HIV Diagnoses Falling in Fast-Track Cities Making Changes

Marcia Frellick

November 21, 2019

BASEL, Switzerland — HIV diagnoses have fallen 16% in Paris in the 3 years since the rollout of a strategy that combines extensive pre-exposure prophylaxis (PrEP) coverage and screenings with political support for community engagement, according to new data.

And in the subset of French-born men who have sex with men, diagnoses dropped by 28%, said Eve Plenel, executive director of Vers Paris sans SIDA. At the same time, HIV testing increased by 10% overall, she reported here at the European AIDS Conference 2019.

The Fast-Track Cities initiative was launched on World AIDS Day 2014, and 26 cities signed on that year, according to UNAIDS. There are now more than 300 cities participating in the program.

In Paris, the program was designed to counteract persistent delays in HIV diagnosis and high levels of undiagnosed HIV in key groups, including men who have sex with men and migrants from sub-Saharan Africa. After the city council approved a proposal to cover the cost of PrEP, with the combination of emtricitabine plus tenofovir disoproxil fumarate (Truvada, Gilead), the program launched in September 2016.

As a result of the program, PrEP has gained legitimacy in the communities of gay men and men who have sex with men, which wasn't the case before, Plenel reported.

She acknowledged that findings from the French National Agency for AIDS Research (ANRS) Prévenir study, which offered daily or on-demand PrEP to seronegative Parisians at high risk for infection, was also responsible for increasing PrEP uptake in the city.

Sexual Health Checkups

The next steps include giving "free HIV tests in medical labs without prescription and incentives for general practitioners to offer sexual health checkups," said Plenel. And the program is looking to establish community-based express clinics for the testing of sexually transmitted infections in 2020, along with new PrEP strategies.

In France overall, the numbers are not as encouraging, said Prévenir investigator Jean-Michel Molina, MD, from the University of Paris Diderot. The decrease in infections for the country as a whole was only 7% overall and 16% for French-born men who have sex with men.

"We can do better," he said. "We need to decrease the time between infection and diagnosis, which is, on average, more than 3 years."

This is the first time France has seen such a large drop in HIV infections, said Ann Sullivan, MD, an HIV consultant at Chelsea and Westminster Hospital in London.

The London program previously reported similar good news, but the good news is tempered by access inequities elsewhere, Sullivan told Medscape Medical News.

"The caution," she said, "is that it is only being seen in specific groups, so issues of equality of access and our coverage of good combination prevention is still not adequate."

Another concern is the capacity of health services elsewhere to provide PrEP medications and accommodate an influx of patients, she said.

"People on PrEP in most settings attend the health service four times a year to have an HIV test and STI screening," Sullivan explained. Some also come in for hepatitis C tests.

The PrEP program also "brings in people who have not previously attended, so they may also need vaccinations, which is good but has associated costs," she said.

European AIDS Conference (EACS) 2019: Abstract PS11/7. Presented November 11, 2019.

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