Can we talk about price with patients when choosing antiretroviral therapy? A survey with people living with HIV and prescribers in France

International audienceObjective The aim of this study was to evaluate people living with HIV (PLWH) and HIV specialist prescribers’ perception of discussing antiretroviral therapy (ART) price in PLWH’s care and the acceptability of choosing or switching to various types of less expensive ARTs. Design Cross-sectional surveys (one in a convenience sample of PLWH and one in a voluntary response sample of HIV specialist prescribers). Setting and participants The surveys were conducted among PLHW attending an HIV clinic in the North of Paris (cohort of 4922 PLWH in 2016), and HIV specialists working in French HIV clinics (210 across 12 districts/28), between January and June 2016. Method Self-administered questionnaires were constructed using data collected during focus groups with PLWH and prescribers. Pretests were carried out to select the questions and items. Descriptive analyses of the 129 complete questionnaires of PLWH and 79 of prescribers are presented. Results Among PLWH, 128/129 were on ART and 54% (69/128) gave a fair estimation of the price of their current regimen. Among prescribers, 24% (19/79) thought that their patients knew this price. Taking into account the price of ART was not perceived as a negative step in the history of French response to HIV epidemic for 53% (68/129) of PLWH and 82% (65/79) of prescribers. Seventy-seven PLWH (60%) would agree to switch to less expensive antiretroviral regimens (as effective and with similar adverse events) if pills were bigger; 42 (33%) if there were more daily doses, and 37 (29%) if there were more pills per dose; prescribers were more circumspect. Conclusion A high proportion of PLWH gave a fair estimate of their ART price and this seemed unexpected by HIV specialists. Consideration of drug prices when choosing ART was perceived as conceivable by PLWH and prescribers if effectiveness and tolerance were also considered

Changes in Tobacco and Alcohol Consumption in France during the Spring 2020 Lockdown: Results of the Coviprev and Viquop Surveys

This study aims to describe changes in tobacco and alcohol consumption in France during the first COVID-19 lockdown in March 2020 and its gradual lifting in May. The associated factors and the reasons reported explaining those changes are also studied. Data came from five waves of the CoviPrev online cross-sectional survey (approximately n = 2000 per wave) and the ViQuoP qualitative survey (n = 60), which took place between April and June. Most people self-reported stable consumption compared to before the lockdown, but 27% to 32% of smokers and 10% to 16% of drinkers had increased their consumption, depending on the wave of the survey. Boredom, stress and the search for pleasure were the main reasons reported. While the sociodemographic factors associated with an increase in tobacco and alcohol use differed according to the product and month, poor mental health was associated with an increase in both products in April and May. Between 10% and 19% of smokers and 22% to 25% of drinkers reported having reduced their consumption for their health or through constraints. The measures taken to manage the spring 2020 epidemic appear to have had contrasting impacts on tobacco and alcohol consumption in France. People whose lifestyles and mental health was most affected appear to have modified their consumption more frequently

Can we talk about price with patients when choosing antiretroviral therapy? A survey with people living with HIV and prescribers in France

International audienceObjective The aim of this study was to evaluate people living with HIV (PLWH) and HIV specialist prescribers' perception of discussing antiretroviral therapy (ART) price in PLWH's care and the acceptability of choosing or switching to various types of less expensive ARTs. Design Cross-sectional surveys (one in a convenience sample of PLWH and one in a voluntary response sample of HIV specialist prescribers). Setting and participants The surveys were conducted among PLHW attending an HIV clinic in the North of Paris (cohort of 4922 PLWH in 2016), and HIV specialists working in French HIV clinics (210 across 12 districts/28), between January and June 2016. Method Self-administered questionnaires were constructed using data collected during focus groups with PLWH and prescribers. Pretests were carried out to select the questions and items. Descriptive analyses of the 129 complete questionnaires of PLWH and 79 of prescribers are presented. Results Among PLWH, 128/129 were on ART and 54% (69/128) gave a fair estimation of the price of their current regimen. Among prescribers, 24% (19/79) thought that their patients knew this price. Taking into account the price of ART was not perceived as a negative step in the history of French response to HIV epidemic for 53% (68/129) of PLWH and 82% (65/79) of prescribers. Seventy-seven PLWH (60%) would agree to switch to less expensive antiretroviral regimens (as effective and with similar adverse events) if pills were bigger; 42 (33%) if there were more daily doses, and 37 (29%) if there were more pills per dose; prescribers were more circumspect. Conclusion A high proportion of PLWH gave a fair estimate of their ART price and this seemed unexpected by HIV specialists. Consideration of drug prices when choosing ART was perceived as conceivable by PLWH and prescribers if effectiveness and tolerance were also considered

