Preparation in France: the autumn after the climb

Net increase

The latest data on Prep in France dates back to December 2019, announcing 20,478 people who started a Prep treatment in France as of June 30, 2019, a 47% increase compared to June 2018. With 32,000 people as of June 30, 2020, ct is an increase of 57% that is observed. (2) “The new data shows that the dynamics of increase in the use of Prep reported in 2018-2019 continued and intensified until the beginning of 2020 with almost 9,000 new users – rice in the period from the beginning of July 2019 at the end of February 2020 “, indicates ANSM. However, access to the Prep remains concentrated in one region: Île-de-France (41% of users) and in particular Paris (25%) and in the vast majority on a single audience, men having sex with men (MSM) representing 97% of users.

Until the fall!

“Prep initiations however collapsed in March, April and May 2020 during the national prison period (…) with a drop that reached 50-80% compared to the months of January and February 2020”, he is alarmed. ‘ANSM. The health agency specifies that Prep’s initiations resumed after the end of the first confinement without resuming the pre-Covid-19 dynamic. Furthermore, ANSM specifies that the vast majority of Prep users (80 to 90%) renew their treatment from one semester to the next, suggesting a good level of maintenance of the Prep. However, in the first half of 2020, the retention rate of the Prep decreased compared to the period 2017-2019.

Get out of the hospital!

Interesting data, ANSM announces that the prescriptions of Prep (initiation and renewal) by prescribers who practice outside the hospital have risen sharply during the last year. What to encourage the deployment of the first prescription by general practitioners in the city, whose application decree should have been signed in March, but which was delayed due to Covid-19.

Until now, the only way to start a Prep treatment was to make an appointment with a doctor who practices in a Cegidd (free information, screening and diagnosis center for HIV and hepatitis viral and sexually transmitted infections) or in a hospital of Smit (department of infectious and tropical diseases). This limitation was a real obstacle for many people depending on the times, the distance and the often saturated services. The attending physician can only renew the prescription and not carry out the initial prescription (first prescription). “These prescribing methods must therefore evolve so that all doctors, in town and in hospitals, can prescribe and start Prep. It is the guarantee of an effective territorial network, of a greater dissemination to health professionals of a global approach to sexual health ”, stated the Minister of Health in a statement published on 1 December. . “For this reason the Council of State has received a draft decree authorizing the first prescription of the Prep by city doctors, and which should make it effective from the beginning of 2021”.

This is therefore good news, which must also be accompanied by the training of general practitioners in the Prep, a tool not so new (accessible and reimbursable in France from January 2016) but still too little known, both by the general population and also some health professionals. In this sense, the SFLS (French Society for the Fight against AIDS) has designed an e-learning platform that will support the training of city doctors in the Prep. “It is multidisciplinary work with various scholarly societies and community actors,” announced Dr. Pascal Pugliese, president of the SFLS, last October, during his congress.

Increase screening for sexually transmitted diseases

Another measure announced on 1 December by the Ministry of Health: diversify and strengthen access for all to screening by expanding these skills to new health professionals. “Knowing your HIV status must remain the main focus of our public health policy. Each of us must realize that being tested also means accessing treatment as soon as possible, saving time, preserving one’s health and that of others, and living fully. her sexual and emotional life, “says Olivier Véran. To this end, access to STI screening will be strengthened by allowing nurses and midwives to prescribe them as part of a cooperation protocol with doctors. This change will be implemented as soon as will be validated by the Haute Autorité de Santé (HAS), in the first half of 2021.

Develop sexual health centers

In his press release, the Minister of Health also announced the trial of community-based sexual health centers (CSSAC) in four cities: the Kiosque Info Sida Toxicomanie in Paris, the Griffon in Lyon, the Spot Longchamp in Marseille and the Spot in Montpellier, in the opening phase. He specified that these centers will offer new ways of organizing, inspired by the success of the Anglo-Saxon model. “The novelty of this approach consists in offering courses based on the principle of“ Test and Treat ”, ie screening and treatment if necessary, in one place and in a short time. “.

The “Test and Treat” model, to which Olivier Véran refers in his press release, actually comes from the Dean Street clinic (3) in London, but what the minister presents as an innovation has already existed in France for more than ten years. 190 (4) and at Checkpoint Paris (5). For a long time health actors have been calling for the development of community health centers with a comprehensive and multidisciplinary approach to sexual health. It is good that the Ministry of Health supports this development, even if still insufficient, given the needs. Every major city in France should be able to offer this type of offer accessible to all.

(1): Since 2017, Epi-Phare, a scientific interest group associating ANSM and CPAM, has been monitoring annual changes in the use of Prep in France based on data from the National Data System Health (SNDS ).
(2): The total number of people aged 15 and over who started Prep treatment in France reached more than 32,000 on 30 June 2020. This is a 57% increase compared to 30 June 2019. Source ANSM (Agence National Safety of Medicines and Health Products), November 2020.
(3): 56 Dean Street Clinic is the largest sexual health clinic in London and possibly the largest HIV clinic in Europe.
(4): 190 is the first community sexual health (LGBT) center to open its doors in Paris in 2010. The center has also been a Cegidd since 2016 and offers both HIV / STI testing and HIV follow-up, Prep, psychologist and addictology.
(5): Open since 2010, Checkpoint Paris offers HIV and STI screening and follow-up for preparation