Spatio‐temporal changes in pre‐exposure prophylaxis uptake among MSM in mainland France between 2016 and 2021: a Bayesian small area approach with MSM population estimation

Abstract

Introduction In France, oral pre‐exposure prophylaxis (PrEP) for HIV prevention has been publicly available since 2016, mainly targeting at men who have sex with men (MSM). Reliable and robust estimations of the actual PrEP uptake among MSM on a localized level can provide additional insights to identify and better reach marginalized MSM within current HIV prevention service provision. This study used national pharmaco‐epidemiology surveillance data and regional MSM population estimations to model the spatio‐temporal distribution of PrEP uptake among MSM in France 2016–2021 to identify marginalized MSM at risk for HIV and increase their PrEP uptake. Methods We first applied Bayesian spatial analyses with survey‐surveillance‐based HIV incidence data as a spatial proxy to estimate the size of (1) regional HIV‐negative MSM populations and (2) MSM who could be eligible for PrEP use according to French PrEP guidelines. We then applied Bayesian spatio‐temporal ecological regression modelling to estimate the regional prevalence and relative probability of the overall‐ and new‐PrEP uptake from 2016 to 2021 across France. Results HIV‐negative and PrEP‐eligible MSM populations vary regionally across France. Île‐de‐France was estimated to have the highest MSM density compared to other French regions. According to the final spatio‐temporal model, the relative probability of overall PrEP uptake was heterogeneous across France but remained stable over time. Urban areas have higher‐than‐average probabilities of PrEP uptake. The prevalence of PrEP use increased steadily (ranging from 8.8% [95% credible interval 8.5%;9.0%] in Nouvelle‐Aquitaine to 38.2% [36.5%;39.9%] in Centre‐Val‐de‐Loire in 2021). Conclusions Our results show that using Bayesian spatial analysis as a novel methodology to estimate the localized HIV‐negative MSM population is feasible and applicable. Spatio‐temporal models showed that despite the increasing prevalence of PrEP use in all regions, geographical disparities and inequalities of PrEP uptake continued to exist over time. We identified regions that would benefit from greater tailoring and delivery efforts. Based on our findings, public health policies and HIV prevention strategies could be adjusted to better combat HIV infections and to accelerate ending the HIV epidemic.

Response to “On the risk of using raw regional data on new HIV infections in France” by Tassi et al.

“…Among the six CVL départements, four (except for Indre-et-Loire [K = 0.9] and Loiret [K = 0.8]) demon-strated particularly low MSM concentrations (K ranged from 0.4 to 0.5), meaning that while the first two départements are close to the French average (K = 1.0), the other four départements have only half or less MSM as expected from the national average. These findings, based on EMIS-2017 data, affirm a notably lower concentration of MSM in the CVL region [1].…”

“…Our colleagues Tassi et al. submitted a Letter to the Editor regarding our recent paper on the spatio‐temporal changes in pre‐exposure prophylaxis (PrEP) uptake among men who have sex with men (MSM) in France [ 1 ]. We appreciate their interest and constructive feedback, and we seek to address their concerns and provide further clarification.…”

On the risk of using raw regional data on new HIV infections in France

“…Dear Editor, We read with particular interest the article by Wang H et al, analysing the spatio-temporal evolution of pre-exposure prophylaxis (PrEP) use among French men who have sex with men (MSM) over the 2016-2021 period [1], as part of the authorship has been actively promoting and studying PrEP intake for several years in the French Centre-Val de Loire region (CVL): implementation of teleconsultations dedicated to PrEP, involvement of community players in these consultations and targeted prevention initiatives [2][3][4]. Thus, we were proud to discover that our region was ranked first in PrEP uptake among MSM, with twice the prevalence rate of other French regions.…”