstract

Background & Aims Coffee has anti-inflammatory and hepato-protective properties. In the general population, drinking ≥3cups of coffee/day has been associated with a 14% reduction in the risk of all-cause mortality. The aim of this study was to investigate the relationship between coffee consumption and the risk of all-cause mortality in patients co-infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Methods ANRS CO13 HEPAVIH is an ongoing French nationwide prospective cohort of patients co-infected with HIV-HCV collecting both medical and psychosocial/behavioural data (annual self-administered questionnaires). We used a Cox proportional hazards model to estimate the effect of elevated coffee consumption (≥3cups/day) at baseline on all-cause mortality during the cohort's five-year follow-up. Results Over a median [interquartile range] follow-up of 5.0 [3.9–5.9] years, 77 deaths occurred among 1,028 eligible patients (mortality rate 1.64/100 person-years; 95% confidence interval [CI] 1.31–2.05). Leading causes of death were HCV-related diseases (n=33, 43%), cancers unrelated to AIDS/HCV (n=9, 12%), and AIDS (n=8, 10%). At the first available visit, 26.6% of patients reported elevated coffee consumption. Elevated coffee consumption at baseline was associated with a 50% reduced risk of all-cause mortality (hazard ratio 0.5; CI 0.3–0.9; p =0.032), after adjustment for gender and psychosocial, behavioral and clinical time-varying factors. Conclusions Drinking three or more cups of coffee per day halves all-cause mortality risk in patients co-infected with HIV-HCV. The benefits of coffee extracts and supplementing dietary intake with other anti-inflammatory compounds need to be evaluated in this population. Lay summary Coffee has anti-inflammatory and hepato-protective properties but its effect on mortality risk has never been investigated in patients co-infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). This study shows that elevated coffee consumption (≥3cups/day) halves all-cause mortality risk in patients co-infected with HIV-HCV. The benefits of coffee extracts and supplementing dietary intake with other anti-inflammatory compounds need to be evaluated in this population.

Published
2017
Full Text
View/download PDF

19. Significant reductions in alcohol use after hepatitis C treatment: results from the ANRS CO13-HEPAVIH cohort

Author

Lionel Piroth, Fabienne Marcellin, Bruno Spire, Rod Knight, Maria Patrizia Carrieri, Laure Esterle, Dominique Salmon-Ceron, Perrine Roux, David Rey, Philippe Sogni, Eric Rosenthal, Antoine Vilotitch, François Boué, and Stéphanie Dominguez

Subjects
medicine.medical_specialty, Hepatitis C virus, Medicine (miscellaneous), Binge drinking, medicine.disease_cause, Unit of alcohol, 03 medical and health sciences, 0302 clinical medicine, Pegylated interferon, Internal medicine, medicine, 030212 general & internal medicine, Prospective cohort study, biology, business.industry, virus diseases, Hepatitis C, medicine.disease, biology.organism_classification, Virology, digestive system diseases, 3. Good health, Psychiatry and Mental health, Cohort, 030211 gastroenterology & hepatology, Cannabis, business, medicine.drug
Abstract

BACKGROUND AND AIMS: Few data exist on changes to substance use patterns before and after hepatitis C virus (HCV) treatment. We used longitudinal data of HIV-HCV co-infected individuals to examine whether receiving pegylated interferon (Peg-IFN)-based therapy irrespective of HCV clearance could modify tobacco, cannabis and alcohol use. DESIGN: A prospective cohort of HIV-HCV co-infected individuals was enrolled from 2006. Participants' clinical data were retrieved from medical records and socio-demographic and behavioural characteristics were collected by yearly self-administered questionnaires. SETTING: Data were collected across 17 hospitals in France. PARTICIPANTS: All HIV-HCV co-infected patients who initiated HCV treatment during follow-up and answered items regarding substance use in at least one yearly questionnaire (258 patients, 671 visits). INTERVENTION: HCV treatment consisted of Peg-IFN-based regimens. MEASUREMENTS: Four time-varying outcomes: hazardous alcohol use (Alcohol Use Disorders Identification Test-C > 3/4 for women/men), number of alcohol units/month, binge drinking, cannabis and tobacco use. Mixed models assessed the effect of HCV treatment status (not yet treated, treated and HCV-cleared, treated and HCV-chronic) on each outcome. FINDINGS: A significant decrease (more than 60% reduction) in both hazardous alcohol use and binge drinking and a reduction of 10 alcohol units/month was observed after HCV treatment (irrespective of HCV clearance). No significant effect of HCV treatment status was found on tobacco use and regular cannabis use, but HCV 'clearers' reported less non-regular use of cannabis. CONCLUSIONS: Hepatitis C virus (HCV) treatment appears to help HIV-HCV co-infected patients reduce alcohol use.

Published
2017
Full Text
View/download PDF

20. Brief Report: Prolonged Viral Suppression Over a 12-Year Follow-up of HIV-Infected Patients: The Persistent Impact of Adherence at 4 Months After Initiation of Combined Antiretroviral Therapy in the ANRS CO8 APROCO-COPILOTE Cohort

Author

Janine Pierret, Camelia Protopopescu, François Raffi, Bruno Spire, O. Picard, Lucile Hardel, Lionel Piroth, Corinne Jadand, Maria Patrizia Carrieri, and Catherine Leport

Subjects
Adult, Male, 0301 basic medicine, medicine.medical_specialty, Time Factors, Sustained Virologic Response, HIV Infections, Logistic regression, Medication Adherence, 03 medical and health sciences, 0302 clinical medicine, Antiretroviral Therapy, Highly Active, Internal medicine, medicine, Humans, Hiv infected patients, Pharmacology (medical), Prospective Studies, 030212 general & internal medicine, Viral suppression, Anthracenes, business.industry, Odds ratio, 030112 virology, Antiretroviral therapy, Confidence interval, Regimen, Infectious Diseases, Anti-Retroviral Agents, Cohort, Female, business, Follow-Up Studies
Abstract

The effect of early adherence on long-term viral suppression was assessed among 1281 patients with HIV starting a protease inhibitor-containing regimen in 1997-1999, followed up to 12 years. Association between 4-month adherence (3-level score) and prolonged viral suppression was evaluated using a multivariate mixed logistic model in 891 eligible patients. High 4-months adherence [odds ratio (95% confidence interval): 3.72 (1.98 to 6.98)] was associated with long-term prolonged viral suppression, irrespective of maintenance adherence. This unexpected long-term virological impact of early adherence reinforces the message that, when starting antiretrovirals, all means should be mobilized to ensure optimum early adherence to achieve prolonged antiretroviral success.

Published
2017
Full Text
View/download PDF

21. On-demand pre-exposure prophylaxis with tenofovir disoproxil fumarate plus emtricitabine among men who have sex with men with less frequent sexual intercourse: a post-hoc analysis of the ANRS IPERGAY trial

Author

Laurence Meyer, Julie Chas, Jean-Guy Baril, Véronique Doré, Michel Morin, Jean-Pierre Aboulker, Marine Saouzanet, Isabelle Durant-Zaleski, Marie Suzan-Monti, Emmanuelle Netzer, Françoise Euphrasie, Nathalie Bajos, Séverine Gibowski, Soizic Le Mestre, Gilles Peytavin, Jean-François Delfraissy, Constance Delaugerre, David Thompson, Brigitte Guillon, Gilles Pialoux, Alpha Diallo, Nicolas Etien, Christian Chidiac, Michel Besnier, Isabelle Charreau, Benoit Trottier, Baptiste Demoulin, Julie Timsit, Bruno Spire, Joanne Otis, Laurent Cotte, Julien Fonsart, W. Rozenbaum, Mark A. Wainberg, Gabriel Girard, Eric Cua, Guillemette Antoni, Daniela Rojas Castro, Catherine Capitant, Luis Sagaon-Teyssier, Antoine Cheret, Marie-Christine Simon, Cécile Tremblay, Nicolas Leturque, Johan Binesse, Diane Carette, Valérie Foubert, Anaïs Mennecier, Grégoire Cattin, Jean-Michel Molina, Yacine Saïdi, Nicolas Lorente, Elias Choucair, François Raffi, Cecile Rabian, Armelle Pasquet, Marie Préau, Thomas Huleux, Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Essais Thérapeutiques et Maladies Infectieuses, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR CHUM), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM)-Université de Montréal (UdeM), Génomes, biologie cellulaire et thérapeutiques (GenCellDi (UMR_S_944)), Collège de France (CdF (institution))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), Hôpital Archet 2 [Nice] (CHU), Coalition PLUS [Pantin, France] (Community Research Laboratory Pantin), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Gustave Dron [Tourcoing], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), ANRS (France Recherche Nord and Sud Sida-HIV Hépatites), the Canadian HIV Trials Network, Fonds Pierre Bergé (Sidaction), Gilead Sciences, and the Bill & Melinda Gates Foundation., ANRS IPERGAY study group: Jean-Pierre Aboulker, Nathalie Bajos, Jean-Guy Baril, Michel Besnier, Johan Binesse, Diane Carette, Grégoire Cattin, Antoine Chéret, Christian Chidiac, Elias Choucair, Jean-François Delfraissy, Baptiste Demoulin, Alpha Diallo, Isabelle Durant-Zaleski, Véronique Doré, Nicolas Etien, Françoise Euphrasie, Julien Fonsart, Valérie Foubert, Séverine Gibowski, Gabriel Girard, Brigitte Guillon, Soizic Le Mestre, France Lert, Nicolas Leturque, Nicolas Lorente, Anaïs Mennecier, Michel Morin, Emmanuelle Netzer, Joanne Otis, Armelle Pasquet, Gilles Peytavin, Gilles Pialoux, Marie Préau, Cécile Rabian, Willy Rozenbaum, Luis Sagaon-Teyssier, Yacine Saïdi, Marine Saouzanet, Marie-Christine Simon, Marie Suzan-Monti, David Thompson, Julie Timsit, Benoît Trottier, Mark Wainberg, Dupuis, Christine, Génomes, biologie cellulaire et thérapeutiques (GenCellDi (U944 / UMR7212)), Collège de France (CdF (institution))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
0301 basic medicine, Male, MESH: Sexual Behavior, Epidemiology, [SDV]Life Sciences [q-bio], HIV Infections, Men who have sex with men, MESH: HIV-1, Pre-exposure prophylaxis, Sexual and Gender Minorities, 0302 clinical medicine, MESH: Tenofovir, Medicine, MESH: Double-Blind Method, 030212 general & internal medicine, MESH: Incidence, MESH: Anti-HIV Agents, education.field_of_study, Incidence (epidemiology), Incidence, MESH: HIV Infections, 3. Good health, [SDV] Life Sciences [q-bio], MESH: Sexual and Gender Minorities, Infectious Diseases, Pill, France, medicine.drug, Adult, medicine.medical_specialty, Canada, Anti-HIV Agents, Sexual Behavior, Immunology, Population, Placebo, Emtricitabine, Medication Adherence, MESH: Homosexuality, Male, 03 medical and health sciences, Double-Blind Method, MESH: Canada, Virology, Internal medicine, Humans, Homosexuality, Male, education, Tenofovir, MESH: Humans, business.industry, MESH: Adult, MESH: Medication Adherence, 030112 virology, MESH: Male, MESH: France, Sexual intercourse, HIV-1, Pre-Exposure Prophylaxis, business, MESH: Pre-Exposure Prophylaxis
Abstract

Summary Background ANRS IPERGAY found that on-demand pre-exposure prophylaxis (PrEP) with oral tenofovir disoproxil fumarate plus emtricitabine was associated with an 86% relative reduction of HIV-1 incidence compared with placebo among men who have sex with men at high risk of HIV. We aimed to investigate whether on-demand PrEP was similarly effective among individuals with lower exposure to HIV risk. Methods Participants in the ANRS IPERGAY trial were randomly assigned to receive PrEP (fixed-dose combination of 300 mg tenofovir disoproxil fumarate and 200 mg emtricitabine per pill) or placebo. The primary endpoint was the diagnosis of HIV-1 infection. Pill uptake was assessed by counting returned pills at each follow-up and by estimating tenofovir concentration from frozen plasma samples. Participants were interviewed at each visit to assess the pattern of PrEP use. All participants enrolled in the modified intention-to-treat population of the double-blind phase of the ANRS IPERGAY trial were eligible for this post-hoc analysis. We calculated the total follow-up time for periods of less frequent sexual intercourse with high PrEP adherence (15 pills or fewer per month taken systematically or often during sexual intercourse). To estimate the time of HIV acquisition, fourth-generation HIV-1/2 ELISA assays, plasma HIV-1 RNA assays, and western blot analyses were done with use of frozen samples, and the stage of HIV infection was defined according to Fiebig staging. HIV incidence was compared between the two treatment groups among individuals who had less frequent sexual intercourse with high PrEP adherence. The ANRS IPERGAY trial is registered with ClinicalTrials.gov , NCT01473472 . Findings 400 participants who were randomly assigned to receive PrEP (n=199) or placebo (n=201) between Feb 22, 2012, and Oct 17, 2014, were included in this analysis. 270 participants had at least one period of less frequent sexual intercourse with high PrEP adherence during the study, representing 134 person-years of follow-up and 31% of the total study follow-up. During these periods, participants in both groups reported a median of 5·0 (IQR 2·0–10·0) episodes of sexual intercourse per month and used a median of 9·5 (6·0–13·0) pills per month. Six HIV-1 infections were diagnosed in the placebo group (HIV incidence of 9·2 per 100 person-years; 95% CI 3·4–20·1) and none were diagnosed in the tenofovir disoproxil fumarate plus emtricitabine arm (HIV incidence of 0 per 100 person-years; 0–5·4; p=0·013), with a relative reduction of HIV incidence of 100% (95% CI 39–100). Interpretation A choice between daily or on-demand PrEP regimens could be offered to men who have sex with men who have less frequent sexual intercourse. Funding ANRS (France Recherche Nord and Sud Sida-HIV Hepatites), the Canadian HIV Trials Network, Fonds Pierre Berge (Sidaction), Gilead Sciences, and the Bill & Melinda Gates Foundation.

