Comportements à risque des personnes vivant avec le VIH en France dans le contexte des multithérapies antirétrovirales

L arrivée en 1996 des multithérapies a considérablement modifié les perspectives de vie des personnes vivant avec le VIH, faisant craindre une reprise des pratiques à risque. Cette thèse propose d étudier les déterminants des comportements à risque chez des personnes vivant avec le VIH en France, et d analyser dans quelle mesure le traitement par multithérapies a modifié ou non ces comportements. Cette thèse s appuie sur les données de deux enquêtes : - MANIF 2000, cohorte de 467 patients infectés par le VIH par injection de drogues intraveineuse, initiée en 1995. - L enquête ANRS-EN12-VESPA, conduite en 2003 auprès d un échantillon de près de 3000 personnes, représentative de la population séropositive suivie en milieu hospitalier. Les résultats empiriques montrent qu aucun marqueur lié à la progression de la maladie n apparaît comme un déterminant significatif des rapports non protégés, quelle que soient l orientation sexuelle et le type de partenaire considéré. En revanche, les effets secondaires apparaissent comme étant associés à une fréquence plus importante de prises de risque parmi les usagers/ex-usagers de drogue intraveineuse dans le cadre de relations avec des partenaires occasionnels. Il en est de même pour l altération de la qualité de vie mentale qui apparaît comme un déterminant capital des conduites à risque avec des partenaires occasionnels chez les homosexuels. Les analyses conduites auprès des hétérosexuels montrent le poids de la précarité financière sur la prévalence des rapports non protégés quelque soit le sexe. Au sein des couples séro-différents, il existe un lien significatif entre prise de risque et dissimulation du statut sérologique. Enfin, une dernière analyse montre l influence du vécu de la séropositivité sur les difficultés sexuelles perçues par les personnes vivant avec le VIH.The advent of Highly Active Antiretroviral Therapy (HAART) in 1996 considerably changed life perspectives of people living with HIV (PLWHs). However, concerns have been raised that these improvements may increase the opportunities for relapse to risk behaviors. This thesis proposes to study the determinants of risky behaviors among PLWHs in France, and to analyze to what extent HAART has modified or not these behaviors. This thesis uses data of two surveys: - MANIF 2000, cohort of 467 patients HIV-infected through injection drug use, initiated in 1995. - The ANRS-EN12-VESPA, conducted in 2003 among a sample of nearly 3000 individuals, representative of people living with HIV followed in hospital. Empirical results show that none of the HIV-clinical outcomes appears as significantly determinant of risky behaviors, whatever the sexual orientation and the type of partner considered. However, HAART related side effects appear as significantly associated with a higher frequency of unsafe sex among injecting drug users engaged in occasional relationships. Poor mental quality of life is also a capital determinant of unsafe sex with occasional partners among gay men. Within heterosexual men and women, analyses point out the impact of social vulnerability on risky behaviors. Among sero-nonconcordant couples, there is a significant relationship between risky behaviors and concealment of HIV-status. Finally, the last analysis shows the impact of HIV-experience on sexual difficulties perceived by PLWHs.AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Health Literacy and Clinical Trial Participation in French Cancer Patients: A National Survey

Few studies have explored the relationship between health literacy (HL) and trial participation. In this context, we aimed to study this relationship in French cancer patients. We used data from the French national VIe après le CANcer (VICAN) survey. Two questionnaire items focused on previous invitations to participate in clinical trials and subsequent enrollment. The Single Item Literacy Screener was used to measure functional HL. In total, 1954 cancer patients responded to both VICAN surveys (two and five years after diagnosis). Mean age was 54.1 ± 12.7 years at diagnosis, and 37.6% were classified as having limited HL. One in ten (10.3%) respondents reported having been previously invited to participate in a clinical trial. Of these, 75.5% had enrolled. Limited HL was associated with fewer trial invitations but not with enrollment once invited. Multivariate analysis confirmed the negative effect of limited HL on clinical trial invitation (adjOR = 0.55 (0.39 to 0.77), p < 0.001) after adjustment for multiple characteristics. Patients with limited HL received fewer invitations to participate in trials but were likely to enroll when asked. Addressing HL is necessary to create a more inclusive health system and to reduce inequalities not only in access to innovative cancer care, but to health inequalities in general

Les besoins de santé des femmes séropositives ayant recours à une association telle que Aides

