Impact of a primary care national policy on HIV screening in France: a longitudinal analysis between 2006 and 2013.
BACKGROUND
Early diagnosis of HIV infection is a major public health issue worldwide. In 2009, the French National Authority for Health (Haute Autorité de Santé) developed specific guidelines and recommended mass screening of 15-70-year-olds across the general population. The guidelines were supported by communication directed at healthcare professionals, especially GPs.


OBJECTIVE
To assess the impact of the national mass screening policy on HIV testing.


METHODS
The study used data from the French National Health Insurance Fund database, from January 2006 to December 2013. Males and females aged 15-70 years, excluding HIV-positive individuals and pregnant females, were followed up throughout the 2006-2013 period. During the study period, 2 176 657 person-years and a total of 329 748 different individuals were followed up.


METHODS
Standardised and non-standardised rates of HIV screening were calculated for each year; the impact of the policy was assessed using adjusted segmented regression analyses.


RESULTS
Overall, annual HIV screening rates increased over the study period, from 4.2% (95% confidence interval [CI] = 4.2 to 4.3) in 2006 to 5.8% (95% CI = 5.7 to 5.9) in 2013 with a more pronounced trend after 2010 (P<0.0001). This increase was more significant for those who regularly consulted a GP. For these individuals, the policy led to a 20.4% increase (95% CI = 17.0 to 23.8) in HIV screening in 2013 compared with only a 4.5% increase (95% CI = 4.4 to 4.5) for those who did not consult a GP regularly in 2013.


CONCLUSIONS
The results show that the mass screening policy coordinated by GPs had a significant impact on HIV testing in France, which could result in positive impacts on public and individual health outcomes.
INSERM, Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Paris-Sud, UVSQ, Paris, France.
Jonathan
J
Sicsic
INSERM, Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Paris-Sud, UVSQ, Paris, France, and Faculty of Health Sciences Simone Veil, Department of Family Medicine, Université Versailles Saint-Quentin en Yvelines, Versailles, France.
Olivier
O
Saint-Lary
CHU Ambroise Paré, Boulogne-Billancourt, France.
Elisabeth
E
Rouveix
INSERM, Centre for Research in Epidemiology and Population Health, University Paris-Saclay, University Paris-Sud, UVSQ, Paris, France.
Nathalie
N
Pelletier-Fleury
D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006291:Health Policy; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics
HIV testing; longitudinal studies; mass screening; policy evaluation; primary care; segmented regression analysis
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