Published
2019
Full Text
View/download PDF

22. Long-term safety and vaccine-induced seropositivity in healthy volunteers from HIV vaccine trials

Author

Bénédicte Bonnet, Anrs, Jean-Daniel Lelièvre, Christelle Paul, Isabelle Poizot-Martin, Amel Bouakane, Corinne Desaint, Laurence Meyer, Odile Launay, Sophie Grabar, Lise Cuzin, Bruno Spire, Christine Durier, Gilles Pialoux, Benjamin Silbermann, Essais Therapeutiques et Infection Par Le Vih, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC - Biotherapie - AP-HP (cochin - Pasteur), Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'immunologie clinique [Créteil], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de médecine interne et centre de référence des maladies rares [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Maladies infectieuses et tropicales [CHU Tenon], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service Maladies infectieuses et tropicales [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Assistance Publique - Hôpitaux de Marseille (APHM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), ANRS France Recherche Nord & sud Sida-hiv hépatites, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC Cochin Pasteur (CIC 1417), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôtel-Dieu-Université Paris Descartes - Paris 5 (UPD5)-Groupe hospitalier Broca-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes, Sorbonne Paris Cité, Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Hôpital Cochin [AP-HP], INSERM U64 [AP-HP Hôpital Tenon], Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Tenon [AP-HP], CHU Toulouse [Toulouse], Centre hospitalier universitaire de Nantes (CHU Nantes), Aix Marseille Université (AMU), Santé et droits sexuels et reproductifs (Unité Ined - Inserm - Université Paris Sud - UVSQ) (UR14), Institut national d'études démographiques (INED), Service de Maladies Infectieuses et Tropicales, Service des maladies infectieuses et tropicales [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe hospitalier Broca-Université Paris Descartes - Paris 5 (UPD5)-Hôtel-Dieu-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and GRABAR, SOPHIE

Subjects
0301 basic medicine, Vaccine-induced seropositivity, Male, HIV Infections, long-term follow-up, HIV Antibodies, 0302 clinical medicine, vaccine-induced seropositivity, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Surveys and Questionnaires, Immunology and Allergy, 030212 general & internal medicine, Prospective Studies, HIV vaccine, Prospective cohort study, AIDS Vaccines, education.field_of_study, Clinical Trials as Topic, Clinical Trials, Phase I as Topic, risk of HIV exposure, Middle Aged, Healthy Volunteers, 3. Good health, Infectious Diseases, Cohort, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, France, Adult, safety, medicine.medical_specialty, Sexual Behavior, Immunology, Population, Time, 03 medical and health sciences, Clinical Trials, Phase II as Topic, Internal medicine, medicine, Humans, Adverse effect, education, Social Behavior, Retrospective Studies, business.industry, preventive HIV vaccine trials, Retrospective cohort study, 030104 developmental biology, Standardized mortality ratio, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

International audience; Background: The ANRS COV1-COHVAC cohort was a long-term safety cohort of healthy volunteers who received preventive HIV-vaccine candidates in 17 phase I/II clinical trials.Methods: Data collected from the first vaccine candidate administration and annually after inclusion in the cohort included grade 3/4 adverse events and all grade adverse events suggestive of neurological, ophthalmological and immune disorders, self-administered questionnaires on behaviors and HIV ELISA results. Age-and-sex-standardized mortality ratios (SMRs) were calculated with respect to the French population. The cohort was early terminated in 2016 due to the absence of safety signal.Results: Of 496 volunteers, 488 were included: 355 in the 7-year prospective follow-up and 133 in the retrospective data collection only. The total follow-up after the first vaccination was 4934 person-years (median: 10 years) and 270 (76%) volunteers completed their follow-up. No relevant adverse event possibly related to the vaccine was reported. Breast cancer incidence and woman mortality did not differ from those of the French general population (standardized incidence ratio = 1.47, P = 0.45 and SMR = 0.65, P = 0.28, respectively) while man mortality was significantly lower (SMR = 0.26, P = 0.0003). At the last visit, 21/29 (72%) volunteers who received the recombinant HIV gp160 protein still showed vaccine-induced seropositivity after a median follow-up of 23 years. Only a few volunteers reported risky sexual practices (men: 20/192, women: 2/162).Conclusion: Volunteers showed a sustained high commitment. No long-term safety alert was identified during the postvaccine follow-up. Participating in vaccine trials did not increase risky behaviors for HIV infection. Vaccine-induced seropositivity may persist for more than 23 years after receiving rgp160.

Published
2019
Full Text
View/download PDF

23. Disclosure of HIV Status Beyond Sexual Partners by People Living with HIV in France: A Call for Help? Results from the National Cross-Sectional Survey ANRS-VESPA2

Author

Fabienne, Marcellin, Marie, Suzan-Monti, Antoine, Vilotitch, Luis, Sagaon-Teyssier, Marion, Mora, Rosemary, Dray-Spira, Marie, Préau, France, Lert, Bruno, Spire, and Martin, Duracinsky

Subjects
Male, medicine.medical_specialty, Self Disclosure, Social Psychology, Cross-sectional study, Population, Friends, HIV Infections, Truth Disclosure, 03 medical and health sciences, Social support, 0302 clinical medicine, Surveys and Questionnaires, medicine, Humans, Family, 030212 general & internal medicine, education, Multinomial logistic regression, education.field_of_study, 030505 public health, Social network, business.industry, Public health, Public Health, Environmental and Occupational Health, Social Support, Health psychology, Cross-Sectional Studies, Sexual Partners, Infectious Diseases, Multivariate Analysis, Female, France, Hiv status, 0305 other medical science, business, Psychology, Demography, Clinical psychology
Abstract

HIV status disclosure remains a complex issue for most people living with HIV (PLWH). We analyzed PLWH disclosure behaviors in France, where treatment is free and where the social image of HIV has improved in the general population. Analyses focused on disclosure to the social network excluding sexual partners (close family, other relatives, friends, colleagues). The study sample comprised 3016 participants from the nationally representative survey ANRS-VESPA2. Three PLWH clusters were identified using hierarchical classification ("high disclosure level": 28.2 %, "medium disclosure level": 27.5 %, and "low disclosure level": 44.3 %). In multivariable analyses, the variable "not living in a couple but psychological social support needed" was independently associated with medium (AOR [95 % CI] 1.8 [1.4; 2.3]) and high levels of disclosure (1.4 [1.1; 1.8]) (multinomial regression models). For PLWH living alone, HIV status disclosure may reveal a need for psychological social support, a key component to treatment adherence and positive prevention.

Published
2016
Full Text
View/download PDF

24. Short article

Author

Camelia Protopopescu, Maria Patrizia Carrieri, Laure Esterle, Linda Wittkop, Bruno Spire, Isabelle Poizot-Martin, Dominique Salmon-Ceron, Patrick Miailhes, Fabienne Marcellin, François Dabis, and Aurélie Bocquier

Subjects
medicine.medical_specialty, Palliative care, Hepatology, business.industry, Ribavirin, Hepatitis C virus, Gastroenterology, Hcv clearance, virus diseases, medicine.disease_cause, digestive system diseases, 03 medical and health sciences, chemistry.chemical_compound, Exact test, 0302 clinical medicine, chemistry, Internal medicine, Cohort, medicine, Hcv treatment, Physical therapy, 030211 gastroenterology & hepatology, 030212 general & internal medicine, business, Psychosocial
Abstract

OBJECTIVES To analyze the impact of fatigue on individuals' global, cognitive, physical, and psychosocial functioning in the long term after hepatitis C virus (HCV) treatment and its relationship with HCV clearance among patients coinfected with HIV and HCV exposed to peg-interferon/ribavirin-containing regimens. PATIENTS AND METHODS The study sample included 107 coinfected patients treated for HCV during follow-up in the French ANRS CO13-HEPAVIH cohort. Analyses used scores from the Fatigue Impact Scale (FIS), assessed before treatment initiation and at last available measure after the end of treatment (2 years in median). Patient proportions with a clinically significant improvement in fatigue impact, defined as a decrease higher than 10 points in the 160-point global FIS score, were compared between HCV clearers and chronic HCV patients (Fisher's exact test). Relationships between HCV clearance and FIS scores were analyzed in linear regression models adjusted for sex, time since end of HCV treatment, and pretreatment scores. RESULTS Twenty-nine percent of patients showed a clinically significant improvement in fatigue (15/57 in HCV clearers vs. 16/50 in chronic HCV patients, P=0.52). HCV clearance was not significantly associated with FIS scores in multivariate models. CONCLUSION The role of HCV clearance in coinfected patients' functional recovery in the long term after peg-interferon/ribavirin treatment may be lesser than expected. Additional studies are needed in patients treated with direct-acting antiviral agents. In the meantime, the effectiveness of palliative care and targeted psychological treatments such as cognitive-behavioral therapy in reducing fatigue impact needs to be assessed in the many HCV-cured patients with HIV exposed to suboptimal interferon-based first-generation therapies.

Published
2016
Full Text
View/download PDF

25. Heterosexual practices of women and men living with HIV attending hospital outpatient services (ANRS-VESPA2 survey): a French comparative study with the general population (CSF survey)

Author

Nathalie Bajos, Fabienne Marcellin, Henri Panjo, Rosemary Dray-Spira, V Boyer, Luis Sagaon-Teyssier, Bruno Spire, and Antoine Vilotitch

Subjects
Male, 0301 basic medicine, Pediatrics, Health (social science), HIV Infections, Human sexuality, law.invention, Condoms, 0302 clinical medicine, law, Surveys and Questionnaires, 030212 general & internal medicine, SANTE PUBLIQUE, Young adult, Transients and Migrants, education.field_of_study, SIDA, Transmission (medicine), Risk of infection, Middle Aged, Sexual Partners, COMPORTEMENT SEXUEL, Bisexuality, Female, France, Adult, medicine.medical_specialty, Adolescent, Social Psychology, Population, THERAPIE ANTIRETROVIRALE, TRAITEMENT MEDICAL, Young Adult, 03 medical and health sciences, Risk-Taking, Sex Factors, Condom, ETUDE COMPARATIVE, medicine, Humans, Heterosexuality, education, business.industry, Public Health, Environmental and Occupational Health, ANTHROPOLOGIE DE LA SANTE, PREVENTION SANITAIRE, 030112 virology, Case-Control Studies, Propensity score matching, ENQUETE, GESTION DU RISQUE, business, Demography
Abstract

HAART has improved the well-being of many people living with HIV (PLWH). This study aimed at (i) comparing heterosexual practices between PLWH and the general population by gender, and (ii) identifying factors associated with sexual practices and at-risk behaviors in the two populations. Self-reported data were collected among PLWH attending hospitals (VESPA2 survey; n = 3022) and the general population (CSF survey; n = 10,280). Significant differences between the two samples were corrected for by implementing propensity score matching on both socio-demographic characteristics and sexual behavior in terms of number of partners. Men not reporting heterosexual intercourse were excluded. After matching, 61% of women (out of 707) and 68% of men (out of 709) were sexually active in both populations. PLWH practiced oral sex less than the general population and used condoms more consistently over the previous 12-month period, irrespective of having multiple sexual partners or not. For women living with HIV: those with several sexual partners and those consuming drugs over the previous 12 months were more likely to practice oral sex; those living in a couple for at least 6 years and migrants were less likely to practice anal intercourse. For men living with HIV: those reporting bisexual relationships and those with multiple sexual partners over the previous 12 months were more likely to practice anal heterosexual intercourse; migrants reported less oral sex, irrespective of HIV status. Error term correlations showed that anal intercourse was not linked to condom use for women or men from either population. Our results show that PLWH had a lower rate of heterosexual practices compared with the general population, and used condoms more often, irrespective of the number of sexual partners and strong cultural background (e.g., for Sub-Saharan African women). Further preventive information needs to be disseminated on the risk of infection transmission through heterosexual anal intercourse.

