In France, about 6600 people every year discover that they are HIV seropositive. Almost half (42%) of these new cases are among men who have sex with men, for whom there has been a rise in new infections since 2011. Other at-risk populations include heterosexual migrants and people from French Guiana.
HIV-infected people unaware they are seropositive account for most (64%) of these new infections in France. The challenge therefore is to initiate and evaluate new approaches to prevention, such as pre-exposure prophylaxis and screening for HIV, so as to stem the rise in new cases of infection.
An important part of the work done by the ANRS is community-based research conducted in close partnership with patient groups. Representatives of patient groups and nonprofit organizations are increasingly involved in the research effort (some manage projects) and help to ensure that the research chimes with public health needs.
ELIMINATING HIV TRANSMISSION
UNAIDS has set the target of ending the HIV epidemic by 2030, starting with achieving the 90-90-90 objective by 2020: 90% of people infected diagnosed, 90% on treatment, and 90% virally suppressed. To meet these objectives, we must improve early screening for HIV infection, so as to reduce the time between infection and treatment initiation, and also to heighten prevention, notably in key populations.
"Stem the rise in new infections"
RAPID SCREENING TO EXPEDITE TREATMENT
Rapid HIV screening is an alternative to usual screening. Such screening, which can be performed onsite and is not restricted to healthcare centers, can be done by healthcare professionals or by community stakeholders, provided that they belong to an accredited organization and are trained in the technique.
ANRS Cube is studying the acceptability of rapid screening for HIV and hepatitis B and C. It is under way in Paris among populations exposed to the risks of infection: men who have sex with men, sex workers, and drug users.
Another approach to screening has been available in France since mid-2015: HIV self-testing. Its impact on screening, notably in the two populations among whom the prevalence of HIV is high—men who have sex with men and migrants from sub-Saharan Africa—is being tested in V3T (HIV: Teste-Toi Toi-même; HIV: Test Yourself), a study of the difficulties and obstacles that can hamper access to self-testing. V3T will also yield information on access to treatment, should screening prove positive.
The city of Paris is committed to rising to the challenge set by UNAIDS: eradicate HIV by 2030 (Towards Paris without AIDS). The ANRS supports this initiative scientifically through its community-based research program ANRS PREVENIR. The aim is to limit the number of new HIV infections in the Paris–Ile-de-France region by promoting access to pre-exposure prophylaxis among the populations most at risk of infection (men who have sex with men/ transgender people/sex workers/migrants).
REDUCING THE RISKS OF INFECTION IN PRISONS
The risk of infection is high in prisons (large proportion of drug users, high prevalence of HIV and of hepatitis C virus…) and access to risk reduction measures is insufficient (condoms, syringe exchange programs, liquid bleach, screening for HIV and hepatitis…).
ANRS PRIDE is a study that is analyzing the obstacles to the setting up of a suitable risk reduction policy in prisons. Designed to evaluate the acceptability of measures to reduce risks for all categories of personnel and for the prisoners, ANRS PRIDE will start in 2017 at the Baumettes penitentiary in Marseille, before being deployed from 2018 in three other prisons in France and a French overseas department.
THE COST OF ANTIRETROVIRAL TREATMENTS
"Treatment costs are rising"
The efficacy of antiretroviral treatments in people living with HIV has led to considerable increase in their life expectancy, which is now close to that of the general population. The cost of these lifelong treatments is often high and associated with healthcare expenses generated by co-morbidities and other complications, and the cost of the overall care of people living with HIV/AIDS has increased in recent years. Once safety and efficacy criteria are met, the cost of antiretroviral treatment could be taken into account upon prescription when it is possible to choose between several treatment combinations.
INFORMATION HELPS CONTAIN COSTS
ANRS GOTA (Gestion Optimale de Traitements ARV; Optimal Management of Antiretroviral Treatments) at the Bichat Hospital in Paris is a study evaluating the impact of interventions among physicians and HIV-infected patients designed to reduce the cost of antiretroviral prescriptions. The aim is to inform patients and prescribers about the cost of antiretroviral treatments. These interventions should not affect treatment efficacy or safety or the patient-physician relationship.
STRENGTHENING RESEARCH IN FRENCH GUIANA
Since 2011, French overseas departments have been prioritized in the fight against HIV/AIDS. French Guiana is the department of France most affected by HIV/AIDS.
"The prevalence of HIV in Guiana exceeds 1%"
The region along the Maroni River, on the border with Suriname, is particularly affected. It comprises highly mobile Amerindian and Maroon communities that are isolated, vulnerable, and at high risk of infection because HIV screening is rare among these people, for whom we lack epidemiological data.
IMPROVING EPIDEMIOLOGICAL KNOWLEDGE
The ANRS supports a study of the epidemiology of HIV (and also hepatitis B, C, and D) in the general adult population living along the Maroni River, on the border between French Guiana and Suriname. The aim is to estimate the prevalence of HIV, hepatitis C, and hepatitis D, and also hepatitis B infection status. This study will also enable people who screen positive to be directed to a care center.