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To date, no study has evaluated the detection rate of head and neck squamous cell carcinoma (HNSCC) in cause-of-death records in Europe. Our objectives were to compare the number of deaths attributable to HNSCC from two national databases in France and to identify factors associated with under-reporting of HNSCC in cause-of-death records. The national hospital discharge database and the national underlying cause-of-death records were compared for all HNSCC-attributable deaths in adult patients from 2008 to 2012 in France. Factors associated with under-reporting of HNSCC in cause-of-death records were assessed using multivariate Poisson regression. A total of 41,503 in-hospital deaths were attributable to HNSCC as compared to 25,647 deaths reported in national UCoD records (a detection rate of 62%). Demographics at death were similar in both databases with respect to gender (83% men), age (54% premature deaths at 25-64 years), and geographic distribution. In multivariate Poisson regression, under-reporting of HNSCC in cause-of-death records significantly increased in 2012 compared to 2010 (+7%) and was independently associated with a primary HNSCC site other than the larynx, a former primary or second synchronous cancer other than HNSCC, distant metastasis, palliative care, and death in hospitals other than comprehensive cancer care centers. The main study results were robust in a sensitivity analysis which also took into account deaths outside hospital (overall, 51,129 HNSCC-attributable deaths; a detection rate of 50%). For the year 2012, the age-standardized mortality rate for HNSCC derived from underlying cause-of-death records was less than half that derived from hospital discharge summaries (14.7 compared to 34.1 per 100,000 for men and 2.7 compared to 6.2 per 100,000 for women). HNSCC is largely under-reported in cause-of-death records. This study documents the value of national hospital discharge databases as a complement to death certificates for ascertaining cancer deaths.

Introduction Despite the advent of HIV cure‐related clinical trials (HCRCT) for people living with HIV (PLWH), the risks and uncertainty involved raise ethical issues. Although research has provided insights into the levers and barriers to PLWH and physicians' participation in these trials, no information exists about stakeholders' preferences for HCRCT attributes, about the different ways PLWH and physicians value future HCRCT, or about how personal characteristics affect these preferences. The results from the present study will inform researchers' decisions about the most suitable HCRCT strategies to implement, and help them ensure ethical recruitment and well‐designed informed consent. Methods Between October 2016 and March 2017, a discrete choice experiment was conducted among 195 virally controlled PLWH and 160 physicians from 24 French HIV centres. Profiles within each group, based on individual characteristics, were obtained using hierarchical clustering. Trade‐offs between five HCRCT attributes (trial duration, consultation frequency, moderate (digestive disorders, flu‐type syndrome, fatigue) and severe (allergy, infections, risk of cancer) side effects (SE), outcomes) and utilities associated with four HCRCT candidates (latency reactivation, immunotherapy, gene therapy and a combination of latency reactivation and immunotherapy), were estimated using a mixed logit model. Results Apart from severe SE – the most decisive attribute in both groups – PLWH and physicians made different trade‐offs between HCRCT attributes, the latter being more concerned about outcomes, the former about the burden of participation (consultation frequency and moderate SE). These different trades‐offs resulted in differences in preferences regarding the four candidate HCRCT. PLWH significantly preferred immunotherapy, whereas physicians preferred immunotherapy and combined therapy. Despite the heterogeneity of characteristics within the PLWH and physician profiles, results show some homogeneity in trade‐offs and utilities regarding HCRCT. Conclusions Severe SE, not outcomes, was the most decisive attribute determining future HCRCT participation. Particular attention should be paid to providing clear information, in particular on severe SE, to potential participants. Immunotherapy would appear to be the best HCRCT candidate for both PLWH and physicians. However, if the risk of cancer could be avoided, gene therapy would become the preferred strategy for the latter and the second choice for the former.

