Impact of a Primary Care National Policy on HIV Screening in France: a Longitudinal Analysis Between 2006 and 2013

Overview

Journal Br J Gen Pract

Specialty Public Health

Date 2016 Sep 28

PMID 27672140

Citations 3

Authors

Jonathan Sicsic

Olivier Saint-Lary

Elisabeth Rouveix

Nathalie Pelletier-Fleury

Affiliations

Soon will be listed here.

Abstract

Background: Early diagnosis of HIV infection is a major public health issue worldwide. In 2009, the French National Authority for Health (Haute Autorité de Santé) developed specific guidelines and recommended mass screening of 15-70-year-olds across the general population. The guidelines were supported by communication directed at healthcare professionals, especially GPs.

Aim: To assess the impact of the national mass screening policy on HIV testing.

Design And Setting: The study used data from the French National Health Insurance Fund database, from January 2006 to December 2013. Males and females aged 15-70 years, excluding HIV-positive individuals and pregnant females, were followed up throughout the 2006-2013 period. During the study period, 2 176 657 person-years and a total of 329 748 different individuals were followed up.

Method: Standardised and non-standardised rates of HIV screening were calculated for each year; the impact of the policy was assessed using adjusted segmented regression analyses.

Results: Overall, annual HIV screening rates increased over the study period, from 4.2% (95% confidence interval [CI] = 4.2 to 4.3) in 2006 to 5.8% (95% CI = 5.7 to 5.9) in 2013 with a more pronounced trend after 2010 (P<0.0001). This increase was more significant for those who regularly consulted a GP. For these individuals, the policy led to a 20.4% increase (95% CI = 17.0 to 23.8) in HIV screening in 2013 compared with only a 4.5% increase (95% CI = 4.4 to 4.5) for those who did not consult a GP regularly in 2013.

Conclusion: The results show that the mass screening policy coordinated by GPs had a significant impact on HIV testing in France, which could result in positive impacts on public and individual health outcomes.

Citing Articles

Rationale, design and initial results of an educational intervention to improve provider-initiated HIV testing in primary care.

Bogers S, Schim van der Loeff M, van Dijk N, Groen K, Groot Bruinderink M, de Bree G Fam Pract. 2020; 38(4):441-447.

PMID: 33367646 PMC: 8317217. DOI: 10.1093/fampra/cmaa139.

Evaluating a pilot process for reviewing late HIV diagnoses in England and Wales.

Lee M, Curtis H, van Halsema C, Chadwick D Clin Med (Lond). 2020; 20(2):189-195.

PMID: 32188657 PMC: 7081807. DOI: 10.7861/clinmed.2019-0183.

HIV testing within general practices in Europe: a mixed-methods systematic review.

Deblonde J, Van Beckhoven D, Loos J, Boffin N, Sasse A, Nostlinger C BMC Public Health. 2018; 18(1):1191.

PMID: 30348140 PMC: 6196459. DOI: 10.1186/s12889-018-6107-0.

References

Wagner A, Soumerai S, Zhang F, Ross-Degnan D . Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002; 27(4):299-309. DOI: 10.1046/j.1365-2710.2002.00430.x. View

Beckwith C, Flanigan T, Del Rio C, Simmons E, Wing E, Carpenter C . It is time to implement routine, not risk-based, HIV testing. Clin Infect Dis. 2005; 40(7):1037-40. DOI: 10.1086/428620. View

De Cock K, Bunnell R, Mermin J . Unfinished business--expanding HIV testing in developing countries. N Engl J Med. 2006; 354(5):440-2. DOI: 10.1056/NEJMp058327. View

Marks G, Crepaz N, Janssen R . Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS. 2006; 20(10):1447-50. DOI: 10.1097/01.aids.0000233579.79714.8d. View

Weiser S, Heisler M, Leiter K, Korte F, Tlou S, Demonner S . Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns. PLoS Med. 2006; 3(7):e261. PMC: 1502152. DOI: 10.1371/journal.pmed.0030261. View

Branson B, Handsfield H, Lampe M, Janssen R, Taylor A, Lyss S . Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006; 55(RR-14):1-17. View

