TY - JOUR
T1 - Revealing geographical and population heterogeneity in HIV incidence, undiagnosed hiv prevalence and time to diagnosis to improve prevention and care
T2 - Estimates for France
AU - HERMETIC Study Group
AU - Marty, Lise
AU - Cazein, Francçoise
AU - Panjo, Henri
AU - Pillonel, Josiane
AU - Costagliola, Dominique
AU - Supervie, Virginie
AU - Apers, Hanne
AU - Deblonde, Jessika
AU - Ķīvīte, Anda
AU - Loos, Jasna
AU - Marty, Lise
AU - Nöstlinger, Christiana
AU - Castro, Daniela Rojas
AU - Supervie, Virginie
AU - Van Beckhoven, Dominique
N1 - Funding Information:
LM, DC and VS thank INSEE and Réeseau Quetelet for kindly providing national and subnational statistics on population size (Donnéees harmoniséees des recensements de la population: Tabulation sur mesure, INSEE [producteur], ADISP-CMH [diffuseur]). LM, DC and VS also thank Christophe Godéereaux for optimizing the code written in C and Eric Janssen (OFDT) for sharing his estimates on drug use in France before publication as well as providing additional estimates. This work was supported by ANRS throughout the project ANRS 95017 INDIC and the framework of HIVERA JTC 2014. The sponsor had no role in the study.
Publisher Copyright:
© 2018 The Authors.
PY - 2018/3
Y1 - 2018/3
N2 - To close gaps in HIV prevention and care, knowledge about locations and populations most affected by HIV is essential. Here, we provide subnational and sub-population estimates of three key HIV epidemiological indicators, which have been unavailable for most settings. Methods: We used surveillance data on newly diagnosed HIV cases from 2004 to 2014 and back-calculation modelling to estimate in France, at national and subnational levels, by exposure group and country of birth: the numbers of new HIV infections, the times to diagnosis, the numbers of undiagnosed HIV infections. The denominators used for rate calculations at national and subnational levels were based on population size (aged 18 to 64) estimates produced by the French National Institute of Statistics and Economic Studies and the latest national surveys on sexual behaviour and drug use. Results: We estimated that, in 2014, national HIV incidence was 0.17& (95% confidence intervals (CI): 0.16 to 0.18) or 6607 (95% CI: 6057 to 7196) adults, undiagnosed HIV prevalence was 0.64& (95% CI: 0.57 to 0.70) or 24,197 (95% CI: 22,296 to 25,944) adults and median time to diagnosis over the 2011 to 2014 period was 3.3 years (interquartile range: 1.2 to 5.7). Three mainland regions, including the Paris region, out of the 27 French regions accounted for 56% of the total number of new and undiagnosed infections. Incidence and undiagnosed prevalence rates were 2-to 10-fold higher than the national rates in three overseas regions and in the Paris region (p-values < 0.001). Rates of incidence and undiagnosed prevalence were higher than the national rates for the following populations (p-values < 0.001): born-abroad men who have sex with men (MSM) (respectively, 108-and 78-fold), French-born MSM (62-and 44-fold), born-abroad persons who inject drugs (14-and 18-fold), sub-Saharan African-born heterosexuals (women 15-and 15-fold, men 11-and 13-fold). Importantly, affected populations varied from one region to another, and in regions apparently less impacted by HIV, some populations could be as impacted as those living in most impacted regions. Conclusions: In France, some regions and populations have been most impacted by HIV. Subnational and sub-population estimates of key indicators are not only essential to adapt, design implement and evaluate tailored HIV interventions in France, but also elsewhere where similar heterogeneity is likely to exist.
AB - To close gaps in HIV prevention and care, knowledge about locations and populations most affected by HIV is essential. Here, we provide subnational and sub-population estimates of three key HIV epidemiological indicators, which have been unavailable for most settings. Methods: We used surveillance data on newly diagnosed HIV cases from 2004 to 2014 and back-calculation modelling to estimate in France, at national and subnational levels, by exposure group and country of birth: the numbers of new HIV infections, the times to diagnosis, the numbers of undiagnosed HIV infections. The denominators used for rate calculations at national and subnational levels were based on population size (aged 18 to 64) estimates produced by the French National Institute of Statistics and Economic Studies and the latest national surveys on sexual behaviour and drug use. Results: We estimated that, in 2014, national HIV incidence was 0.17& (95% confidence intervals (CI): 0.16 to 0.18) or 6607 (95% CI: 6057 to 7196) adults, undiagnosed HIV prevalence was 0.64& (95% CI: 0.57 to 0.70) or 24,197 (95% CI: 22,296 to 25,944) adults and median time to diagnosis over the 2011 to 2014 period was 3.3 years (interquartile range: 1.2 to 5.7). Three mainland regions, including the Paris region, out of the 27 French regions accounted for 56% of the total number of new and undiagnosed infections. Incidence and undiagnosed prevalence rates were 2-to 10-fold higher than the national rates in three overseas regions and in the Paris region (p-values < 0.001). Rates of incidence and undiagnosed prevalence were higher than the national rates for the following populations (p-values < 0.001): born-abroad men who have sex with men (MSM) (respectively, 108-and 78-fold), French-born MSM (62-and 44-fold), born-abroad persons who inject drugs (14-and 18-fold), sub-Saharan African-born heterosexuals (women 15-and 15-fold, men 11-and 13-fold). Importantly, affected populations varied from one region to another, and in regions apparently less impacted by HIV, some populations could be as impacted as those living in most impacted regions. Conclusions: In France, some regions and populations have been most impacted by HIV. Subnational and sub-population estimates of key indicators are not only essential to adapt, design implement and evaluate tailored HIV interventions in France, but also elsewhere where similar heterogeneity is likely to exist.
KW - Exposure group
KW - Geographical analysis
KW - Hiv incidence
KW - Map
KW - Modelling
KW - Subnational and sub-population estimates
KW - Time to HIV diagnosis
KW - Undiagnosed hiv prevalence
UR - http://www.scopus.com/inward/record.url?scp=85051019363&partnerID=8YFLogxK
U2 - 10.1002/jia2.25100
DO - 10.1002/jia2.25100
M3 - Article
C2 - 29603879
AN - SCOPUS:85051019363
SN - 1758-2652
VL - 21
JO - Journal of the International AIDS Society
JF - Journal of the International AIDS Society
IS - 3
M1 - e25100
ER -