(76) Roll-Out of HIV Pre-Exposure Prophylaxis Use in France: A Nationwide Study from 2016 to 2021

Publication Number: 1121

Background: HIV pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) has been available and fully reimbursed for people at high risk of sexual HIV infection in France since January 2016. Its dissemination and appropriate use have been largely promoted in France to reduce HIV incidence in high-risk populations.

Objectives: This study aimed to evaluate the roll-out of PrEP use in France from its implementation up to mid-2021.

Methods: Using the French National Health Data System (SNDS) covering 99% of the French population, all PrEP users as defined by individuals aged 15 years or older who received at least one dispensing of TDF-FTC for PrEP between 1 January 2016 and 30 June 2021 were identified. Numbers of incident and prevalent PrEP users and their sociodemographic and PrEP management (PrEP consumption, PrEP prescribers) characteristics were assessed over the study period.

Results: As of 30 June 2021, a total of 42 159 individuals had initiated PrEP in France. Monthly PrEP initiations increased steadily up to 1 027 in February 2020, and then slowed down sharply from the onset of the COVID-19 epidemic until a recovery in the first semester 2021. During the first semester 2021, 26 812 people used PrEP, of whom 6 610 (24.7%) were PrEP initiators and 20 202 (75.3%) were prevalent users. PrEP users were overwhelmingly men (97.5%), aged 36 years on average, living in a large metropolitan area (73.8%), and among whom a minority (7.0%) were socio-economically disadvantaged. Throughout the study period, 80-90% of users renewed PrEP from one semester to another, suggesting a good level of treatment maintenance. Nevertheless, PrEP consumption was low (median of 3 renewals in the first 6 months following initiation), suggesting sporadic or interrupted use in a substantial proportion of users. Private practitioners accounted for a minority (21.3%) of PrEP renewal prescriptions.

Conclusions: Although PrEP roll-out has been substantial among MSM in France, further actions are needed to expand access to PrEP to all other groups of the population who could benefit from it, including women, socioeconomically-deprived people and those living in remote areas, and to promote adherence to treatment.