Published
2016
Full Text
View/download PDF

26. No significant effect of cannabis use on the count and percentage of circulating CD4 T-cells in HIV-HCV co-infected patients (ANRS CO13-HEPAVIH French cohort)

Author

Eric Rosenthal, Camelia Protopopescu, Perrine Roux, Caroline Lions, Linda Wittkop, Maria Patrizia Carrieri, Fabienne Marcellin, François Dabis, Philippe Sogni, Bruno Spire, and Dominique Salmon-Ceron

Subjects
Drug, medicine.medical_specialty, Health (social science), biology, business.industry, Hepatitis C virus, media_common.quotation_subject, Human immunodeficiency virus (HIV), Medicine (miscellaneous), Cannabis use, medicine.disease_cause, biology.organism_classification, Confidence interval, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Bayesian multivariate linear regression, Cohort, medicine, 030211 gastroenterology & hepatology, 030212 general & internal medicine, Cannabis, business, media_common
Abstract

Introduction and aims Despite cannabis use being very common in patients co-infected with HIV and hepatitis C virus (HCV), its effect on these patients' immune systems remains undocumented. Documenting the potential effect of cannabis use on HIV immunological markers would help caregivers make more targeted health recommendations to co-infected patients. We performed a longitudinal analysis of the relationship between cannabis use and peripheral blood CD4 T-cell measures in co-infected patients receiving antiretroviral therapy. Design and methods Cannabis use was assessed using annual self-administered questionnaires in 955 patients (2386 visits) enrolled in the ANRS CO13-HEPAVIH cohort. The effect of cannabis use on circulating CD4 T-cell count and percentage was estimated using multivariate linear regression models with generalised estimating equations. Sensitivity analyses were conducted after excluding visits where (i) tobacco use and (ii) smoking >=10 tobacco cigarettes/day were reported. Results At the first visit, 48% of patients reported cannabis use during the previous four weeks, and 58% of these patients also smoked ≥10 tobacco cigarettes/day. After multiple adjustment, cannabis use was not significantly associated with either circulating CD4 T-cell count [model coefficient (95% confidence interval): 0.27 (-0.07; 0.62), P = 0.12] or percentage [-0.04 (-0.45; 0.36), P = 0.83]. Sensitivity analyses confirmed these results. Discussion and conclusions Findings show no evidence for a negative effect of cannabis use on circulating CD4 T-cell counts/percentages in HIV-HCV co-infected patients. In-depth immunological studies are needed to document whether cannabis has a harmful effect on CD4 levels in lungs and on cells' functional properties. [Marcellin F, Lions C, Rosenthal E, Roux P, Sogni P, Wittkop L, Protopopescu C, Spire B, Salmon-Ceron D, Dabis F, Carrieri MP, HEPAVIH ANRS CO13 Study Group. No significant effect of cannabis use on the count and percentage of circulating CD4 T-cells in HIV-HCV co-infected patients (ANRSCO13-HEPAVIH French cohort). Drug Alcohol Rev 2017;36:227-238].

Published
2016
Full Text
View/download PDF

27. An Assessment of Health Interventions Required to Prevent the Transmission of HIV Infection Among Men Having Sex with Men in Bujumbura, Burundi

Author

Candide Kayonde, Bruno Spire, Arsène Nitunga, Emmanuel Trenado, Adeline Bernier, Gabriel Mujimbere, and Pierre-Julien Coulaud

Subjects
Adult, Male, 0301 basic medicine, medicine.medical_specialty, Health (social science), Adolescent, Burundi, Sexual Behavior, Voluntary counseling and testing, Population, Psychological intervention, HIV Infections, Health Promotion, law.invention, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Condom, law, Surveys and Questionnaires, Health care, Disease Transmission, Infectious, Humans, Medicine, 030212 general & internal medicine, Homosexuality, Male, Psychiatry, education, education.field_of_study, business.industry, Public Health, Environmental and Occupational Health, virus diseases, 030112 virology, Sexual intercourse, Cross-Sectional Studies, HIV-positive people, Health promotion, Family medicine, business, Risk Reduction Behavior
Abstract

Data regarding HIV among men having sex with men (MSM) in Burundi are scarce. In a context where same-sex practices are illegal, national recommendations including MSM have been issued in 2012. However, no study has been conducted to evaluate MSM's health needs, which would be useful to adapt recommendations and implement evidence-based interventions. This study aimed at identifying health needs expressed by MSM. A cross-sectional study was conducted in Bujumbura in 2014, in collaboration with the National Association for HIV positive people and AIDS patients. Fifty-one MSM, recruited during HIV prevention activities, self-completed a questionnaire. A descriptive analysis was conducted. Participants had a median age of 23 years, over 60 % declared being a member of an LGBT organisation and 76 % lived their homosexuality secretly or discretely. Over the last month, 67 % declared having had sex with a man and 32 % with a woman. In the previous 6 months, 40 % declared having systematically used a condom during sexual intercourse. In terms of health needs, 22 % did not use the services offered by HIV providers. Participants expressed needs in terms of prevention (access to rapid HIV tests, in a confidential setting, with counselling) and care (listening centre, free treatment, confidentiality). Medical expertise and being a good listener were the predominant healthcare staff qualities desired by participants. Results suggest that Burundian MSM represent an at-risk population, with low access to HIV services, in need of a comprehensive approach for HIV prevention, with community-based activities (HIV testing, counselling, prevention tools), psychological and social support.

Published
2016
Full Text
View/download PDF

28. A prospective, longitudinal study of sleep disturbance and comorbidity in opiate dependence (the ANRS Methaville study)

Author

Sandra Nordmann, Bruno Spire, Marion Mora, Caroline Lions, Alain Morel, Gwenaëlle Maradan, Perrine Roux, Laurent Michel, Antoine Vilotitch, and M. Patrizia Carrieri

Subjects
Adult, Male, Sleep Wake Disorders, medicine.medical_specialty, Methadone maintenance, Pediatrics, Narcotic Antagonists, 03 medical and health sciences, 0302 clinical medicine, Opiate Substitution Treatment, medicine, Humans, Attention deficit hyperactivity disorder, Longitudinal Studies, Prospective Studies, 030212 general & internal medicine, Psychiatry, Depression (differential diagnoses), Psychiatric Status Rating Scales, Pharmacology, Sleep disorder, Odds ratio, Opioid-Related Disorders, medicine.disease, Comorbidity, Analgesics, Opioid, Female, Psychology, Methadone, 030217 neurology & neurosurgery, medicine.drug
Abstract

Sleep disturbance is frequent in opioid-dependent patients. To date, no data are available about the impact of methadone maintenance treatment on sleep disturbance. Using 1-year follow-up data from the Methaville trial, we investigated the impact of methadone initiation and other correlates on sleep disturbance in opioid-dependent patients. Sleep disturbance severity was evaluated using two items from different scales (Center for Epidemiological Studies Depression Scale for depression and Opiate Treatment Index). We assessed the effect of methadone and other correlates on sleep disturbance severity during follow-up (months 0, 6, and 12) using a mixed multinomial logistic regression model. We included 173 patients who had 1-year follow-up data on sleep disturbance, corresponding to 445 visits. At enrolment, 60.5 % reported medium to severe sleep disturbance. This proportion remained stable during methadone treatment: 54.0 % at month 6 and 55.4 % at month 12. The final multivariate model indicated that younger patients (odds ratio (OR) [95 % CI] 0.95 [0.90–1.00]), patients with pain (OR [95 % CI] 2.45 [1.13–5.32]), patients with high or very high nicotine dependence (OR [95 % CI] 5.89 [2.41–14.39]), and patients at suicidal risk (2.50 [1.13–5.52]) had a higher risk of severe sleep disturbance. Because of collinearity between suicidal risk and attention deficit hyperactivity disorder (ADHD) symptoms, ADHD was not associated with sleep disturbance in the final model. Receiving methadone treatment had no significant effect on sleep disturbance. Sleep disturbance is frequent among opioid-dependent patients. It can be regarded as an important signal of more complex psychiatric comorbidities such as suicidal risk and ADHD. However, sleep disturbance should not be considered an obstacle to methadone maintenance treatment (MMT) initiation or continuation.

Published
2016
Full Text
View/download PDF

29. Is on-demand HIV pre-exposure prophylaxis a suitable tool for men who have sex with men who practice chemsex ? Results from a substudy of the ANRS-IPERGAY trial

Author

Catherine Capitant, Luis Sagaon-Teyssier, Laurence Meyer, Cécile Tremblay, Daniela Rojas-Castro, Jean-Michel Molina, Lisa Fressard, Marie Suzan-Monti, Perrine Roux, Gilles Pialoux, Bruno Spire, Julie Chas, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de Recherche pour le Développement (IRD), Essais Thérapeutiques et Maladies Infectieuses, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Essais Therapeutiques et Infection Par Le Vih, Université de Montréal (UdeM), Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), AIDES [Pantin] (Siège national), Institut Universitaire d'Hématologie (IUH), Université Paris Diderot - Paris 7 (UPD7), ANRS, Canadian HIV Trials Network, Fonds de Dotation Pierre Bergé pour la Prévention, Gilead Sciences donated the TDF-FTC and placebo used in the study, and partly funded for the pharmacokinetics analysis., Bill and Melinda Gates Foundation, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11), and Lissalde, Claire

Subjects
Adult, Male, medicine.medical_specialty, chemsex, HIV Infections, Logistic regression, Medication Adherence, law.invention, Men who have sex with men, 03 medical and health sciences, Pre-exposure prophylaxis, 0302 clinical medicine, Double-Blind Method, Randomized controlled trial, gay, prevention, law, Humans, Medicine, Pharmacology (medical), 030212 general & internal medicine, Homosexuality, Male, harm reduction, Generalized estimating equation, [SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Harm reduction, 030505 public health, business.industry, HIV, Odds ratio, Middle Aged, PrEP, Risk perception, Infectious Diseases, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Pre-Exposure Prophylaxis, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 0305 other medical science, business
Abstract

International audience; Background: Chemsex-the use of psychoactive substances during sexual encounters-among men who have sex with men is a growing concern. On-demand HIV pre-exposure prophylaxis (PrEP) may be a suitable tool to prevent HIV transmission among "chemsexers." We used the open-label extension study of the ANRS-IPERGAY trial to describe chemsexers and their PrEP use. Methods: Among the 361 men who have sex with men enrolled in ANRS-IPERGAY's open-label extension study, we selected the 331 with available data on drug use. A 2-monthly web questionnaire on sociobehavioral data was used to compare sexual behaviors between questionnaires where chemsex was reported and those where it was not. Using a generalized estimating equation logistic regression, we studied whether practicing chemsex was associated with correct PrEP use. Results: Among the 331 participants, 30% reported chemsex practice at least once during follow-up and were considered chemsexers. Chemsex was reported in 16% of all questionnaires. Chemsexers were not significantly different from nonchemsexers regarding sociodemographic characteristics, although they reported greater use of anxiolytics and more sensation-seeking. Reporting chemsex was associated with more high-risk sexual practices and a higher perception of risk. After adjustment for other potential correlates, chemsex remained associated with correct PrEP use [odds ratio (95% confidence interval) = 2.24 (1.37 to 3.66)]. Conclusions: Our findings show that chemsexers were more likely to report high-risk sexual practices but also had a higher perception of risk. They were also more likely to use PrEP correctly when practicing chemsex. Consequently, PrEP may be a suitable tool to reduce HIV-risk transmission among chemsexers.

