Missed opportunities for HIV pre-exposure prophylaxis among people with recent HIV infection: The French ANRS 95041 OMaPrEP study

Caroline Lions; Helene Laroche; Marion Mora; Gilles Pialoux; Laurent Cotte; Eric Cua; Lionel Piroth; Jean Michel Molina; Maria Salnikova; Gwenaëlle Maradan; Isabelle Poizot-Martin; Bruno Spire

doi:10.1111/hiv.13367

Missed opportunities for HIV pre-exposure prophylaxis among people with recent HIV infection: The French ANRS 95041 OMaPrEP study

HIV Med. 2023 Feb;24(2):191-201. doi: 10.1111/hiv.13367. Epub 2022 Aug 9.

Authors

Caroline Lions¹, Helene Laroche¹, Marion Mora², Gilles Pialoux³, Laurent Cotte⁴, Eric Cua⁵, Lionel Piroth⁶, Jean Michel Molina^{7

8

9}, Maria Salnikova¹, Gwenaëlle Maradan², Isabelle Poizot-Martin^{1

10}, Bruno Spire²

Affiliations

¹ Immunohematology Clinical Unit/HIV Clinical Center, APHM, Sainte- Marguerite Hospital, Marseille, France.
² Inserm, IRD, SESSTIM, ISSPAM, Aix Marseille University, Marseille, France.
³ Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Maladies Infectieuses, Sorbonne Université, Paris, France.
⁴ Maladies Infectieuses, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Lyon, France.
⁵ Maladies Infectieuses, Hôpital L'Archet, Nice, France.
⁶ Département d'infectiologie, CHU Dijon Bourgogne, INSERM CIC1432 Université de Bourgogne, Dijon, France.
⁷ Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.
⁸ INSERM UMR 944, Biologie Cellulaire des Infections Virales, Paris, France.
⁹ Université de Paris, Paris, France.
¹⁰ Immunohematology Clinical Uni, APHM, INSERM, IRD, SESSTIM, ISSPAM, Sainte-Marguerite Hospital, Aix Marseille University, Marseille, France.

PMID: 35943165
DOI: 10.1111/hiv.13367

Abstract

Objectives: Our objective was to identify missed opportunities for the use of pre-exposure prophylaxis (PrEP) in people with recently acquired HIV, factors associated with PrEP knowledge, and reasons for not using PrEP.

Design: This was a French national cross-sectional multicentre study enrolling people diagnosed with recent HIV (incomplete Western blot or negative HIV test in the previous 6 months) in 28 HIV clinical centres. Data were gathered using a self-administered questionnaire (SAQ).

Method: We analysed missed opportunities for PrEP use via a retrospective prep cascade. Factors associated with prior knowledge of PrEP and reasons for PrEP non-use among those who knew about PrEP were described using univariate and multivariate logistic regression models.

Results: Of the 224 eligible patients, 185 completed the SAQ and 168 (91%) were eligible for PrEP. Of these, 90% reported seeing at least one physician during the previous year, 26% received information about PrEP, and 5% used PrEP. Factors independently associated with a higher probability of knowing about PrEP were being a man who has sex with men, being aged 25-30 years (vs older), undergoing HIV screening at least once every semester (vs less often; odds ratio [OR] 4.11; 95% confidence interval [CI] 2.00-8.45), and practicing chemsex (OR 3.19; 95% CI 1.12-9.10). Fear of side effects and a low perceived risk of HIV infection were the two most common reasons for not using PrEP (N = 40 [33.33%] and N = 34 [28.3%], respectively).

Conclusions: We found two gaps in the retrospective PrEP cascade: insufficient provision of PrEP information by healthcare providers (mainly general practitioners) and low PrEP acceptability by informed, eligible patients. More diverse healthcare providers need to be involved in PrEP prescription, and at-risk people need to be sensitized to the risk of HIV infection.

Keywords: HIV prevention; HIV testing; PrEP; missed opportunities for uptake; new HIV diagnosis.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Anti-HIV Agents* / therapeutic use
Cross-Sectional Studies
HIV Infections* / drug therapy
Health Personnel
Homosexuality, Male
Humans
Male
Pre-Exposure Prophylaxis*
Retrospective Studies

Substances

Anti-HIV Agents