Revealing geographical and population heterogeneity in HIV incidence, undiagnosed HIV prevalence and time to diagnosis to improve prevention and care: estimates for France

• Published in: Journal of the International AIDS Society 2018-03, Vol.21 (3), p.e25100-n/a
• Main Authors: Marty, Lise, Cazein, Françoise, Panjo, Henri, Pillonel, Josiane, Costagliola, Dominique, Supervie, Virginie, Apers, Hanne, Deblonde, Jessika, Ķīvīte, Anda, Loos, Jasna, Nöstlinger, Christiana, Castro, Daniela Rojas, Van Beckhoven, Dominique
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; AIDS/HIV; Care and treatment; Diagnosis; Disease prevention; Disease transmission; Epidemics; Estimates; exposure group; Female; France - epidemiology; geographical analysis; Geography; HIV; HIV incidence; HIV infections; HIV Infections - epidemiology; HIV Infections - prevention & control; Homosexuality, Male - statistics & numerical data; Human health and pathology; Human immunodeficiency virus; Humans; Incidence; Infections; Life Sciences; Male; Middle Aged; modelling; Population; Prevalence; Prevalence studies (Epidemiology); Prevention; Risk factors; subnational and sub‐population estimates; Time Factors; time to HIV diagnosis; Trends; undiagnosed HIV prevalence; Young Adult
• ISSN: 1758-2652; 1758-2652
• DOI: 10.1002/jia2.25100

Introduction 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