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

Abstract

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.

Birth Country Influences the Choice of Antiretroviral Therapy in HIV-Infected Individuals: Experience From a French HIV Centre

“…These empirical observations are corroborated by several published data. [14][15][16][17][18][19][20][21][22][23][24] Favoring PIs has the advantage of reducing the risk of emerging resistance in the event of poor compliance, because of the high genetic barrier of this class. Conversely, this choice could have a negative impact because of the poorer overall tolerance of PIs compared to INSTIs, 29,30 which is potentially compounded by taking 3 tablets instead of 1 (in France, no single tablet regimen including PIs is available).…”

“…Many studies have reported that migrants living with HIV frequently have poor HIV clinical outcomes in comparison with native-born persons. 8 These outcomes included higher frequency of AIDS status and lower CD4 T-cell count at entry into HIV care [9][10][11][12][13] and higher risk of loss to follow-up (LFU), [14][15][16][17] poor ART adherence, and a high risk of virologic failure once in care. [18][19][20][21][22][23][24] These poor results could be mainly because of socio-economic barriers, including difficulties with administrative procedures, finding a job and housing, and difficulties in understanding the health care system.…”