Long E, Brandeau M, Galvin C, Vinichenko T, Tole S, Schwartz A . Effectiveness and cost-effectiveness of strategies to expand antiretroviral therapy in St. Petersburg, Russia. AIDS. 2006; 20(17):2207-15. DOI: 10.1097/QAD.0b013e328010c7d0. View

Le Vu S, Pillonel J, Semaille C, Bernillon P, Le Strat Y, Meyer L . Principles and uses of HIV incidence estimation from recent infection testing--a review. Euro Surveill. 2008; 13(36). View

Zhang F, Wagner A, Soumerai S, Ross-Degnan D . Methods for estimating confidence intervals in interrupted time series analyses of health interventions. J Clin Epidemiol. 2008; 62(2):143-8. PMC: 3828652. DOI: 10.1016/j.jclinepi.2008.08.007. View

10.

Deblonde J, de Koker P, Hamers F, Fontaine J, Luchters S, Temmerman M . Barriers to HIV testing in Europe: a systematic review. Eur J Public Health. 2010; 20(4):422-32. DOI: 10.1093/eurpub/ckp231. View

11.

Le Vu S, Le Strat Y, Barin F, Pillonel J, Cazein F, Bousquet V . Population-based HIV-1 incidence in France, 2003-08: a modelling analysis. Lancet Infect Dis. 2010; 10(10):682-7. DOI: 10.1016/S1473-3099(10)70167-5. View

12.

Yazdanpanah Y, Sloan C, Charlois-Ou C, Le Vu S, Semaille C, Costagliola D . Routine HIV screening in France: clinical impact and cost-effectiveness. PLoS One. 2010; 5(10):e13132. PMC: 2956760. DOI: 10.1371/journal.pone.0013132. View

13.

. Vital signs: HIV testing and diagnosis among adults--United States, 2001-2009. MMWR Morb Mortal Wkly Rep. 2010; 59(47):1550-5. View

14.

Aggarwal A, Spitzer R, Caccia N, Stephens D, Johnstone J, Allen L . Repeat screening for sexually transmitted infection in adolescent obstetric patients. J Obstet Gynaecol Can. 2010; 32(10):956-61. DOI: 10.1016/s1701-2163(16)34683-7. View

15.

DAlmeida K, Kierzek G, De Truchis P, Le Vu S, Pateron D, Renaud B . Modest public health impact of nontargeted human immunodeficiency virus screening in 29 emergency departments. Arch Intern Med. 2011; 172(1):12-20. DOI: 10.1001/archinternmed.2011.535. View

16.

Kennedy C, Fonner V, Sweat M, Okero F, Baggaley R, OReilly K . Provider-initiated HIV testing and counseling in low- and middle-income countries: a systematic review. AIDS Behav. 2012; 17(5):1571-90. PMC: 3927322. DOI: 10.1007/s10461-012-0241-y. View

17.

Birrell P, Gill O, Delpech V, Brown A, Desai S, Chadborn T . HIV incidence in men who have sex with men in England and Wales 2001-10: a nationwide population study. Lancet Infect Dis. 2013; 13(4):313-8. PMC: 3610092. DOI: 10.1016/S1473-3099(12)70341-9. View

18.

Herrin J, Wesolowski L, Heffelfinger J, Bostick N, Hall H, Ethridge S . HIV screening practices and hospital characteristics in the US, 2009-2010. Public Health Rep. 2013; 128(3):161-9. PMC: 3610068. DOI: 10.1177/003335491312800306. View

19.

Ortblad K, Lozano R, Murray C . The burden of HIV: insights from the Global Burden of Disease Study 2010. AIDS. 2013; 27(13):2003-17. PMC: 3748855. DOI: 10.1097/QAD.0b013e328362ba67. View

20.

Fernandez-Gerlinger M, Bernard E, Saint-Lary O . What do patients think about HIV mass screening in France? A qualitative study. BMC Public Health. 2013; 13:526. PMC: 3669626. DOI: 10.1186/1471-2458-13-526. View