Published
2018
Full Text
View/download PDF

30. Evolution of patients’ socio-behavioral characteristics in the context of DAA: Results from the French ANRS CO13 HEPAVIH cohort of HIV-HCV co-infected patients

Author

Issifou Yaya, Perrine Roux, Fabienne Marcellin, Linda Wittkop, Laure Esterle, Bruno Spire, Stéphanie Dominguez, Boni Armand Elegbe, Lionel Piroth, Philippe Sogni, Dominique Salmon-Ceron, Maria Patrizia Carrieri, ANRS CO13 HEPAVIH Study Group, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), DILTEC - Didactique des langues, des textes et des cultures - EA 2288 (DILTEC), Université Sorbonne Nouvelle - Paris 3, GHU A. Chenevier - Henri Mondor (Inserm U955, équipe 16), Département d'infectiologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service d'hépatologie médicale [CHU Cochin], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CIC - Biotherapie - AP-HP (cochin - Pasteur), Institut National de la Santé et de la Recherche Médicale (INSERM), ANRS CO13-HEPAVIH Study Group ANRS CO13-HEPAVIH Study Group, Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), CIC Bordeaux, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'information médicale, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques (CIC-EC), Université de Bourgogne (UB)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Physiopathologie du système immunitaire, Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Service Maladies infectieuses et tropicales [AP-HP Hôpital Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], ANRS CO13 HEPAVIH Study Group¶, and DUFOUR, Jean-Charles

Subjects
RNA viruses, Male, Health Behavior, Social Sciences, lcsh:Medicine, HIV Infections, Hepacivirus, Geographical locations, Chronic Liver Disease, 0302 clinical medicine, Risk Factors, Prevalence, Psychology, Alcohol consumption, Prospective Studies, 030212 general & internal medicine, Young adult, Prospective cohort study, lcsh:Science, Pathology and laboratory medicine, media_common, Chronic hepatitis, Drug injection, Clinical Trials as Topic, Multidisciplinary, biology, Pharmaceutics, Coinfection, Hepatitis C virus, Liver Diseases, virus diseases, Medical microbiology, Middle Aged, Prognosis, Hepatitis C, Addicts, 3. Good health, Europe, Behavioral Pharmacology, Drug users, Viruses, Cohort, Female, 030211 gastroenterology & hepatology, Drug therapy, France, Pathogens, Research Article, Adult, Drug, medicine.medical_specialty, Substance-Related Disorders, media_common.quotation_subject, Liver fibrosis, Addiction, Context (language use), Gastroenterology and Hepatology, Microbiology, Antiviral Agents, Young Adult, 03 medical and health sciences, Pharmacotherapy, Recreational Drug Use, Internal medicine, medicine, Humans, European Union, Nutrition, Aged, Cannabis, Medicine and health sciences, Pharmacology, Biology and life sciences, Flaviviruses, business.industry, lcsh:R, Organisms, Viral pathogens, HIV, biology.organism_classification, Hepatitis viruses, digestive system diseases, Microbial pathogens, Diet, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, lcsh:Q, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, People and places, business
Abstract

International audience; BACKGROUND:Direct-acting antivirals (DAA) have dramatically increased HCV cure rates with minimal toxicity in HIV-HCV co-infected patients. This study aimed to compare the socio-behavioral characteristics of patients initiating pegylated-interferon (PEG-IFN)-based HCV treatment with those of patients initiating DAA-based treatment.METHODS:ANRS CO13 HEPAVIH is a national multicenter prospective cohort started in 2005, which enrolled 1,859 HIV-HCV co-infected patients followed up in French hospital outpatient units. Both clinical/biological and socio-behavioral data were collected during follow-up. We selected patients with socio-behavioral data available before HCV treatment initiation.RESULTS:A total of 580 patients were included in this analysis. Of these, 347 initiated PEG-IFN-based treatment, and 233 DAA-based treatment. There were significant differences regarding patient mean age (45 years±6 for the PEG-IFN group vs. 52 years±8 for the DAA group, p

Published
2018
Full Text
View/download PDF

31. Posttraumatic Stress Disorder as a Significant Correlate of Voluntary Antiretroviral Treatment Interruption in Adult HIV-Infected Patients Followed up in French Hospitals

Author

Perrine, Roux, Fabienne, Marcellin, Khadim, Ndiaye, Marie, Suzan-Monti, Aurélie, Mayet, Martin, Duracinsky, Laélia, Briand-Madrid, Gwenaëlle, Maradan, Marion, Mora, Marie, Préau, Pierre, Verger, Patrizia, Carrieri, Rosemary, Dray-Spira, and Bruno, Spire

Subjects
Adult, Male, medicine.medical_specialty, Cross-sectional study, Population, MEDLINE, Emigrants and Immigrants, HIV Infections, Comorbidity, Logistic regression, Stress Disorders, Post-Traumatic, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, mental disorders, Antiretroviral treatment, Humans, Medicine, 030212 general & internal medicine, education, Psychiatry, Africa South of the Sahara, education.field_of_study, 030505 public health, business.industry, Odds ratio, Middle Aged, medicine.disease, Health Surveys, 3. Good health, Psychiatry and Mental health, Cross-Sectional Studies, Anti-Retroviral Agents, Turnover, Patient Compliance, Female, France, 0305 other medical science, business
Abstract

OBJECTIVE: Although antiretroviral treatment (ART) no longer requires 100% adherence, voluntary treatment interruption (VTI) still may have a negative impact on virologic success. Previous studies have shown that posttraumatic stress disorder (PTSD) is more prevalent in HIV-infected patients than in the general population. However, no study has yet investigated the relationship between PTSD and VTI. We analyzed this relationship using data from a French national survey representative of HIV-infected adults followed up in hospitals. METHODS: A total of 3,022 HIV-infected adults participated in the ANRS-VESPA2 survey (April 2011-January 2012) and answered a face-to-face questionnaire that included the Composite International Diagnostic Interview Short-Form to diagnose PTSD and assess sociobehavioral variables such as VTI. Multivariable logistic regression models were used to study the relationship between PTSD and VTI. RESULTS: Among the 2,768 ART-treated participants with available data for both PTSD screening and ART interruption (study sample), prevalence of PTSD was 13.3%, and 7.2% of individuals reported VTI during the previous month. After adjustment for being a female Sub-Saharan African immigrant and reporting harmful alcohol consumption (Alcohol Use Disorders Identification Test score ≥ 8), lifetime PTSD was found to be independently associated with VTI (adjusted odds ratio [95% CI] = 1.64 [1.07-2.53], P = .025). CONCLUSIONS: PTSD is highly prevalent in HIV-infected patients followed up in French hospitals and is a significant predictor of VTI. PTSD is a psychiatric disorder that is still underdiagnosed and undertreated in many countries despite its negative consequences on health behaviors. As there is evidence of effective treatment for PTSD, HIV care providers need to be trained in screening for this disorder.

Published
2018
Full Text
View/download PDF

32. Positive Virological Outcomes of HIV-Infected Patients on Protease Inhibitor-Based Second-Line Regimen in Cambodia: The ANRS 12276 2PICAM Study

Author

Olivier Ségéral, Eric Nerrienet, Sansothy Neth, Bruno Spire, Vohith Khol, Laurent Ferradini, Saramony Sarun, Chandara Mom, Sopheak Ngin, Charlotte Charpentier, Pagnaroat Men, Marion Mora, Vun Mean Chhi, Penhsun Ly, Vonthanak Saphonn, Agence Nationale de Recherches sur le Sida et les Hépatites Virales (ANRS), University of Health Sciences [Phnom-Penh, Cambodia] (UHS), Institut Pasteur [Paris] (IP), France Expertise Internationale [Paris], Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Dermatology and STD [Phnom Penh, Cambodia], National Center for HIV/AIDS [Phnom Penh, Cambodia], Cambodia Office [Phnom Penh, Cambodia] (WHO), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Virologie [AP-HP Hôpital Bichat-Claude-Bernard], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), AIDS Healthcare Foundation [Phnom-Penh, Cambodia], This study was funded by ANRS., Institut Pasteur [Paris], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), and Dupuis, Christine

Subjects
0301 basic medicine, medicine.medical_specialty, HIV RNA, 030106 microbiology, protease inhibitors, Integrase inhibitor, 03 medical and health sciences, 0302 clinical medicine, Second line, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Internal medicine, Genotype, medicine, Hiv infected patients, 030212 general & internal medicine, genotype resistance tests, Darunavir, Original Research, adherence counseling, business.industry, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Lopinavir, lcsh:RA1-1270, HIV infection, 3. Good health, Atazanavir, Regimen, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, southeast Asia, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Public Health, business, medicine.drug
Abstract

International audience; Background:Assessment of virological outcomes among HIV-infected patients receiving protease (PR) inhibitor-based second-line regimen are uncommon in Cambodia. The objective of this study is to assess the virological effectiveness of this regimen as well as impact of adherence boosting for patients experiencing virological failure.Methods:The 2PICAM study (Clinicaltrial: NCT01801618) is a cross-sectional study of HIV-infected adults on PR inhibitor-based second-line regimen since at least 6 months, conducted in 13 representative sites, comprising more than 90% of the target population. Adults with HIV RNA above 250 copies/mL (threshold of the assay) at inclusion received boosted adherence counseling during 3 months followed by HIV RNA control. For confirmed virological failure, genotype resistance test was performed and expert committee used results for therapeutic decision.Results:Among the 1,317 adults enrolled, the median duration of second-line regimen was 5 years. At inclusion, 1,182 (89.7%) patients achieved virological success (250 copies/mL). In multivariable analysis, factors associated with virological success were: CD4 cell count between 201 and 350/mm3 (OR: 4.66, 95% CI: 2.57-8.47, p 350/mm3 (OR: 6.67, 95% CI: 4.02-11.06, p 2 years (OR: 1.64, 95% CI: 1.03-2.62, p = 0.037), ATV-containing regimen (0R: 1.65, 95% CI: 1.04-2.63, p = 0.034) and high level of adherence (OR: 2.41, 95% CI: 1.07-5.41, p = 0.033). After adherence counseling, 63 (46.7%) patients were rescued while 72 (53.3%) were not. For the 54 patients with genotype resistance tests available, high or intermediate levels of resistance to lopinavir, atazanavir, and darunavir were reported for 13 (24%), 12 (22.2%), and 2 (3.7%) patients, respectively. Change to an alternative PR inhibitor-based regimen was recommended for 17 patients and to third-line regimen, including integrase inhibitors for 12.Conclusion:This study reports high rate of virological suppression of second-line regimen and importance of adherence boosting prior to deciding any change of ART regimen. Genotype resistance tests appear necessary to guide decisions. Such information was of great importance for National HIV Program to adapt guidelines and program needs for third-line regimen.

Published
2018
Full Text
View/download PDF

33. Treatment interruption in HIV-positive patients followed up in Cameroon's antiretroviral treatment programme : individual and health care supply-related factors (ANRS-12288 EVOLCam survey)

Author

Christelle, Tong, Marie, Suzan-Monti, Luis, Sagaon-Teyssier, Mohamed, Mimi, Christian, Laurent, Gwenaëlle, Maradan, Marie-Thérèse, Mengue, Bruno, Spire, Christopher, Kuaban, Laurent, Vidal, Sylvie, Boyer, I, Seyep, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Institut de Recherche pour le Développement (IRD), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université Catholique d'Afrique Centrale - Institut Catholique de Yaoundé (UCAC), Department of Internal Medicine and Subspecialties [Yaoundé, Cameroon], University of Yaoundé [Cameroun], This study was approved by the Cameroonian Ministry of Public Health and was financially supported by the French National Agency for Research on AIDS and viral hepatitis (ANRS)., EVOL Cam group, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), and Lissalde, Claire

Subjects
0301 basic medicine, Program evaluation, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, Tuberculosis, Cross-sectional study, Anti-HIV Agents, [SDV]Life Sciences [q-bio], Developing country, HIV Infections, interruption du traitement antirétroviral, antiretroviral treatment interruption, health care supply-related factors, Logistic regression, Lower risk, Health Services Accessibility, 03 medical and health sciences, 0302 clinical medicine, Antiretroviral Therapy, Highly Active, Health care, Medicine, Humans, 030212 general & internal medicine, Cameroon, [SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, business.industry, 1. No poverty, Public Health, Environmental and Occupational Health, VIH, HIV, facteurs liés à l'offre des soins de santé, Patient Acceptance of Health Care, individual factors, medicine.disease, facteurs individuels, 030112 virology, 3. Good health, [SDV] Life Sciences [q-bio], Infectious Diseases, Cross-Sectional Studies, Family medicine, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Population study, Patient Compliance, Parasitology, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; introduction Decreasing international financial resources for HIV and increasing numbers of antiretroviral treatment (ART)-treated patients may jeopardise treatment continuity in low-income settings. Using data from the EVOLCam ANRS-12288 survey, this study aimed to document the prevalence of unplanned treatment interruption for more than 2 consecutive days (TI>2d) and investigate the associated individual and health care supply-related factors within the Cameroonian ART programme. methods A cross-sectional mixed methods survey was carried out between April and December 2014 in 19 HIV services of the Centre and Littoral regions. A multilevel logistic model was estimated on 1885 ART-treated patients in these services to investigate factors of TI>2d in the past 4 weeks. results Among the study population, 403 (21%) patients reported TI>2d. Patients followed up in hospitals reporting ART stock-outs were more likely to report TI>2d while those followed up in the Littoral region, in medium-or small-sized hospitals and in HIV services proposing financial support were at lower risk of TI>2d. The following individual factors were also associated with a lower risk of TI>2d: living in a couple, having children, satisfaction with attention provided by doctor, tuberculosis co-infection and not having consulted a traditional healer. conclusions Besides identifying individual factors of TI>2d, our study highlighted the role of health care supply-related factors in shaping TI in Cameroon's ART programme, especially the deleterious effect of ART stock-outs. Our results also suggest that the high proportion of patients reporting TI could jeopardise progress in the fight against HIV in the country, unless effective measures are quickly implemented like ensuring the continuity of ART supply. keywords HIV, Cameroon, antiretroviral treatment interruption, individual factors, health care supply-related factors

Published
2018
Full Text
View/download PDF

34. Acceptability of HIV cure-related trials: the challenges for physicians and people living with HIV (ANRS-APSEC)

Author

Christel Protière, Marion Mora, Marie Préau, Jean-Daniel Lelièvre, François Raffi, Cécile Goujard, Marjolaine Doumergue, Bruno Spire, Marie Suzan-Monti, Laurence Meyer, Olivier Lambotte, Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Bicêtre, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques (BMNST), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Strasbourg (UNISTRA), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-IFR10, Maladies infectieuses et tropicales, Service de Médecine Interne et Immunologie clinique [AP-HP Hôpital Bicêtre], Immunologie des Maladies Virales et Autoimmunes (IMVA - U1184), Université Paris-Sud - Paris 11 (UP11)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM), The ANRS APSEC survey was supported by ANRS (France Recherche Nord & sud Sida-hiv Hépatites)., Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de médecine interne et maladies infectieuses, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bicêtre, Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, Service d'immunologie clinique [Créteil], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), INSERM U1012, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), and Greps, Laboratoire