L'analyse des données de l'enquête « Aides et toi - 2005 » effectuée sur un échantillon de 1 932 personnes montre que la moitié des femmes répondantes sont infectées par le VIH/sida et que 38 % de ces femmes séropositives sont des immigrées, essentiellement d'Afrique sub-saharienne. Ces femmes cumulent des éléments défavorables pour ce qui concerne leur qualité de vie, les soins et la prévention, facteurs qui tiennent à leurs conditions de vie : isolement, grande précarité sociale, économique et relationnelle. Ils sont plus marqués pour les femmes accueillies à Aides que pour la population générale des femmes séropositives suivies à l'hôpital et étudiées par l'enquête Anrs-Vespa. Les femmes immigrées/étrangères sont plus fragilisées économiquement et socialement. Elles ressentent davantage de discriminations, notamment intracommunautaires. Les actions d'une association telle que Aides, par les actions qu'elle mène, constitue un lieu d'expression des besoins de santé des femmes les plus précarisées, notamment pour les immigrées. L'identification de ces difficultés appuie l'élaboration de réponses collectives en termes de soutien

Les femmes séropositives : vie sexuelle et prévention

La vie sexuelle est profondément affectée par la séropositivité. Les 1 712 hommes et femmes hétérosexuels ayant participé à l'enquête Anrs-Vespa réalisée en 2003 ont été répartis par sexe en distinguant les immigrés, les personnes ayant une histoire de consommation de drogue par injection et les autres, français non immigrés et non-usagers de drogue. L'activité sexuelle est réduite par la moindre fréquence des relations de couple dans cette population, les différences entre hommes et femmes portent principalement sur les partenaires occasionnels comme en population générale. Les enjeux importants que constituent la révélation de la séropositivité dans le couple et l'utilisation systématique du préservatif apparaissent relativement homogènes entre hommes et femmes et entre groupes. Le maintien du secret envers le partenaire stable est un peu plus rare chez les personnes immigrées, tandis que les femmes consommatrices ou ex-consommatrices de drogue apparaissent les plus en difficulté dans le comportement de protection. Les résultats observés suggèrent que l'infection à VIH tend à araser l'hétérogénéité des comportements sexuels et préventifs. Des travaux complémentaires sont nécessaires pour saisir les situations de risque de façon dynamique

Multiple health literacy dimensions are associated with physicians' efforts to achieve shared decision-making

International audienceObjectives: Shared decision-making (SDM) in health care is widely encouraged. However, for SDM to occur patients need to be able to obtain, understand and apply medical information. Our aim was to assess the relationship between health literacy (HL), numeracy and SDM (using French translations of validated measures). Methods: A cross-sectional survey using a self-administered online questionnaire was proposed to all members of the Seintinelles association. Several scales were used to measure HL (FCCHL and 3HLQ/SILS), numeracy (SNS-3), the SDM process (CollaboRATE) and explore their interrelationships. Results: Data from 2 299 respondents (96.7% women, 46.1% with a history of cancer) were analysed. All measurement scales showed adequate psychometric properties. Functional HL, communicative HL and numeracy were positively associated with SDM while no significant relation was observed between critical HL and SDM. Furthermore, perceived difficulties in asking physicians' questions and deprivation were negatively associated with SDM. Conclusion: Patient support to reach SDM requires high levels of HL, particularly in the functional and communicative domains. Efforts must be made to improve access and understanding of health information. Practice implications: Brief self-reported measures could be used to screen for low levels of health literacy, tailor information accordingly and improve patient involvement in healthcare decision-making

Inequality in income change among cancer survivors five years after diagnosis: Evidence from a French national survey

International audienceWorldwide, around 18 million people receive a cancer diagnosis each year, most of whom survive long enough to face additional cancer-related costs. In France, most costs directly related to cancer are covered by the National Health Insurance Fund, and cancer patients can receive treatments without paying advance fees. In this context, the costs faced by cancer survivors are mostly social costs. Drawing on fundamental cause theory, this study aimed to explore the socially-differentiated evolution of cancer survivor's income five years after diagnosis. Our study draws on the findings of VICAN5, a French national survey that was conducted in 2015/2016 in a representative sample of 4,174 cancer survivors to obtain information on living conditions five years after diagnosis, and that was restricted to 12 tumour sites accounting for 88% of global cancer incidence in France. We used the multiple imputation method and the Heckman selection model to identify the factors associated with a decrease in household income per consumption unit (HICU), while accounting for missing data. Among survivors still working five years after diagnosis, 17.6% reported lower income at survey than at diagnosis. After adjustment for socio-demographic and medical characteristics, the decrease in HICU was more frequent in women, singles, low educated survivors, and survivors with reduced working time. Finally, subjective measures of income variation and economic well-being were a useful complement to objective measures since 31.6% of cancer survivors still working five years after diagnosis reported a perceived decrease in household income. In conclusion, inequalities in economic well-being persist long after diagnosis in France, and this despite the fact that most cancer-related costs are covered by the French National Health Insurance Fund. Consequently, more attention should be paid to cancer patients with low socio-economic status to help reduce inequalities in post-diagnosis living conditions

Pratiques de prise en charge des jeunes suicidants dans les établissements habilités à accueillir des urgences en région Provence-Alpes-Côte d’Azur