Effectiveness of a French mass media campaign in raising knowledge of both long-term alcohol-related harms and low-risk drinking guidelines, and in lowering alcohol consumption.

AIMS To evaluate the effectiveness of a French mass media campaign in raising knowledge of both long-term alcohol-related harms (LTH) and low-risk drinking guidelines (LRDG), as well as in lowering alcohol consumption. DESIGN An 8-month longitudinal survey from February to October 2019, with three waves of online data collection (T0 before the campaign, T1 just after it ended, and T2 6 months after it ended). SETTING France PARTICIPANTS: 2,538 adult drinkers (18-75 years old) MEASUREMENTS: The main outcomes' variables were LTH knowledge (cancer, hypertension, brain haemorrhage), LRDG knowledge (two guidelines: 'maximum of 2 drinks a day' and 'minimum of 2 days without alcohol per week'), intention to reduce alcohol consumption, and self-declared consumption with respect to the French LRDG. At T1, exposure to the campaign was measured using self-reported campaign recall. FINDINGS In T1, we observed significant positive interactions between exposure group based on campaign recall and survey waves on knowledge of i) the 'maximum 2 drinks a day' guideline (adjusted odds ratio [aOR] 1.32 [95% confidence interval 1.08-1.62], p=0.008), ii) brain haemorrhage (aOR = 1.80 [1.44-2.25], p<0.001), and iii) hypertension (aOR = 1.41 [1.09-1.81], p=0.008) risks. Campaign exposure was also associated with a significant decrease in at-risk drinking in women (aOR=0.67 [0.50-0.88], p=0.004). No significant interaction was observed at T1 for the knowledge of the 'minimum of 2 days without alcohol a week' guideline, or of cancer risk. At T2, no significant interaction was observed for the main outcomes' variables. CONCLUSIONS There appears to be an association between exposure to a 2019 French mass-media campaign to raise knowledge of long-term alcohol-related harms and low-risk drinking guidelines (LRDG) and reduce alcohol consumption and i) improved knowledge of the 'maximum 2 drinks per day guideline', ii) knowledge of the risks of hypertension and brain haemorrhage, and iii) a reduction in the proportion of people exceeding LRDG (in the general population only). These associations were only observed over the short term and, in some cases, only for certain segments of the population

Informer des risques à long terme liés à l’alcool et des repères de consommation : efficacité d’une campagne médiatique sur les connaissances et la consommation d’alcool