Subjects
0301 basic medicine, Male, medicine.medical_specialty, Health (social science), Social Psychology, Anti-HIV Agents, Attitude of Health Personnel, 030106 microbiology, Human immunodeficiency virus (HIV), [SHS.PSY]Humanities and Social Sciences/Psychology, HIV Infections, medicine.disease_cause, HIV culture, [SHS.PSY] Humanities and Social Sciences/Psychology, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), cure trial, Willingness to participate in clinical trials, Physicians, Epidemiology, Medicine, Humans, 030212 general & internal medicine, Infectious disease (athletes), HIV history, ComputingMilieux_MISCELLANEOUS, business.industry, Public Health, Environmental and Occupational Health, Middle Aged, Focus group, 3. Good health, Clinical trial, Family medicine, Quality of Life, Female, France, business, Psychosocial
Abstract

International audience; Essential HIV cure-related clinical trials (HCRCT) have a potentially high-risk profile in terms of participants' health, which could hinder enrollment by people living with HIV (PLWH) and healthcare professionals (HP). The ANRS-APSEC survey is part of the IAS "Towards an HIV cure" initiative, which promotes multidisciplinary research for a safe, affordable and scalable cure. The study objectives were to understand the psychosocial mechanisms underlying PLWH and HP viewpoints about future HCRCT. Six focus group discussions (three with PLWH (n = 21) and three with HP (n = 30)) were held in three French infectious disease units. From these, three perspectives on HCRCT were identified. The first involved beliefs and knowledge associating HCRCT with poorer health and quality of life for PLWH. The second concerned perceptions of HCRCT as a biological and epidemiological flashback to a situation when HIV infection was left uncontrolled. The third was characterized by aspects of historical HIV culture that embrace innovation.

Published
2018
Full Text
View/download PDF

35. The ANRS-Ipergay trial, an opportunity to use qualitative research to understand the perception of the 'participant'-physician relationship

Author

Marion Di Ciaccio, Marie Suzan-Monti, Martin Siguier, Eric Cua, Laurent Cotte, Bruno Spire, Marie Préau, Jean-Michel Molina, Daniela Rojas Castro, Christel Protière, Julie Chas, Di Ciaccio, Marion, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), AIDES [Pantin, France] (Mission Innovation Recherche Expérimentation), Coalition Internationale Sida [Pantin, France] (Programme Recherche Communautaire), Service de Maladies infectieuses et tropicales [CHU Tenon], CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service des maladies infectieuses et tropicales [CH Lyon Sud - HCL] (Hôpital de la Croix-Rousse), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL)-Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Génétique et Ecologie des Virus, Génétique des Virus et Pathogénèse des Maladies Virales, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département des Maladies Infectieuses [CHU Nice] (Hôpital de l'Archet), Hôpital l'Archet - CHU de Nice, Service des Maladies Infectieuses et Tropicales, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), ANRS IPERGAY Study Group, Epidémiologie et Sciences Sociales Appliquées à l'Innovation Médicale, Université de la Méditerranée - Aix-Marseille 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Service des Maladies Infectieuses et Tropicales [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Tenon [APHP], Equipe 16, Centre de Recherche en Cancérologie de Lyon (CRCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Nice (CHU Nice), Service de maladies infectieuses et tropicales [Saint-Louis], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Service des maladies infectieuses et tropicales [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL)-Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Adult, Counseling, Male, medicine.medical_specialty, Health (social science), Social Psychology, Anti-HIV Agents, ANRS-IPERGAY trial, media_common.quotation_subject, Identity (social science), [SHS.PSY]Humanities and Social Sciences/Psychology, HIV Infections, Context (language use), Men who have sex with men, Paternalism, Condoms, [SHS.PSY] Humanities and Social Sciences/Psychology, 03 medical and health sciences, 0302 clinical medicine, Physicians, Perception, Humans, Medicine, 030212 general & internal medicine, Homosexuality, Male, Medical prescription, patient-as-partner, Qualitative Research, ComputingMilieux_MISCELLANEOUS, media_common, Physician-Patient Relations, 030505 public health, Patient-physician relationship, business.industry, Public Health, Environmental and Occupational Health, Middle Aged, PrEP, 3. Good health, Sexual Partners, Family medicine, Female, Pre-Exposure Prophylaxis, 0305 other medical science, business, Construct (philosophy), Qualitative research
Abstract

International audience; The ANRS-IPERGAY trial consisted in providing sexual activity-based antiretroviral prophylaxis for HIV prevention (PrEP) with a package of prevention tools (counselling, condoms, HIV and sexually transmitted infections' screening) to highly exposed HIV-negative men who have sex with men (MSM). Few data exist concerning the patient-physician relationship in the particular context of PrEP, where physicians discuss sexual behaviours with MSM who are not classic patients, in that consultation is for prevention purposes, not for illness. This study took place during the open-label extension of ANRS-IPERGAY trial when all participants received PrEP. In this qualitative study, we examined how physicians perceived their relationship with participants in the ANRS-IPERGAY trial. Of all 30 physicians involved in the trial who were contacted by email to participate in an interview about their opinions and perceptions of ANRS-IPERGAY 18 volunteered to participate in the current sub-study. We performed a vertical analysis for each interview to identify the extract in each physician's discourse concerning their relationship with MSM participants, and conducted a horizontal analysis to construct the thematic tree and subsequently investigate differences and similitudes between themes. An analysis of all physicians' discourses showed that the participant-physician relationship during the trial could be described through 4 themes: (i) personal experience of the relationship, (ii) trust and non-judgement, (iii) positive relational climate and (iv) influence of physician's characteristics (age, gender, etc.) on relationship. We found that the particular context of PrEP led some physicians to adopt a patient-as-partner approach during consultations rather than a paternalist or hierarchical approach. Indeed, the close follow-up provided by the trial and the active role of patients in their own prevention care trajectory, are more compatible with the patient-as-partner approach. The prescription of PrEP may lead to an evolution in patient-physician relationships and may even modify the professional identity of physicians.

Published
2018
Full Text
View/download PDF

36. Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

Author

Collins C Iwuji, Joanna Orne-Gliemann, Joseph Larmarange, Eric Balestre, Rodolphe Thiebaut, Frank Tanser, Nonhlanhla Okesola, Thembisa Makowa, Jaco Dreyer, Kobus Herbst, Nuala McGrath, Till Bärnighausen, Sylvie Boyer, Tulio De Oliveira, Claire Rekacewicz, Brigitte Bazin, Marie-Louise Newell, Deenan Pillay, François Dabis, Collins Iwuji, Kevi Naidu, Tulio de Oliveira, Tamsen Rochat, Johannes Viljoen, Thembelihle Zuma, Sophie Karcher, Melanie Plazy, Mélanie Prague, Rodolphe Thiébaut, Thierry Tiendrebeogo, Hermann Donfouet, Andrea Gosset, Laura March, Camelia Protopopescu, Bruno Spire, Alexandra Calmy, Maxime Inghels, Hassimiou Diallo, Vincent Calvez, Anne Derache, Anne-Geneviève Marcelin, Rosemary Dray-Spira, France Lert, Kamal El Farouki, Richard Lessells, Kenneth Freedberg, John Imrie, Marie-Laure Chaix, Colin Newell, Jan Hontelez, Africa Health Research Institute [Durban/Mtubatuba] (AHRI), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Statistics In System biology and Translational Medicine (SISTM), Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)- Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Agence Nationale de Recherches sur le Sida et les Hépatites Virales (ANRS), University of Southampton, Brighton and Sussex Medical School (BSMS), Research Department of Infection and Population Health [London], University College of London [London] (UCL), Santé, vulnérabilités et relations de genre au sud (SAGESUD - ERL Inserm U1244), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), School of nursing and public health [Durban, KwaZulu-Natal, South Africa], University of KwaZulu-Natal (UKZN), Academic Unit of Primary Care and Population Sciences [Southampton, UK] (Department of Social statistics & Demography), Department of Global Health and Population [Boston, MA, USA] (Harvard School of Public Health), Harvard University [Cambridge], Institute of Public Health [Heidelberg, Germany] (Medical School), Ruprecht-Karls-University [Heidelberg, Germany], Nelson R Mandela School of Medicine [Durban, KwaZulu-Natal, South Africa] (College of Health Sciences), Human Health and Development [Southampton, UK] (Global Health Research Institute), Division of Infection and Immunity [London, UK], Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), ANRS 12249 TasP Study Group : Bärnighausen T, Herbst K, Iwuji C, Makowa T, Naidu K, Newell ML, Okesola N, de Oliveira T, Pillay D, Rochat T, Tanser F, Viljoen J, Zuma T, McGrath N, Balestre E, Dabis F, Karcher S, Orne-Gliemann J, Plazy M, Prague M, Thiébaut R, Tiendrebeogo T, Boyer S, Donfouet H, Gosset A, March L, Protopopescu C, Spire B, Calmy A, Larmarange J, Inghels M, Diallo H, Calvez V, Derache A, Marcelin AG, Dray-Spira R, Lert F, El Farouki K, Lessells R, Freedberg K, Imrie J, Chaix ML, Newell C, Hontelez J, Bazin B, Rekacewicz C., Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité)-Institut de Recherche pour le Développement (IRD)-Université Paris Cité (UPCité), School of nursing and public health, University of KwaZulu-Natal [Durban, Afrique du Sud] (UKZN), Harvard School of Public Health, Global Health Research Institute, Division of Immunity and Infection, The Medical School, Edgbaston, Dupuis, Christine, and Harvard University

Subjects
0301 basic medicine, Cyclopropanes, Male, Epidemiology, HIV Infections, TaSP, law.invention, chemistry.chemical_compound, South Africa, 0302 clinical medicine, Randomized controlled trial, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, HIV Seropositivity, Emtricitabine, Mass Screening, 030212 general & internal medicine, education.field_of_study, Incidence (epidemiology), Incidence, Hazard ratio, Middle Aged, 3. Good health, SISTM, Infectious Diseases, Treatment Outcome, Research Design, Alkynes, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, medicine.drug, Adult, medicine.medical_specialty, Efavirenz, Adolescent, Anti-HIV Agents, Immunology, Population, IDLIC, 03 medical and health sciences, Young Adult, Virology, medicine, Humans, education, Tenofovir, Mass screening, business.industry, 030112 virology, Benzoxazines, chemistry, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Demography
Abstract

BackgroundUniversal antiretroviral therapy (ART), as per the 2015 WHO recommendations, might reduce population HIV incidence. We investigated the effect of universal test and treat on HIV acquisition at population level in a high prevalence rural region of South Africa.MethodsWe did a phase 4, open-label, cluster randomised trial of 22 communities in rural KwaZulu-Natal, South Africa. We included individuals residing in the communities who were aged 16 years or older. The clusters were composed of aggregated local areas (neighbourhoods) that had been identified in a previous study in the Hlabisa subdistrict. The study statisticians randomly assigned clusters (1:1) with MapInfo Pro (version 11.0) to either the control or intervention communities, stratified on the basis of antenatal HIV prevalence. We offered residents repeated rapid HIV testing during home-based visits every 6 months for about 4 years in four clusters, 3 years in six clusters, and 2 years in 12 clusters (58 cluster-years) and referred HIV-positive participants to trial clinics for ART (fixed-dose combination of tenofovir, emtricitabine, and efavirenz) regardless of CD4 cell count (intervention) or according to national guidelines (initially ≤350 cells per μL and FindingsBetween March 9, 2012, and June 30, 2016, we contacted 26 518 (93%) of 28 419 eligible individuals. Of 17 808 (67%) individuals with a first negative dried blood spot test, 14 223 (80%) had subsequent dried blood spot tests, of whom 503 seroconverted after follow-up of 22 891 person-years. Estimated HIV incidence was 2·11 per 100 person-years (95% CI 1·84–2·39) in the intervention group and 2·27 per 100 person-years (2·00–2·54) in the control group (adjusted hazard ratio 1·01, 95% CI 0·87–1·17; p=0·89). We documented one case of suicidal attempt in a woman following HIV seroconversion. 128 patients on ART had 189 life-threatening or grade 4 clinical events: 69 (4%) of 1652 in the control group and 59 (4%) of 1367 in the intervention group (p=0·83).InterpretationThe absence of a lowering of HIV incidence in universal test and treat clusters most likely resulted from poor linkage to care. Policy change to HIV universal test and treat without innovation to improve health access is unlikely to reduce HIV incidence.FundingANRS, GiZ, and 3ie.

