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The Politics of PrEP The French Experience

The Politics of PrEP The French Experience. Jean- M ichel Molina Saint-Louis Hospital , University of Paris D iderot , ANRS (National Agency for AIDS Research) Inserm U941, Paris, France 22 th International AIDS Conference Amsterdam, July 26, 2018. Disclosures. Research grants: Gilead

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The Politics of PrEP The French Experience

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  1. The Politics of PrEPThe French Experience Jean-Michel Molina Saint-Louis Hospital, University of Paris Diderot, ANRS (National Agency for AIDS Research) Inserm U941, Paris, France 22th International AIDS Conference Amsterdam, July 26, 2018

  2. Disclosures Research grants: Gilead Advisory Boards : Merck, Gilead, ViiV, Teva Shareholder: none

  3. From Biological Efficacy to Public Health Implementation PrEP works in clinical trials and even better in the real world…when it is taken ! Low level of implementation: many countries still reluctant to implement/up-scale PrEP Share experiences across countries to help breaking the barriers to PrEP acceptability and implementation Community and civil society empowerment to increase awareness about HIV prevention

  4. Increase in Newly Diagnosed HIV- Infections among MSM in France 6000 new HIV-infections in France in 2016 Newlydiagnosed HIV-infections 43% MSM 2500 2000 1500 23% ForeignHeterosexual W 15% Foreign Heterosexual M 9% French heterosexual M 7% French heterosexual W 2% IVDU 1000 500 0 Public Health France, December 2017

  5. Path to PrEP Approval in France • Discussions at ANRS with the community (TRT-5, AIDES) (2009): approval of a first grant on « on demand » PrEP • Community consultation and empowerment (TRT-5): 2009-12 • ANRS Ipergay trial starts (February 2012) • Results of the ANRS Ipergay and PROUD trials in March 2015: appreciation of the high efficacy of PrEP • ECDC comment on PrEP in Europe (April 2015) Integrate PrEP into existing HIV prevention package for those most at-risk of HIV • WHO updated guidelines (October 2015): PrEP should be offered as an additional prevention choice for people at risk of HIV infection • EACS Guidelines (October 2015): PrEP recommended in MSM and transgender individuals with inconsistent condom use • French group of experts (October 2015) : PrEP recommended in high risk populations • First PrEP clinic opens in Paris (November 2015)

  6. January 2016 Approval for PrEP in France

  7. PrEP in France Today PrEP approved and fully reimbursed since 01/16 Adults at high risk of sexual acquisition of HIV Prescriptions: hospitals, STI clinics and GP TDF/FTC in hospital and private pharmacies Generic TDF/FTC available since July 2017

  8. National PreventionCampaign for MSM

  9. National PreventionCampaign for MSM

  10. Support from the City of Paris City Hall meeting, February 2016

  11. Paris Campaignduring 9th IAS 2017

  12. OralPrEPGlobalRoll-out in2018 1,100 225,000 700 Est. numbers on PrEP: <100 1,500 100 - 1,000 14,600 1,000 – 10,000 10,000 – 100,000 >100,000 Data from AVAC.org 2018 - https://www.prepwatch.org/country-updates/

  13. Ratio PrEP Users / HIV Diagnoses HIV-infections: 6,000 PrEP Users: 8,000 Ratio: 1.3:1 HIV-infections: 40,000 PrEP Users: 225,000 Ratio: 5.6:1 HIV-infections: 1,100 PrEP Users: 14,600 Ratio: 13:1

  14. Advertising for PrEP in Melbourne

  15. Decline in HIV-Infections among MSM in the Epic Study (NSW) PrEP 25%decline 2015-2017 Grulich A. et al et al CROI 2018, Boston

  16. AIDES Advertising Campaign 2018

  17. Lessons Learned in France Community empowerment and lobbying: PrEP approval and implementation Increase awareness among doctors and people at risk about this new preventive tool High risk individuals should benefit from comprehensive sexual health care including PrEP Up-scale PrEP implementation and show its public healthbenefiton the HIV epidemic

  18. Acknowledgments

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