International audienceIntroduction –In 2019, Santé publique France ran its first mass-media campaign aimed at raising the population’s awareness of long-term alcohol-related harms and the newly developed low-risk drinking guidelines (LRDG), in order to encourage drinkers to reduce their alcohol consumption. In this article we present the main results of the campaign’s evaluation and discuss their implications.Method –From February to October 2019, a total of 2,538 alcohol consumers aged 18–75 years were interviewed online in a longitudinal survey with three waves: before the campaign was broadcast (T0), just after the broadcast (T1) and around 6 months later (T2).Results –Between T0 and T1, positive interactions between exposure (recall of the campaign) and survey waves were observed for knowledge of the “2 drinks a day maximum” guideline (adjusted odds ratio [aOR]=1.32 [95% confidence interval: 1.08–1.62], p=0.008), the risk of brain haemorrhage (aOR=1.80 [1.44–2.25], p&lt;0.001) and of the risk of hypertension (aOR=1.41 [1.09–1.81], p=0.008; or, among the most advantaged people only, ORa=1.90 [1.31–2.75], p=0.001). However, this was not observed for knowledge of cancer risks, nor the guideline of “at least 2 days a week without drinking”. Campaign exposure was also associated with a significant decrease in at-risk drinking in women (aOR=0.67 [0.50–0.88], p=0.004). Between T0 and T2, no significant interaction was observed for the main outcome variables.Discussion –These results show that the campaign combining messages about risks and LRDG had a positive effect on people’s knowledge and behaviour. They provide new elements to the currently scarce scientific literature on the impact of alcohol campaigns. The effects observed are not uniform across all groups and are only visible in the short term: attention should therefore be paid to social inequalities in health, with frequent broadcasts that ensure regular repetition of the messages.Introduction –En 2019, Santé publique France a diffusé pour la première fois une campagne de communication visant à améliorer les connaissances de la population concernant les risques à moyen-long termes liés aux consommations d’alcool et les repères de consommation à moindre risque, dans l’objectif d’inciter les buveurs à la réduction de leur consommation. Cet article présente les principaux résultats de l’évaluation d’efficacité de la campagne et discute de leurs implications.Méthode –De février à octobre 2019, 2 538 consommateurs d’alcool âgés de 18 à 75 ans ont été interrogés en ligne à 3 reprises : avant la diffusion de la campagne (T0), juste après la diffusion (T1) et environ 6 mois après (T2).Résultats –Entre T0 et T1, des interactions positives entre l’exposition à la campagne et la vague d’enquête ont été observées pour la connaissance du repère « maximum 2 verres par jour » (odds ratio ajustés, ORa=1,32 ; intervalle de confiance à 95%, IC95%: [1,08-1,62], p=0,008), du risque d’hémorragie cérébrale (ORa=1,80 [1,44-2,25], p&lt;0,001) et du risque d’hypertension (ORa=1,41 [1,09-1,81], p=0,008 ; visible uniquement parmi les plus favorisés : ORa=1,90 [1,31-2,75], p=0,001) , mais pas pour la connaissance du risque de cancer ni celle du repère « minimum 2 jours sans consommation ». Une interaction significative entre l’exposition à la campagne et la vague d’enquête a été observée entre T0 et T1 pour la consommation d’alcool à risque, parmi les femmes seulement (ORa=0,67 [0,50-0,88], p=0,004). Entre T0 et T2, aucune interaction significative n’a été détectée sur les variables étudiées.Discussion –Les résultats de cette étude suggèrent que cette campagne sur les risques et les repères a eu un effet positif sur les connaissances et les comportements de la population. Ils viennent nourrir la littérature scientifique encore trop peu abondante concernant l’impact des campagnes médiatiques de prévention alcool. Les effets observés ne sont pas homogènes dans tous les groupes sociodémographiques et ne sont visibles qu’à court terme : une attention en matière d’inégalités sociales de santé et une répétition régulière des messages pourraient permettre d’améliorer ces deux aspects

Le marketing social : définition, contours et exemples de mobilisation des professionnels de santé

International audienceIn Anglo-Saxon countries, it is common to implement prevention programs that rely on social marketing techniques and steps to develop more effective actions to change the attitudes and behaviours of target populations. The objective of this article is to clarify the contours and approach of this discipline and to illustrate, based on the expertise of Santé publique France, the role of social marketing in involving health professionals in preventio

Effectiveness of ‘Mois sans tabac 2016’: A French social marketing campaign against smoking