Published
2018
Full Text
View/download PDF

37. What will it really take to end the HIV epidemic?

Author

Mark Tomlinson, Sarah Skeen, Jose Catalan, Bridgette Prince, Bruno Spire, Alison Swartz, Diane Cooper, Richard Harding, Lucie Cluver, Heidi van Rooyen, Lorraine Sherr, Barbara Hedge, Christopher J. Colvin, Udi Davidovich, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and DUFOUR, Jean-Charles

Subjects
medicine.medical_specialty, 030505 public health, Health (social science), Social Psychology, business.industry, [SDV]Life Sciences [q-bio], Hiv epidemic, Public Health, Environmental and Occupational Health, Human immunodeficiency virus (HIV), MEDLINE, Disease, medicine.disease_cause, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], 03 medical and health sciences, Health services, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Family medicine, medicine, 030212 general & internal medicine, 0305 other medical science, business
Abstract

Gaining access to medication against HIV is just the first step towards creating health for PLWHIV and those at risk of it, it is not the last step … PLWHIV need health services, not just disease s...

Published
2018
Full Text
View/download PDF

38. Developing a patient-reported outcome measure for HIV care on perceived barriers to antiretroviral adherence: assessing the needs of HIV clinicians through qualitative analysis

Author

Isabelle Toupin, Bertrand Lebouché, François Raffi, David Lessard, Leo Wong, Bruno Spire, Kim Engler, Andràs Lènàrt, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and DUFOUR, Jean-Charles

Subjects
Male, medicine.medical_specialty, Anti-HIV Agents, [SDV]Life Sciences [q-bio], HIV Infections, Medication Adherence, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Physicians, medicine, Humans, Patient Reported Outcome Measures, 030212 general & internal medicine, Medical prescription, Socioeconomic status, Data collection, business.industry, 030503 health policy & services, Public health, Public Health, Environmental and Occupational Health, Focus Groups, Focus group, 3. Good health, [SDV] Life Sciences [q-bio], Cross-Sectional Studies, Family medicine, Quality of Life, Female, Patient-reported outcome, 0305 other medical science, business, Inclusion (education), Clinical psychology
Abstract

To identify HIV clinicians' needs for the clinical use of a new patient-reported outcome measure (PRO) on barriers to antiretroviral therapy (ART) adherence. In 2015, five focus groups with 31 clinicians from France were transcribed, coded with Atlas.ti, and submitted to a typological analysis. The analysis identified seven patient profiles, each tied to distinct barriers to adherence and to specific needs for the PRO's content, data collection and transmission. Clinicians preferred, for the patient who is: (1) `passive,' that the PRO collect information on ART knowledge, to ensure that the prescription's instructions are being respected; (2) `misleading,' that it be able to detect adherence to ART and socially desirable responses; (3) `stoic,' that questions challenge the patient to recognize treatment-specific side effects; (4) `hedonistic,' that the PRO contains content on lifestyle and risk-taking; (5) `obsessive,' that the PRO captures quality of life and stressful life events; (6) `overburdened,' that the PRO provides information on the person's home environment, socioeconomic status and cultural constraints. For all or most patient profiles, the clinicians wished that the PRO be completed, minimally, prior to the medical consultation and to receive alerts, under varying conditions, when problematic scores were detected. Depending on the profile, there was preference for the inclusion of open-ended questions and transmission of cross-sectional, periodic or longitudinal PRO data. Overall, this study's findings suggest that to support the clinical management of ART adherence, our PRO must meet the needs of a wide variety of patients and must perform multiple functions.

Published
2018
Full Text
View/download PDF

39. Costs and benefits of on-demand HIV preexposure prophylaxis in MSM

Author

Daniela Rojas, Christian Chidiac, Catherine Capitant, Laurent Cotte, Julie Chas, Pierre Mutuon, Jean-Michel Molina, Isabelle Durand-Zaleski, Cécile Tremblay, Laurence Meyer, Bruno Spire, Gilles Pialoux, Isabelle Charreau, Service de santé publique [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Essais Thérapeutiques et Maladies Infectieuses, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), AIDES [Pantin, France] (Mission Innovation Recherche Expérimentation), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Maladies Infectieuses et Tropicales [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Génétique et Ecologie des Virus, Génétique des Virus et Pathogénèse des Maladies Virales, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Sorbonne Paris Cité (USPC), Service des Maladies Infectieuses et Tropicales [CHU Saint Louis], Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], The study was sponsored by the ANRS (France Recherche Nord & Sud Sida-HIV Hépatites) and funded by ANRS, the Canadian HIV Trials Network, the Fonds de dotation Pierre Bergé pour la Prévention – SIDACTION, Gilead Sciences, and the Bill and Melinda Gates Foundation., ANRS IPERGAY Study Group., Service des maladies infectieuses et tropicales [CHU Tenon], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Maladies infectieuses et tropicales [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Dupuis, Christine

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, Tenofovir, Anti-HIV Agents, Immunology, preexposure prophylaxis, MEDLINE, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, prevention, immune system diseases, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, On demand, Disease Transmission, Infectious, medicine, Humans, Immunology and Allergy, Prospective Studies, 030212 general & internal medicine, MSM, Homosexuality, Male, Intensive care medicine, health care economics and organizations, Cost–benefit analysis, business.industry, cost-benefit analysis, virus diseases, HIV, economics, 030112 virology, 3. Good health, Infectious Diseases, intermittent, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Economic evaluation, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Pre-Exposure Prophylaxis, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business, Disease transmission, medicine.drug
Abstract

International audience; Objectives: We undertook the economic evaluation of the double-blind randomized ANRS-IPERGAY trial, which showed the efficacy of on-demand preexposure prophy-laxis (PrEP) with tenofovir disoproxil fumarate (TDF)-emtricitabine (FTC) in preventing HIV infection among high-risk MSM. Design and methods: The economic evaluation was prospective. Counseling, drugs (TDF-FTC at s500.88 for 30 tablets), tests, visits, and hospital admissions were valued based on in-trial use. The cost of on-demand PrEP/HIV infection averted was compared with the yearly and lifetime costs of HIV infection in France in a cost and benefits analysis. Results: The yearly number of participants needed to treat to prevent one HIV infection was 17.6 (95% confidence interval ¼ 10.7-49.9). The annual cost of counseling was s690/participant. The total 1-year costs of PrEP were s4271/participant, of which s3129 (73%) were drug costs corresponding to 15 tablets of TDF-FTC/month. The yearly cost of on-demand PrEP to avoid one infection was s75 258. Using TDF-FTC generic (s179.9/30 tablets) reduced the 1-year costs of on-demand PrEP to s2271/ participant and s39 970/infection averted, respectively. Using TDF-FTC at international market discounted prices (s60/30 tablets) reduced the costs to s1517/participant and the cost to s26 787/infection averted, comparable with the yearly treatment cost of HIV infection in France. On-demand PrEP was found to be cost saving in France if the duration of exposure was less than 7.5 years at current drug price and 13 years at generic price. Conclusion: On-demand PrEP in high-risk MSM with TDF-FTC can be considered cost saving. Other benefits include the treatments of other diseases and reductions in secondary infections.

Published
2018
Full Text
View/download PDF

40. Week 96 efficacy of lopinavir/ritonavir monotherapy in virologically suppressed patients with HIV: a randomized non-inferiority trial (ANRS 140 DREAM)

Author

Valérie Boilet, Catherine Fagard, Cécile Rabian, Sybilla Peron, Caroline Roussillon, Françoise Couturier, Isabelle Cohen-Codar, Pierre-Marie Girard, Monique Termote, Eric Bellissant, Olivier Bouchaud, Karine Amat, Babacar Sylla, Aïda Benalycherif, O. Patey, Jean-Marie Poirier, Anne-Marie Taburet, Yazdan Yazdanpanah, Isabelle Poizot, Laetitia Moinot, Elisabeth Rouveix, Patrick Mercié, Eve Todesco, Amel Besseghir, Stéphane De Wit, Isabelle Pellegrin, Bruno Spire, Geneviève Chêne, Adélaïde Perrier, Laurence Morand-Joubert, Sandrine Couffin-Cadiergues, Roland Landman, Jean-Luc Meynard, S. Kolta, Vincent Bouteloup, Dupuis, Christine, Services des Maladies Infectieuses et Tropicales [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de médecine et d'épidémiologie appliquée [AP-HP Hôpital Bichat-Claude Bernard] (IMEA), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Service des maladies infectieuses et tropicales, Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Service d’information Médicale [CHU de Bordeaux] (Pôle de Santé Publique), CHU Bordeaux [Bordeaux], ANRS 140 DREAM Study Group : Girard PM, Meynard JL, Chêne G, Kolta S, Landman R, Mercié P, Moinot L, Morand-Joubert L, Cohen-Codar I, Couffin-Cadiergues S, Poirier JM, Poizot I, Rabian C, Spire B, Taburet AM, Yazdanpanah Y, Bellissant E, Pellegrin I, Peron S, De Wit S, Patey O, Rouveix E, Yazdanpanah Y, Amat K, Benalycherif A, Sylla B, Boilet V, Bouteloup V, Couturier F, Perrier A, Roussillon C, Termote M., Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service des maladies infectieuses et tropicales [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Institut de médecine et d'épidémiologie appliquée [AP-HP Hôpital Bichat-Claude Bernard], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], and Hôpital Avicenne-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris 13 (UP13)

Subjects
Adult, Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Efavirenz, 030106 microbiology, Lopinavir/ritonavir, HIV Infections, Emtricitabine, Lopinavir, Hospitals, University, 03 medical and health sciences, chemistry.chemical_compound, immune system diseases, Internal medicine, medicine, Clinical endpoint, Humans, Pharmacology (medical), Pharmacology, Ritonavir, business.industry, virus diseases, Middle Aged, Viral Load, 3. Good health, Regimen, Infectious Diseases, Anti-Retroviral Agents, chemistry, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, HIV-1, RNA, Viral, Reverse Transcriptase Inhibitors, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business, Viral load, medicine.drug
Abstract

Background: Sparing of antiretroviral drug classes could reduce the toxicity and cost of maintenance treatment for HIV infection. Objectives: To evaluate the non-inferiority of efficacy and the safety of lopinavir/ritonavir (r) monotherapy versus a single-tablet regimen of efavirenz, emtricitabine and tenofovir (EFV/FTC/TDF) over 2 years. Methods: Adults on stable ART with plasma HIV-1 RNA viral load

Published
2018
Full Text
View/download PDF

41. Long-term effectiveness of Sofosbuvir-based hepatitis C regimens in Central and West Africa (ANRS 12342)

Author

Alain Attia, Maame Esi Woode, Babacar Sylla, Gwenaëlle Maradan, Raoul Moh, Nicolas Rouveau, M. Seydi, Sylvie Boyer, Bruno Spire, Maud Lemoine, Maël Baudoin, Charles Kouanfack, Marie Libérée Nishimwe, Karine Lacombe, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and DUFOUR, Jean-Charles

Subjects
Pediatrics, medicine.medical_specialty, Hepatology, Sofosbuvir, business.industry, [SDV]Life Sciences [q-bio], Hepatitis C, medicine.disease, 3. Good health, West africa, Term (time), [SDV] Life Sciences [q-bio], 03 medical and health sciences, 0302 clinical medicine, Medicine, 030212 general & internal medicine, business, 030217 neurology & neurosurgery, medicine.drug
Abstract

International Liver Congress (ILC), Paris, FRANCE, APR 11-15, 2018

Published
2018
Full Text
View/download PDF

42. Suicidal risk among patients enrolled in methadone maintenance treatment: HCV status and implications for suicide prevention (ANRS Methaville)

Author

Gwenaëlle Maradan, Alain Morel, Patrizia Carrieri, Marion Mora, Laurent Michel, Perrine Roux, Caroline Lions, Fabienne Marcellin, Bruno Spire, Troubles du comportement alimentaire de l'adolescent (UMR_S 669), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Oppelia [Paris] (Association de prévention et de soin en addictologie), Methaville Study Group., Lissalde, Claire, Université Paris-Sud - Paris 11 (UP11)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, Suicide Prevention, Methadone maintenance, medicine.medical_specialty, lcsh:RC435-571, Poison control, Hepacivirus, Suicide prevention, Risk Assessment, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, lcsh:Psychiatry, Opiate Substitution Treatment, Medicine, Humans, 030212 general & internal medicine, Psychiatry, Mini-international neuropsychiatric interview, Primary Health Care, business.industry, Hepatitis C, Middle Aged, medicine.disease, 3. Good health, Analgesics, Opioid, Psychiatry and Mental health, Clinical Psychology, Suicide, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Food Assistance, business, Risk assessment, 030217 neurology & neurosurgery, Methadone, medicine.drug
Abstract

International audience; BACKGROUND:Suicide is a critical issue among opioid users. The aim of this study was to assess the relationship between HCV status and suicidal risk in patients receiving methadone treatment.METHODS:We used data from Methaville, a multicenter, pragmatic randomized trial designed to evaluate the feasibility of methadone induction in primary care compared with induction in specialized centers. Suicidal risk was assessed at enrollment and after one year of methadone treatment using the suicidality module in the MINI International Neuropsychiatric Interview. Socio-demographic characteristics, drug and alcohol consumption, behavioral and personality factors, history of drug use and health indicators were also assessed.RESULTS:A total of 195 individuals were enrolled from January 2009 to December 2010. Suicidal risk assessment was available at month 0 (M0) and M12 for 159 (72%) and 118 (73%) individuals, respectively. Forty-four (28%) were at risk of suicide at M0 and 17 (14%) at M12 (p=0.004). One patient attempted suicide by overdose during the one-year follow-up. The following three factors were associated with suicidal risk: hepatitis C virus (HCV) positive status (OR [95%CI]=17.25 [1.14-161.07]; p=0.04), receiving food assistance (OR [95%CI]=0.05 [0.00-1.05]; p=0.05) and a higher number of health problems (OR [95%CI]=1.24 [1.08-1.44]; p=0.003).CONCLUSIONS:Special attention should be given to HCV-positive patients through suicidal risk prevention strategies and routine suicide assessment as part of a comprehensive approach to prevention and care for opioid users. Our results represent a new and powerful argument for the expansion of access to HCV treatment to drug users with chronic infection.

