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PrEP rollout recipients in France top 1,000: full trial results report 97% effectiveness
Gus Cairns, 2016-07-29 09:10:00

Up to July 2016, 1077 people, 96.4% of them gay men, have started HIV pre-exposure prophylaxis (PrEP) through the public healthcare system in France, Jean-Michel Molina, principal investigator of the Ipergay trial, told delegates at the AIDS 2016 conference. Ninety clinics now offer PrEP assessment and prescription and 273 doctors have accredited as PrEP physicians.

Half of PrEP recipients are in the Paris/Île de France area while more than 10% each are in the Auvergne, Rhone/Alpes and Provence/Côte d'Azur regions. However there is no region of mainland France that does not now include some PrEP recipients.

PrEP approval by the European Medicines Agency on 22 July means that France can now supply PrEP as a normal part of healthcare rather than via the emergency Temporary Recommendation for Use (RTU) pathway.

Molina said that two-thirds of PrEP users in France had opted to take PrEP intermittently in accordance with the regimen used in the Ipergay trial; two pills in the 24 hours before sex and one each on the two days afterwards, or daily if sex is continued. The other third opted to take it daily.

The average age of the PrEP recipients was 38, and all but 3.6% of them were gay men. Of the nine people who were women, three of them were transgender.

There have been two infections among the 1077 recipients. One of these tested positive at his one-month clinic visit and turned out to have had acute HIV infection the day he started PrEP. He had developed resistance to emtricitabine. The other was assessed for PrEP in November but decided he could not afford the initial charges that are largely recoupable through the healthcare system (see this report). He decided instead to get what were, by his own account, suboptimal doses of PrEP from friends. He tested HIV positive four months later.

At Molina's own clinic in Paris, where 396 people have started PrEP up to 1 July, one in six people wanting it had already used 'informal PrEP' and over half had used post-exposure prophylaxis (P.E.P). Molina said that 39% had heard about PrEP from friends, 25% from the internet and 19% via the helpline run by AIDES. Three (0.7%) tested HIV positive at baseline. Twenty-two per cent were referred to psychiatric services - "This is a vulnerable population," said Molina.

PrEP was proving challenging to implement, he said. Doctors willing to prescribe PrEP had to agree to at least ten consultations per week in addition to their existing workload, including 2-3 evening ones. There was a need to train more sexual health nurses, not just for PrEP assessment but to meet the increased need for STI treatment due to more diagnoses. There was not enough patient-friendly PrEP guidance and more resources were needed for the peer counselling offered by AIDES and for community engagement.