International audienceINTRODUCTION In October 2016, the first edition of Mois sans tabac (Tobacco-Free Month) was launched, a campaign which had invited French smokers to challenge themselves to quit smoking for the whole month of November. We aimed to study the effectiveness of this social marketing intervention on quit attempts (QA) in the general French population, and to study possible differences according to sociodemographic characteristics. METHODS This study used data from the 2017 Health Barometer survey, a random survey conducted by telephone on 25319 individuals. It included 6341 respondents who reported that they were daily smokers when the Mois sans tabac campaign was launched in 2016. The association between self-declared exposure to the campaign and making a QA has been studied using multivariate logistic regressions. RESULTS Exposure to the 2016 Mois sans tabac campaign is associated with a QA lasting at least 24 hours in the final quarter of 2016 (AOR=1.32; 95% CI: 1.07–1.63, p<0.01), with a QA lasting at least 30 days (AOR=1.95; 95% CI: 1.31–2.91, p<0.001), and being abstinent at the time of the interview in 2017 (AOR=2.39; 95% CI: 1.37–4.15, p<0.01). A dose-effect relationship is observed between the frequency of exposure to the campaign and QA, which is mostly explained by the number of sources of exposure (television, radio, posters, the press, the internet and social networks). Although certain priority groups (e.g. manual workers, the unemployed) had poorer recall of the campaign than other groups, the impact of self-reported exposure to the campaign on QA in unemployed people or those with less than high school educational level appears to have been greater. CONCLUSIONS These analyses suggest the effectiveness of the 2016 Mois sans tabac intervention, in a context of strengthening public tobacco control policies in France, which may have contributed to the drop in smoking observed between 2016 and 2019. Published by European Publishing. © 2021 Guignard R. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License. (https://creativecommons.org/licenses/by/4.0/

How are women living with HIV in France coping with their perceived side effects of antiretroviral therapy? Results from the EVE study.

OBJECTIVE:Side effects of antiretroviral therapy (ART) can have a negative impact on health-related quality of life threatening long-term retention in HIV care and adherence to ART. The aim of the French community-based survey EVE was to document personal experiences with side effects, the related physician-patient communication, and solutions found to deal with them. DESIGN:Cross-sectional study of women between September 2013 to September 2014. METHODS:An anonymous online questionnaire included the HIV Symptom Distress Module, which explores 20 symptoms. RESULTS:In all, 301 women on ART participated in the study (median age: 49 years; median duration of ART: 14 years). They reported having experienced a median of 12 symptoms (Q1-Q3: 9-15) during the previous 12 months. Overall, 56% of them reported having found at least a partial solution to dealing with their symptoms. Women reporting financial difficulties were twice less likely to have found solutions to coping with their side effects (AOR: 0.5; 95% CI: 0.3-0.8). Feeling supported by the health-care provider (AOR: 2.1; 95% CI: 1.1-3.9) and being in contact with HIV/AIDS organisations (AOR: 1.9; 95% CI: 1.2-3.2) were positively associated with coping. Seventeen percent reported having modified their ART regimen to improve tolerance, with only 2 in 3 informing their physician afterwards. Reporting financial difficulties and living with more bothersome symptoms increased the risk of ART regimen modification without health-care provider consultation. CONCLUSION:The EVE study has called attention to the large number of side effects experienced by WLWHIV, only half of whom have found self-care strategies to manage their symptoms. Modification of ART regimen by the women themselves was not uncommon

Sociodemographic and clinical characteristics of the 301 women living with HIV who participated in the EVE study (2014).

<p>Sociodemographic and clinical characteristics of the 301 women living with HIV who participated in the EVE study (2014).</p

Differences in characteristics between women who reported having modified their ART regimen by decreasing the dosage or increasing the dosing intervals without prior consulting their health-care provider and those who did not: the EVE study (2014).

<p>Differences in characteristics between women who reported having modified their ART regimen by decreasing the dosage or increasing the dosing intervals without prior consulting their health-care provider and those who did not: the EVE study (2014).</p