Published
2015
Full Text
View/download PDF

43. Concomitant use of benzodiazepine and alcohol in methadone-maintained patients from the ANRS-Methaville trial: Preventing the risk of opioid overdose in patients who failed with buprenorphine

Author

Fabienne Marcellin, Laurent Michel, Marion Mora, Carrieri M. Patrizia, Morel Alain, Caroline Lions, Antoine Vilotitch, Perrine Roux, Gwenaëlle Maradan, and Bruno Spire

Subjects
medicine.medical_specialty, Benzodiazepine, Health (social science), medicine.drug_class, business.industry, 030508 substance abuse, Medicine (miscellaneous), Binge drinking, Opioid overdose, Odds ratio, medicine.disease, Drug overdose, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Concomitant, Emergency medicine, medicine, 030212 general & internal medicine, 0305 other medical science, Psychiatry, business, Methadone, medicine.drug, Buprenorphine
Abstract

Introduction and Aims Concomitant elevated alcohol consumption and use of benzodiazepines (BZD) during methadone treatment is widespread and particularly worrying because of the increased risk of overdose. Using concomitant binge drinking and use of BZD as a proxy of overdose risk, we aimed to study whether buprenorphine switchers were at higher risk of overdose during methadone treatment. Design and Methods The French National Agency for Research for Aids and Viral Hepatitis –Methaville multisite randomised trial enrolled 195 patients to assess the feasibility of initiating methadone in primary care by comparing it with methadone initiation in specialised centres. We selected 174 patients with available data on BZD use and alcohol binge drinking at baseline and 12 months, accounting for 318 visits. The outcome was defined to take into account an overdose risk gradient as follows: no BZD use, BZD use without and with binge drinking during the previous month. To identify factors associated with the outcome, we performed a mixed multinomial logistic regression analysis. Results At baseline, 26% of the sample reported BZD use alone while 16% reported BZD use and binge drinking. Half of the sample (51%) was switching from buprenorphine treatment. After multivariate analysis, employment, depressive symptoms and switching treatment from buprenorphine to methadone [odds ratio (95% confidence interval) 5.38 (1.74–16.62)] remained associated with BZD use and binge drinking. Discussion and Conclusions As well as the importance of identifying socially vulnerable and depressed methadone-maintained patients, clinicians should be aware that patients who fail buprenorphine treatment and switch to methadone require greater clinical monitoring and management to avoid the risk of overdose. [Roux P, Lions C, Michel L, Mora M, Maradan G, Marcellin F, Spire B, Alain M, Patrizia CM, the ANRS Methaville Study Group. Concomitant use of benzodiazepine and alcohol in methadone-maintained patients from the ANRS Methaville trials: Preventing the risk of opioid overdose in patients who failed with buprenorphine. Drug Alcohol Rev 2015; ●●:●●–●●]

Published
2015
Full Text
View/download PDF

44. Innovative community‐based educational face‐to‐face intervention to reduce HIV, hepatitis C virus and other blood‐borne infectious risks in difficult‐to‐reach people who inject drugs: results from the ANRS–AERLI intervention study

Author

Jean-Marie Le Gall, Marie Suzan-Monti, Marion Mora, Caroline Lions, Camelia Protopopescu, Perrine Roux, Marie Debrus, Maria Patrizia Carrieri, Bruno Spire, Khadim Ndiaye, Baptiste Demoulin, Aurelie Haas, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), AIDES [Marseille, France] (Association loi de 1901), Médecins du Monde [Paris, France] (Association médicale militante de solidarité internationale), French National Agency for Research for AIDS and Viral Hepatitis (ANRS)., and Lissalde, Claire

Subjects
Adult, Male, Program evaluation, medicine.medical_specialty, local complications, 030508 substance abuse, Medicine (miscellaneous), HIV Infections, Communicable Diseases, Education, 03 medical and health sciences, Risk-Taking, 0302 clinical medicine, Harm Reduction, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Intervention (counseling), Cluster Analysis, Humans, Medicine, Community Health Services, injecting drug user, 030212 general & internal medicine, Substance Abuse, Intravenous, Health Education, intervention, Drug injection, Harm reduction, business.industry, HIV, Hepatitis C, medicine.disease, Checklist, 3. Good health, Psychiatry and Mental health, Telephone interview, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, HCV, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Health education, France, 0305 other medical science, business, Social psychology, Program Evaluation
Abstract

Aims To study the effectiveness of an educational intervention on risks associated with drug injection, comparing primary [unsafe HIV–hepatitis C virus (HCV) practices] and secondary (local complications at injecting site) end-points in harm reduction (HR) programmes offering this intervention versus HR programmes not offering it. Design This non-random clustered intervention study was conducted in nine intervention groups (programmes offering the intervention) and eight control groups (programmes not offering it). Each participant was followed-up through a telephone interview at enrolment and at 6 and 12 months. Setting The study took place in 17 cities throughout France. Participants Of the 271 participants, 144 were enrolled into the intervention group and 127 in the control group. Of the latter, 113 received at least one educational session. Intervention A series of participant-centred face-to-face educational sessions. Each session included direct observation by trained non-governmental organization (NGO) staff or volunteers of participants’ self-injecting the psychoactive product they used habitually; analysis by the trained NGO staff or volunteers of the participant's injecting practices, identification of injection-related risks and explanation of safer injecting practices; and an educational exchange on the individual participant's injection practices and the questions he or she asked. Measurements Primary and secondary outcomes were ‘at least one unsafe HIV–HCV practice’ and at least one injection-related complication (derived from a checklist). Findings The proportion of participants with at least one unsafe HIV–HCV practice in the intervention group decreased significantly, from 44% at M0 to 25% at M6, as well as complications at the injection site (from 66 to 39% at M12), while in the control group it remained mainly stable. Multivariate probit analyses showed that the intervention group experienced a significant reduction in unsafe HIV–HCV practices at M6 [coefficient, 95% confidence interval (CI) = −0.73 (−1.47 to 0.01)] and in injection-related complications at M12 [coefficient, 95% CI = −1.01 (−1.77 to −0.24)], compared with the control group. Conclusions An inexpensive and easily implemented educational intervention on risks associated with drug injection reduces significantly unsafe HIV–HCV transmission practices and injection-related complications.

Published
2015
Full Text
View/download PDF

45. Women living with HIV still lack highly effective contraception: results from the ANRS VESPA2 study, France, 2011

Author

Christine Hamelin, Rosemary Dray-Spira, Nathalie Bajos, B. Maraux, Bruno Spire, F. Lert, Centre for Geobiology [Bergen], University of Bergen (UiB), Agence nationale de sécurité du médicament et des produits de santé [Saint-Denis] (ANSM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Population, HIV Infections, Intrauterine device, law.invention, Condoms, Young Adult, Condom, law, Contraceptive Agents, Female, Humans, Medicine, education, Contraception Behavior, Africa South of the Sahara, Reproductive health, Transients and Migrants, education.field_of_study, business.industry, Obstetrics and Gynecology, Gender studies, Contraceptive Prevalence Surveys, Sexual Partners, Anti-Retroviral Agents, Socioeconomic Factors, Reproductive Medicine, Hormonal contraception, Family planning, Family medicine, Practice Guidelines as Topic, Patient Compliance, Female, France, business, Developed country, Unintended pregnancy
Abstract

Advances in antiretroviral treatment (ART) have led to improvements in reproductive health for women living with HIV. This paper aims to investigate the pattern of contraceptive use among women living with HIV in France.Data were drawn from the ANRS VESPA2 study, which included a representative sample of HIV-positive people. Contraception methods were documented, including condoms, highly effective contraception methods (HEC) and traditional methods. We measured the frequency of not using any modern contraception (neither condoms nor HEC) and of HEC use and studied their correlates (i.e., geographic origin, age, parity, partnership status, education level, material deprivation, employment status, health insurance, visits to a gynecologist, being on ART, cardiovascular risk) among women at risk of an unintended pregnancy.Of the 662 women of reproductive age, 327 were in need of contraception. Overall, 20.5% used HEC, 58.8% used condoms and 20.7% used traditional or no methods, with no difference according to geographic origin [sub-Saharan African (SSA) women vs. French and other migrant women]. Among SSA women, being30years old [odds ratio (OR) 16.39, 95% confidence interval (95%CI) 2.77-97.01], having had at least one child (OR 3.75, 95%CI 1.75-8.04) and being employed (OR 2.36, 95%CI 0.99-5.61) were associated with HEC use; among French and other migrant women, HEC use was associated with being in a stable partnership (OR 4.5, 95%CI 1.2-17.2) and material deprivation (OR 3.3 95%CI 1.4-9.8). Gynecologist visits, health insurance status and cardiovascular risk were not associated with HEC use.Condoms remained the predominant contraceptive method despite the absence of restrictions on hormonal contraception and intrauterine device use for HIV-positive women. The recent recommendations about dual method protection should be actively promoted, targeting HIV-positive women, HIV specialists and gynecologists to overcome the barriers to effective contraception.The information provided in this study constitutes a major contribution to comprehensively inform the scientific community on contraception practices among women living with HIV in France in the early 2010s. Our results show that the therapeutic advances since the late 1990s and the removal of restrictions on hormonal contraception use have not led to the expected shift in contraception patterns. There is an urgent need to promote dual method protection, as condom use may decrease in the future in the context of the preventive effect of ART.

Published
2015
Full Text
View/download PDF

46. Adherence to PI-based 2nd-line regimens in Cambodia is not simply a question of individual behaviour : the ANRS 12276 2PICAM study

Author

Marion Mora, Vohith Khol, Chhi. Vun Mean, Gwenaëlle Maradan, Luis Sagaon-Teyssier, Bruno Spire, Sovatha Mam, Olivier Segeral, Vonthanak Saphonn, Sopheak Ngin, Eric Nerrienet, Bakridine M’madi Mrenda, Laurent Ferradini, Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Dermatology and STD [Phnom Penh, Cambodia], National Center for HIV/AIDS [Phnom Penh, Cambodia], Family Health International (FHI), Family Health International, World Health Organization [Phnom Penh] (WHO), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), University of Health Sciences [Phnom Penh], Institut Pasteur du Cambodge, Réseau International des Instituts Pasteur (RIIP), and Lissalde, Claire

Subjects
0301 basic medicine, Male, Pediatrics, Human immunodeficiency virus (HIV), HIV Infections, Logistic regression, medicine.disease_cause, adhésion, 0302 clinical medicine, schema, Residence Characteristics, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Health care, Odds Ratio, multilevel modelling, PI regimen, Psychology, 030212 general & internal medicine, adherence, schéma à base d’IP, Middle Aged, modélisation multi-niveaux, 3. Good health, adhesion, Infectious Diseases, modelisation multi-niveaux, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Female, Cambodia, Psychosocial, Adult, medicine.medical_specialty, Anti-HIV Agents, Medication Adherence, 03 medical and health sciences, Healthcare delivery, medicine, Antiretroviral treatment, Humans, Quality of Health Care, Adult patients, business.industry, Public Health, Environmental and Occupational Health, Psychosocial Support Systems, 030112 virology, Cross-Sectional Studies, Logistic Models, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Facilitator, Family medicine, a base d'IP, Parasitology, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Health Facilities, Cambodge, Health Expenditures, business
Abstract

