No barrier to care, yet disparities in the HIV care continuum in France: a nationwide population study

Lise Cuzin (1) , Clotilde Allavena (2, 3) , Laurent Cotte (4) , Cyrille Delpierre (5) , Thomas Huleux (6) , Romain Palich (7, 8) , Pierre Delobel (9, 10) , François Raffi (2, 3) , André Cabié (1, 11) , C Drobacheff-Thiébaut , A Foltzer , K Bouiller (12, 13) , L Hustache- Mathieu , C Chirouze (12, 13) , Q Lepiller (13, 14) , F Bozon , O Babre , L Brunel , P Muret (besançon) , H Laurichesse , O Lesens , M Vidal , N Mrozek , C Aumeran , O Baud , V Corbin , P Letertre-Gibert , S Casanova , J Prouteau , C Jacomet (clermont Ferrand) , I Lamaury , I Fabre , E Curlier , R Ouissa , C Herrmann-Storck , B Tressieres , T Bonijoly , M. Receveur , F Boulard , C Daniel , C Clavel (guadeloupe) , D Merrien , P Perré , T Guimard , O Bollangier , S Leautez , M Morrier , L Laine (la Roche Sur Yon) , F Ader , A Becker , F Biron , A Boibieux , T Ferry , P Miailhes , T Perpoint , Stéphane Roux , C Triffault-Fillit , S Degroodt , C Brochier , F Valour , C Chidiac (lyon) , A Ménard , A. Belkhir , P Colson , C Dhiver , A Madrid , M Martin-Degiovani , L Meddeb , M Mokhtari , A Motte , A Raoux , I Ravaux , C Tamalet , C Toméi , H Tissot Dupont , S Brégigeon , O Zaegel-Faucher , V Obry-Roguet , H Laroche , M Orticoni , M. Soavi , P Geneau de Lamarlière , E Ressiot , M. Ducassou , I Jaquet , S Galie , A Galinier , P Martinet , M Landon , A. Ritleng , A Ivanova , C Debreux , C Lions , I Poizot-Martin (marseille Ste Marguerite) , B Bigeard , O Cabras , K Guitteaud , M Illiaquer , A Marquise , S Pierre-François , J Pasquier , K Rome , J. Turmel , C Varache , A Cabié (martinique) , N Atoui , M Bistoquet , E Delaporte , V Le Moing , Alain Makinson (15, 16) , N Meftah , C Merle de Boever , B Montes , A Montoya Ferrer , Edouard Tuaillon (15, 17) , J Reynes (montpellier) , M André , L Boyer , M. Bouillon , M Delestan , C Rabaud , T May , B Hoen (nancy) , C Bernaud , E Billaud , C Biron , B Bonnet , S Bouchez , D Boutoille , C Brunet-Cartier , C Deschanvres , B Gaborti , N Hall , T Jovelin , P Morineau , V Reliquet , S Sécher , M Cavellec , A Soria , V Ferré , E André-Garnier , A Rodallec , M Lefebvre , O Grossi , O Aubry , F Raffi (nantes) , P Pugliese , S Breaud , C Ceppi , D Chirio , E Cua , P Dellamonica , E Demonchy , A de Monte , J Durant , C Etienne , S Ferrando , R Garraffo , C Michelangeli , V Mondain , A Naqvi , N Oran , I Perbost , S Pillet , C Pradier , B Prouvost-Keller , K Risso , V Rio , P. Roger , E Rosenthal , S Sausse , I Touitou , S Wehrlen-Pugliese , G Zouzou (nice) , L Hocqueloux , T Prazuck , C Gubavu , A Sève , A Maka , C Boulard , G Thomas , E Botelho-Nevers , A Gagneux-Brunon , A Frésard , V Ronat , F Lucht , P Fischer , M Partisani , C Cheneau , M Priester , M. Batard , C Bernard-Henry , E de Mautort , S Fafi-Kremer , D Rey , M Alvarez , N Biezunski , A Debard , P Lansalot , L Lelièvre , G Martin-Blondel , M Piffaut , L Porte , K Saune , F Ajana , E Aïssi , I Alcaraz , V Baclet , L Bocket , A Boucher , P Choisy , B Lafon-Desmurs , A Meybeck , M Pradier , O Robineau , N Viget , M Valette , Y Yazdanpanah , R Landman , C Duvivier , M. Valantin , R Agher , C Katlama , P Flandre , O Lortholary , V Avettand-Fenoel , C Rouzioux , P. Consigny , G Cessot , F Touam , R Usubillaga , K Benhadj

1 CHU de la Martinique [Fort de France]
2 CHU Nantes - Centre Hospitalier Universitaire de Nantes
3 CIC Nantes - Centre d’Investigation Clinique de Nantes
4 Service de Maladies Infectieuses et Tropicales [Hôpital de la Croix-Rousse - HCL]
5 UT3 - Université Toulouse III - Paul Sabatier
6 Centre Hospitalier de Tourcoing
7 CHU Pitié-Salpêtrière [AP-HP]
8 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
9 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
10 CPTP - Centre de Physiopathologie Toulouse Purpan
11 CIC - Antilles Guyane - Centre d'Investigation Clinique Antilles-Guyane
12 LCE - Laboratoire Chrono-environnement (UMR 6249)
13 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
14 CEF2P / CARCINO - Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181)
15 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
16 TransVIHMI - Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes
17 PCCEI - Pathogenesis and Control of Chronic and Emerging Infections

Objectives Even in an ‘optimal’ health system, patients’ characteristics may have an impact on their care. We investigated whether age, gender and place of birth have an impact in the HIV care continuum in France, a country with a universal free healthcare system. Methods We estimated differences in the 5 year restricted mean percentage of person-time spent (i) in care, (ii) receiving ART and (iii) on ART and virally suppressed among 2432 (30.2%) women, 3925 MSM (48.7%) and 1709 men who have sex with women (MSW; 21.2%) entering care in the Dat’AIDS French prospective cohort between 1 January 2013 and 31 December 2017. Trial registration: Clinicaltrials.gov reference NCT02898987. Results Men and women spent 85.6% and 82.8% of person-time on ART and 69.9% and 65% suppressed, respectively. MSM, MSW and women spent 86.9%, 82.6% and 82.8% of person-time on ART and 72.5%, 63.7% and 65% suppressed, respectively. Patients born in France (47%) and patients born abroad spent 87.9% and 81.9% of person-time on ART and 74.6% and 62.9% suppressed, respectively. Young men born abroad were found to spend the smallest person-time with non-detectable viral load (53% for MSW and 58.1% for MSM). Conclusions Despite free access to care and universal ART in France, disparities remain in the HIV continuum care across age, country of birth and way of HIV acquisition. Clinical and public health interventions targeting specific patients’ conditions are needed.

Domaines: Médecine humaine et pathologie; Microbiologie et Parasitologie; Maladies infectieuses; Pharmacologie

Lise Cuzin, Clotilde Allavena, Laurent Cotte, Cyrille Delpierre, Thomas Huleux, et al.. No barrier to care, yet disparities in the HIV care continuum in France: a nationwide population study. Journal of Antimicrobial Chemotherapy, 2021, 76 (6), pp.1573-1579. ⟨10.1093/jac/dkab061⟩. ⟨hal-03365008⟩