title: Hepatitis C virus and HIV seroprevalences, sociodemographic characteristics, behaviors and access to syringes among drug users, a comparison of geographical areas in France, ANRS-Coquelicot 2011 survey.
abstract: BACKGROUND
  People who use drugs (PWUDs) are at a high risk for hepatitis C virus (HCV) and human immunodeficiency virus (HIV), but they have different characteristics depending on the local context. In France, seroprevalence, sociodemographic, and behavior information have only been studied at a national level rather than at a local level. The aim of this study was to describe and examine profile and drug use practice differences in seven French cities and departments and to assess whether these differences can explain HCV and HIV seroprevalence variations between French geographical areas.
  
  
  METHODS
  Data were collected from the cross-sectional ANRS-Coquelicot survey conducted for the second time in 2011 among drug users having injected or snorted drugs at least once in their life. Professional interviewers administrated a face-to-face questionnaire in six different areas in France: Paris, Marseille, Bordeaux, Lille, Strasbourg and the Seine-Saint-Denis department (Paris suburbs). Participants were asked to self-collect a fingerpick blood sample in order to search for the presence of anti-HIV and anti-HCV antibodies and to estimate seroprevalence in PWUDs.
  
  
  RESULTS
  Overall, HCV and HIV seroprevalence was 44% [95% CI: 39.6-47.9] and 10% [95% CI: 7.5-12.6] respectively. The highest HCV seroprevalence was 56% in Marseille and the lowest was 24% in Bordeaux and for HIV the highest was 18% in Seine-Saint-Denis and the lowest was 0% in Lille. The population's age differed between areas and could mostly explain HCV seroprevalence variation but not exclusively. Profiles and practices, different in each area, can also explain this variation. In multivariate analysis, HCV seroprevalence was lower in Bordeaux (prevalence ratio [PR]=0.64), Strasbourg (PR=0.76), and Seine-Saint-Denis (PR=0.8) than in Paris. Nearly one-third of injectors declared having had difficulties to obtain syringes in the 6 previous months, but disparities existed between areas.
  
  
  CONCLUSIONS
  HCV risk exposure in PWUDs remains high in France and varies between different areas. Innovative harm reduction strategies including educative programs about safe injecting and supervised consumption rooms need to be developed.
authors.affiliation: Institut de Veille Sanitaire, 94410 Saint-Maurice, France.
authors.forename: L
authors.initials: L
authors.lastname: Weill-Barillet
authors.affiliation: Institut de Veille Sanitaire, 94410 Saint-Maurice, France.
authors.forename: J
authors.initials: J
authors.lastname: Pillonel
authors.affiliation: Institut de Veille Sanitaire, 94410 Saint-Maurice, France.
authors.forename: C
authors.initials: C
authors.lastname: Semaille
authors.affiliation: Institut de Veille Sanitaire, 94410 Saint-Maurice, France.
authors.forename: L
authors.initials: L
authors.lastname: Léon
authors.affiliation: Institut de Veille Sanitaire, 94410 Saint-Maurice, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Le Strat
authors.affiliation: Cermes3, Inserm U988, UMR CNRS 8211, université Paris Descartes, EHESS, 45, rue des Saints-Pères, 75006 Paris, France.
authors.forename: X
authors.initials: X
authors.lastname: Pascal
authors.affiliation: Inserm U966, centre national de référence du VIH, CHU de Bretonneau, université François-Rabelais, 37000 Tours, France.
authors.forename: F
authors.initials: F
authors.lastname: Barin
authors.affiliation: Institut de Veille Sanitaire, 94410 Saint-Maurice, France; Cermes3, Inserm U988, UMR CNRS 8211, université Paris Descartes, EHESS, 45, rue des Saints-Pères, 75006 Paris, France. Electronic address: m.jauffret@invs.sante.fr.
authors.forename: M
authors.initials: M
authors.lastname: Jauffret-Roustide
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002947:Cities / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D015497:HIV-1; D040261:Harm Reduction; D015438:Health Behavior; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012309:Risk-Taking; D016036:Seroepidemiologic Studies; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology*; D013594:Syringes / Q000600:supply & distribution*; D055815:Young Adult
keywords: Access to syringes; Accès au matériel d’injection; City comparison; Comparaison par ville; HCV; HIV; Harm reduction; People who use drugs; Réduction des risques; Seroprevalence; Séroprévalence; Usagers de drogues; VHC; VIH