ObjectivesTo investigate whether adherence to antiretroviral treatment (ART) can be explained not only by individual factors but also by health care facilities' characteristics, among a sample of people living with HIV (PLWH) treated with PI-based regimens in Cambodia. MethodsThe ANRS 12276 2PICAM cross-sectional survey was conducted between February 2013 and April 2014 among PLWH followed up in 13 health care facilities. The 1316 patients in this analysis corresponded to 90% of the total number of adult patients treated with 2nd-line PI-based regimens in Cambodia in the study period. A variable indicating whether patients were non-adherent (=1) or completely adherent (=0) was constructed. Health care facilities and individual characteristics were included in a two-level logistic model to investigate their influence on patients' adherence to ART. ResultsA total of 17% of participants did not adhere to ART. Patients in health care facilities outside the capital Phnom Penh were six times more likely to be non-adherent than those treated in health care facilities in the capital (OR: 6.15, 95% CI [1.47, 25.79]). Providing psychosocial care (provided by psychologist counsellors and/or full-time coaches) was found to be a structural facilitator of adherence, as the probability of non-adherence fell by 38.5% per each additional psychological worker present in health care facilities (OR: 0.62, 95% CI [0.43, 0.89]). Financial constraints were the main individual factor preventing adherence. ConclusionsOur results suggest that inefficiencies in health care delivery are detrimental to PLWH health and to the exceptional progress currently being made by Cambodia in response to HIV. Policy makers should focus on increasing the number of psychosocial workers, especially in areas outside the capital. ObjectifsInvestiguer si l'adhesion au traitement antiretroviral (ART) peut etre expliquee non seulement par des facteurs individuels mais aussi par les caracteristiques des etablissements de sante, dans un echantillon de personnes vivant avec le VIH (PVVIH), traitees par des schemas a base d'IP au Cambodge. MethodesL'enquete transversale ANRS 12276 2PICAM a ete menee entre fevrier 2013 et avril 2014 chez des PLWH suivies dans 13 etablissements de sante. Les 1316 patients dans cette analyse correspondaient a 90% du nombre total des patients adultes traites par des schemas de 2(e) ligne a base d'IP au Cambodge durant la periode d'etude. Une variable indiquant si les patients etaient non adherents (= 1) ou totalement adherents (= 0) a ete construite. Les caracteristiques des etablissements de soins de sante et individuels ont ete incluses dans un modele logistique a deux niveaux afin d'etudier leur influence sur l'adhesion des patients a l'ART. Resultats17% des participants n'on pas adhere a l'ART. Les patients dans les etablissements de soins de sante en dehors de la capitale Phnom Penh etaient six fois plus susceptibles d'etre non-adherents que ceux traites dans les etablissements de sante dans la capitale (OR: 6,15; IC95%: 1,47-25,79). La fourniture de soins psychosociaux (par des psychologues et/ou des coaches a temps plein) a ete trouve comme etant un facilitateur structurel de l'adhesion, vu que la probabilite de non-adhesion a chute de 38,5% par chaque agent psychologique supplementaire present dans les etablissements de sante (OR: 0,62; IC95%: 0,43-0,89). Les contraintes financieres etaient le principal facteur individuel empechant l'adhesion. ConclusionsNos resultats suggerent que l'inefficacite dans la prestation des soins de sante est prejudiciable a la sante des PLWH et aux progres exceptionnels realises actuellement par le Cambodge en reponse au VIH. Les decideurs devraient se concentrer sur l'augmentation du nombre des agents psychosociaux, en particulier dans les zones situees a l'exterieur de la capitale.

Published
2017
Full Text
View/download PDF

47. Will CURE trials introduce an uncomfortable revolution in the field of HIV research?

Author

Olivier Lambotte, Marion Mora, Marjolaine Doumergue, Christel Protière, Marie Suzan-Monti, Bruno Spire, Marie Préau, Epidémiologie et Sciences Sociales Appliquées à l'Innovation Médicale, Université de la Méditerranée - Aix-Marseille 2-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Immunologie des Maladies Virales et Autoimmunes (IMVA - U1184), Université Paris-Sud - Paris 11 (UP11)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), This work was financially supported from ANRS [France Recherche Nord & Sud Sida-hiv Hépatites – N° 14697], and Protière, Christel

Subjects
0301 basic medicine, medicine.medical_specialty, Biomedical Research, Anti-HIV Agents, 030106 microbiology, Human immunodeficiency virus (HIV), Alternative medicine, [SHS.PSY]Humanities and Social Sciences/Psychology, HIV Infections, medicine.disease_cause, Cure trials, [SHS.PSY] Humanities and Social Sciences/Psychology, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Innovation, [SHS.ECO] Humanities and Social Sciences/Economics and Finance, ComputingMilieux_MISCELLANEOUS, Clinical Trials as Topic, Medical education, business.industry, Field (Bourdieu), HIV, medicine.disease, [SHS.ECO]Humanities and Social Sciences/Economics and Finance, 3. Good health, HIV identity, Infectious Diseases, Epistemological break, business
Abstract

Since the start of the HIV/Aids epidemic, in the early eighties, innovations to cope with emergency have come one after another. They have always followed the same logic, that of improving upon cur...

Published
2017
Full Text
View/download PDF

48. Patient profiles as organizing HIV clinicians' ART adherence management: a qualitative analysis

Author

Bertrand Lebouché, François Raffi, Leo Wong, Isabelle Toupin, David Lessard, Bruno Spire, Andràs Lènàrt, Kim Engler, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and DUFOUR, Jean-Charles

Subjects
Adult, Male, medicine.medical_specialty, Health (social science), Psychotherapist, Social Psychology, [SDV]Life Sciences [q-bio], Sexual Behavior, Human immunodeficiency virus (HIV), Patient characteristics, HIV Infections, medicine.disease_cause, Medication Adherence, 03 medical and health sciences, 0302 clinical medicine, Qualitative analysis, Risk-Taking, Antiretroviral Therapy, Highly Active, Physicians, medicine, Humans, 030212 general & internal medicine, Qualitative Research, Social desirability, Physician-Patient Relations, business.industry, 030503 health policy & services, Communication, Public Health, Environmental and Occupational Health, Management styles, Focus Groups, Focus group, Antiretroviral therapy, Art adherence, 3. Good health, [SDV] Life Sciences [q-bio], Sexual Partners, Anti-Retroviral Agents, Socioeconomic Factors, Family medicine, Female, France, 0305 other medical science, business
Abstract

The effectiveness of antiretroviral therapy (ART) depends on optimal clinical management and patient adherence. Little is known about patient characteristics that clinicians consider in the management of ART adherence. Exploring this issue, five focus groups were conducted with 31 HIV-clinicians from across France. A qualitative typological analysis suggests that clinician management of patient adherence is based on characteristics that coalesce into seven patient profiles. For the "passive" patient, described as taking ART exactly as prescribed without questioning their doctor's expertise, a directive and simple management style was preferred. The "misleading" patient is characterized as concerned with social desirability and as reporting no adherence difficulties for fear of displeasing their doctor. If clinical outcomes are suboptimal, the clinicians' strategy is to remind them of the importance of open patient-clinician communication. The "stoic" patient is described as requesting and adequately taking the most potent ART available. Here, clinicians emphasize assessment of side effects, which the patient may minimize. The "hedonistic" patient's festive lifestyle and sexual risk-taking are seen as compromising adherence; with them, clinicians stress the patient's responsibility for their own health and that of their sexual partners. The "obsessive" patient is portrayed as having an irrational fear of ART failure and an inability to distinguish illusory from genuine adherence barriers. With this patient, clinicians seek to identify the latter. The "overburdened" patient is recognized as coping with life priorities that interfere with adherence and, with them, a forgiving ART is favored. The "underprivileged" patient is presented as having limited education, income and housing. In this case, clinicians seek to improve the patient's living conditions and access to care. These results shed light on HIV clinicians' ART adherence management. The value of these profiles for HIV care and patients should be investigated.

Published
2017
Full Text
View/download PDF

49. Prevalence of HIV at the Kokoyo informal gold mining site: What lies behind the glitter of gold with regard to HIV epidemics in Mali ? A community-based approach (The ANRS-12339 Sanu Gundo cross-sectional survey)

Author

B. Dembélé Keita, Marion Mora, Nikos Kalampalikis, Michel Bourrelly, Luis Sagaon-Teyssier, Bruno Spire, Fodié Diallo, H. Balique, Marie Suzan-Monti, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM U 379 / ORS PACA, Institut National de la Santé et de la Recherche Médicale (INSERM), ARCAD-SIDA (ARCAD-SIDA), Groupe de Recherche en Psychologie Sociale (GRePS), Université Lumière - Lyon 2 (UL2), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), and Kalampalikis, Nikos

Subjects
Male, Gerontology, Cross-sectional study, [SHS.PSY]Humanities and Social Sciences/Psychology, HIV Infections, Mali, Health Services Accessibility, Condoms, 0302 clinical medicine, 5. Gender equality, Residence Characteristics, Risk Factors, Surveys and Questionnaires, HIV Seropositivity, Epidemiology, Prevalence, 030212 general & internal medicine, education.field_of_study, Health Policy, public health, Commerce, General Medicine, epidemiology, Female, 0305 other medical science, Adult, medicine.medical_specialty, Sexual Behavior, Population, Context (language use), Mining, [SHS.PSY] Humanities and Social Sciences/Psychology, Young Adult, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), Environmental health, medicine, Humans, Occupations, Epidemics, education, Health policy, Sex Workers, 030505 public health, business.industry, Research, Public health, HIV, medicine.disease, Sex Work, Focus group, Cross-Sectional Studies, Gold, business
Abstract

ObjectivesThe aim of this article was to estimate HIV prevalence and the factors associated with HIV seropositivity in the population living and working at the informal artisanal small-scale gold mining (IASGM) site of Kokoyo in Mali, using data from the Sanu Gundo survey. Our main hypothesis was that HIV prevalence is higher in the context of IASGM than in the country as a whole.DesignThe ANRS-12339 Sanu Gundo was a cross-sectional survey conducted in December 2015. The quantitative survey consisted of face-to-face administration of questionnaires. Five focus groups were conducted for the qualitative survey. HIV prevalence was calculated for the sample, and according to the type of activity performed in IASGM.SettingsThe IASGM site of Kokoyo, one of the largest sites in Mali (between 6000 and 1000 people).Participants224 respondents: 37.5% were gold-diggers, 33% retail traders, 6.7%tombolomas(ie, traditional guards) and 9% female sex workers. The remaining 13.8% reported another activity (mainly street vending).Primary and secondary outcome measuresHIV prevalence and HIV prevalence according to subgroup, as defined by their activity at the Kokoyo IASGM. A probit logistic regression was implemented to estimate the characteristics associated with HIV seropositivity.ResultsHIV prevalence for the total sample was 8% (95% CI 7.7% to 8.3%), which is much higher than the 2015 national prevalence of 1.3%Joint United Nations Programme on HIV/AIDS (UNAIDS). The probability of HIV seropositivity was 7.8% (p=0.037) higher for female non-sex workers than for any other category, and this probability increased significantly with age. Qualitative data revealed the non-systematic use of condoms with sex workers; and long distance from health services was the main barrier to accessing care.ConclusionsIntegrated policymaking should pay special attention to infectious diseases among populations in IASGM zones. Bringing information/prevention activities closer to people working in gold mining zones is an urgent public health action.

Published
2017
Full Text
View/download PDF

50. Self-Reported Bothersome Symptoms Across Different Socioepidemiological Groups of People Living With HIV Attending French Hospitals: Results From the ANRS-VESPA2 Survey

Author

Véronique Boyer, Antoine Vilotitch, Fabienne Marcellin, Baptiste Demoulin, Rosemary Dray-Spira, Bruno Spire, France Lert, Maria Patrizia Carrieri, Christine Hamelin, Nicolas Lorente, Marie Préau, Marie Suzan-Monti, Martin Duracinsky, Marion Mora, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Observatoire régional de la santé Provence-Alpes-Côte d'Azur [Marseille] (ORS PACA), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), French National Agency for Research on Aids and Viral Hepatitis (ANRS) (ANRS-EN12), Lissalde, Claire, Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, Multivariate analysis, Adolescent, Anti-HIV Agents, Population, Human immunodeficiency virus (HIV), Context (language use), HIV Infections, Comorbidity, medicine.disease_cause, Social group, 03 medical and health sciences, Young Adult, 0302 clinical medicine, medicine, Humans, 030212 general & internal medicine, Moderate number, education, Psychiatry, Self report, General Nursing, education.field_of_study, General symptoms, business.industry, 1. No poverty, Middle Aged, self-report, 030112 virology, 3. Good health, Anesthesiology and Pain Medicine, Logistic Models, Socioeconomic Factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Multivariate Analysis, socioepidemiological group, symptoms, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Neurology (clinical), France, Self Report, business, ART
Abstract

Context Twenty years after the advent of combined antiretroviral therapies (ARTs), there is a growing need for up-to-date information about the daily experience of people living with HIV (PLWH). Objectives This study aimed to investigate the relationship between socioepidemiological groups and the types of bothersome symptoms reported by PLWH participating in a national survey in France. Methods We analyzed self-reported bothersome symptoms in a representative sample of PLWH (ANRS-VESPA2 survey), most of whom were receiving ART treatment. PLWH ( N = 2505) were grouped into three clusters according to the number of bothersome symptoms reported: Cluster A (low number, n = 1848), Cluster B (moderate number, n = 271), and Cluster C (high number, n = 386). Results Individuals in Cluster A (low number of bothersome symptoms) were less likely to report all the symptom types investigated. Psychological, sexual, and general symptoms were more likely to be reported in Cluster B (moderate number), whereas gastric-, pain-, and appearance-related symptoms were more likely in Cluster C (high number). In multivariate analyses, women not natives of Sub-Saharan Africa and former/active female injecting drug users were more likely to report a medium or high number of symptoms, and lower adherence to ART. Conclusion Combining new biomedical strategies with coping mechanisms and providing better support to socially vulnerable PLWH may improve this population's quality of health and daily life.

Published
2017
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results