Retain
- A French study Led in 2021-2022 shows that the extension of the initiation of pre-exhibition prophylaxis (PREP) to all doctors in June 2021 made it possible to reach a wider population, but that the profile of users remains comparable to that described before.
- Female audiences, socio-economicly disadvantaged or even from rural or ultramarine territories are still too minority despite their vulnerability in the face of the risk of infection.
Pre-exhibition prophylaxis (PREP) is a preventive drug approach to HIV infection which has been taken care of since January 2016 by health insurance for high risk of HIV infection. This was followed by a craze which has gradually tired, as evidenced by the stagnation of the number of people benefiting from the PREP today. Thus, 20 % of men who have sex with other men (HSH) and 2 to 4 % of eligible women would benefit. In order to expand the dissemination of the Oral PREP to eligible people, the prescription of treatment, which was reserved for specialist doctors, was extended to all prescribers, and in particular general practitioners, from June 2021. PREP is also accessible through state medical aid (AME) and delivered free of charge in sexual health centers for all. In order to know if this development has made it possible to expand both the number and spectrum of people using this means of prevention, researchers analyzed the data Coming from the SNDS (national health data system) over the period 2021-2022.
A contrasting observation
As for encouraging observations, this work shows that 13,500 people began an oral prep between June 2021 and December 2022, with an average monthly number of initiation having gradually increased, from 654 on July-December 2021 to 783 on July-December 2022.
The persons concerned were mainly men (96.3 %), with an average age of 36 years, including 7.5 % socioeconomically disadvantaged. This observation is, this time, equivalent to that which had been drawn up upstream of 1is June 2021 (97.5 % of men; Average age: 35.5 years; 7.5 % of socioeconomically disadvantaged people).
On the geographical level, it was the same: the initiations of PREP had mainly taken place in urban areas. Sixty and eleven percent of the initiations prescribed in primary care were carried out in people who lived in an agglomeration of more than 200,000 inhabitants and 41 % resided in Île-de-France. At the same time, overseas territories brought together only 1.3 % of initiations.
Thus, the extension of the initiation of the PREP to all doctors, who aimed in particular to reach an extended and more diverse population, is not a complete success. The low representation of women contrasts with epidemiological data when we know that these represented nearly a third of the new infections in 2022of sexual origin in 97 % of cases. People living in rural areas and disadvantaged socio-economically people are still very minority.
We can also recall here that the ultramarine territories “rSpread regions where the incidence of HIV infection is the highest, reaching up to 1,149 cases for 1,000,000 inhabitants in 2022 “, Contrasting with metropolitan France where” The highest incidence is observed in Île-de-France, with 190 cases for 1,000,000 inhabitants ».
On the side of the 10,525 prescribers, 88.6 % were general practitioners, but only 44.7 % were their attending physician, which testifies to difficulty approaching the question of sexual health with them.
Finally, 70.8 % of the subjects had a renewal within 6 months of their first prescription of PREP (average of 3.3 renewals), knowing that the study does not include the prep injectable long -term action.
One of the limits of this study is that the SNDS does not identify sexual behavior, transgender people or sex workers, which restricts the analysis of certain key populations. However, the comparison of user profiles before and after the extension of the prescription in primary care suggests that these populations remain marginal. “” Targeted communication adapted to specific profiles [permettrait de] Suggest the PREP to the populations identified as exposed and sub-utilizers of the PREP “, Namely” Individuals who do not have access to the PREP due to social inequalities in health, including geographic inequalities, gender or racial, and men with sexual intercourse (…) who do not consider themselves to be at risk and eligible for Prep ». The awareness of practitioners to identify target people also seems necessary.