International audienceLes tentatives de suicide représentent un problème de santé publique important et posent la question des modalités de leur prise en charge. Une enquête prospective, d'une durée de trois mois, a été réalisée au sein de 18 centres hospitaliers, disposant d'une autorisation d'accueil des urgences, afin d'évaluer les pratiques de prise en charge des jeunes suicidants (11-25 ans). Au total, 393 jeunes suicidants ont été accueillis par ces établissements durant la période de l'enquête, dont une large majorité de filles (77 %). L'intoxication médicamenteuse était le moyen le plus utilisé (85,1 %). Les critères de bonnes pratiques liés à la prise en charge initiale aux urgences étaient les plus fréquemment réalisés contrairement à ceux concernant les modalités de l'hospitalisation et la préparation à la sortie. Les facteurs expliquant la réalisation de ces critères sont liés au type d'établissement d'accueil, à la présence d'une pathologie mentale et à la durée d'hospitalisation du patient. Ces résultats soulignent plusieurs points qui devraient être renforcés dans la prise en charge hospitalière des jeunes suicidants dans la région Paca. Summary : Suicide attempts (SA) represent a significant public health problem and raise questions with respect to the best, most appropriate methods for triage and the delivery of care. A prospective investigation to evaluate the quality of SA health care was carried out over a three month period within 18 hospitals having an emergency care unit. A total of 393 youth having attempted suicide were triaged and treated by these establishments during the period of the survey, with a large majority of them being girls (77%). Medicinal intoxication was the most often used method (85.1%). The criteria and regulations relating to the initial health care provided upon the patient's arrival were most followed, contrary Santé publique 2004, volume 16, n o 3, pp. 541-550 PRATIQUES Pratiques de prise en charge des jeunes suicidants en Provence-Alpes-Côte d'Azur Practice of trauma and emergency units in delivering care to youth who attempt suicide – experiences from Provenc

Colorectal cancer screening practices among cancer survivors five years after diagnosis

International audienceBackgroundColorectal cancer (CRC) has a high incidence worldwide, especially in high-income countries. In France, a national CRC screening program targeting residents aged 50–74 years has been in place since 2009. Little is known about CRC screening practices in cancer survivors, even though some have an increased risk of developing a second cancer in the colorectum. This study aims to identify the barriers to CRC screening among cancer survivors.MethodsThis cross-sectional study based on the French national VICAN survey included individuals diagnosed in 2010 with a cancer in 1 of 11 locations other than the colorectum and interviewed 5 years after diagnosis about various health-related issues. Binary logistic regression was used to identify the factors associated with lack of up-to-date CRC screening in cancer survivors without cancer progression.ResultsOf the 2935 cancer survivors included in the study, 35.3% reported undergoing a screening test in the previous 2 years. The rate of up-to-date CRC screening rose to 49.3% in survivors aged 51–75 years. Among these, lack of CRC screening in the recommended time frame was associated with obesity, current smoking, non-use of complementary medicine, perceived financial difficulties, and poor access to general practitioners.ConclusionsBarriers to CRC screening can be personal and/or institutional

What methods are used to study the association between medication adherence trajectories, estimated with the group-based trajectory modeling (GBTM) method, and health-related outcomes?—a protocol for a systematic review

Background: The group-based trajectory modeling (GBTM) method is increasingly used in pharmacoepidemiologic studies to describe medication adherence trajectories over time. However, assessing the associations between these medication adherence trajectories and health-related outcomes remains challenging. The purpose of this review is to identify and systematically review the methods used to assess the association between medication adherence trajectories, estimated from the GBTM method, and health-related outcomes.Methods: We will conduct a systematic review according to the recommendations of the Cochrane handbook for systematic reviews of interventions 6.2. Results will be reported following PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-analyses) recommendations. We will search in the following databases: PubMed, Embase, PsycINFO, Web of Science, CINAHL, and Cochrane Library. Two reviewers will independently select articles and extract data. Discrepancies at every step will be resolved through discussion, and consensus will be reached for all disagreed articles. A third reviewer will act as a referee if needed. We will produce tables to synthesize the modalities used to estimate medication adherence trajectories with GBTM. We will also synthesize the modalities used to assess the association between these medication adherence trajectories and health-related outcomes by identifying the types of health-related outcomes studied and how they are defined, the statistical models used, and how the medication adherence trajectories were used in these models, and the effect measure yield. We will also review the limitations and biases reported by the authors and their attempts to mitigate them. We will provide a narrative synthesis.Discussion: This review will provide a thorough exploration of the strategies and methods used in medication adherence research to estimate the associations between medication adherence trajectories, estimated with GBTM, and the different health-related outcomes. It will represent the first crucial steps toward optimizing these methods in adherence studies.Systematic review registration: Prospero CRD42021213503