Introduction Today, a growing need exists for greater research into cancer survivorship, focusing on different spheres of the day-to-day life of diagnosed patients. This article describes the design and implementation of VICAN (VIe après le CANcer), a national survey on French cancer survivors. Method and analysis The target population included patients aged 18–82, diagnosed with cancer between January and June 2010, and registered in one of the three main French Health Insurance Schemes. It was restricted to 12 tumour sites. Sampling was stratified using a non-proportional allocation, based on age at diagnosis (18–52 and 53–82) and tumour site. Data were collected from telephone interviews with patients 2 and 5 years after diagnosis, a medical survey completed by the physician who initiated cancer treatment, and information from the national medicoadministrative database on reimbursement data and hospital discharge records. First data collection, 2 years after diagnosis, occurred between March and December 2012. Second data collection, 5 years after diagnosis, will be conducted in 2015. Analyses will be conducted on various outcomes: quality of life, health status and psychosocial conditions, with a particular focus on the impact of cancer diagnosis on the labour market. The variety of measurements included in the survey will enable us to control a wide range of factors. Ethics and dissemination The methodology of the VICAN survey was approved by three national ethics commissions. Results of the study will be disseminated through national and international research conferences, and in articles published in international peer-reviewed journals.

From November 2014 to November 2015, an experiment in French community pharmacies replaced traditional pre-packed boxes by per-unit dispensing of pills in the exact numbers prescribed, for 14 antibiotics. A cluster randomised control trial was carried out in 100 pharmacies. 75 pharmacies counted out the medication by units (experimental group), the other 25 providing the treatment in the existing pharmaceutical company boxes (control group). Data on patients under the two arms were compared to assess the environmental, economic and health effects of this change in drug dispensing. In particular, adherence was measured indirectly by comparing the number of pills left at the end of the prescribed treatment. Out of the 1185 patients included during 3 sessions of 4 consecutive weeks each, 907 patients experimented the personalized delivery and 278 were assigned to the control group, consistent with a 1/3 randomization-rate at the pharmacy level. 80% of eligible patients approved of the per-unit dispensing of their treatment. The initial packaging of the drugs did not match with the prescription in 60% of cases and per-unit dispensing reduced by 10% the number of pills supplied. 13.1% of patients declared that they threw away pills residuals instead of recycling-no differences between groups. Finally, per-unit dispensing appeared to improve adherence to antibiotic treatment (marginal effect 0.21, IC 95, 0.14-0.28). Supplying antibiotics per unit is not only beneficial in terms of a reduced number of pills to reimburse or for the environment (less pills wasted and non-recycled), but also has a positive and unexpected impact on adherence to treatment, and thus on both individual and public health.

The first COVID-19 cases in Mali were reported almost 1 month after the first case in the African continent. However, the outbreak continues to spread faster there than in other countries which, along with Mali, successfully tackled the 2014 Ebola outbreak in Africa. Given this context, specific actions targeting people living with HIV (PLWH) are needed to reinforce prevention. Community-based involvement is crucial to ensure continuity of care and treatment for PLWH. Furthermore, the health of frontline healthcare workers must take priority in any actions taken. The long-established trustful relationship between NGOs and PLWH in Mali is indispensable to disseminate key messages about COVID-19.

ObjectivesDespite the wide implementation of HIV oral pre-exposure prophylaxis (oPrEP), uptake, adherence and persistence issues remain. Long-acting injectable cabotegravir (CAB-LA) is a promising new PrEP HIV prevention option. However, little is known about oPrEP users’ interest in it. We investigated men who have sex with men (MSM) oPrEP users’ willingness to participate (WtP) in a CAB-LA PrEP study in France.MethodsWe designed a cross-sectional questionnaire (‘NewPrEP’) to evaluate attitudes to CAB-LA of daily and event-driven oPrEP users participating in the ANRS-PREVENIR cohort study (2017–2025). The outcome, WtP, was dichotomised into ‘Willing’ (absolutely/probably) or ‘Unwilling’ (probably not/absolutely not/I would like to discuss this with my doctor before making a decision). We used multivariate logistic Bayesian model averaging to estimate factors associated with WtP.ResultsOf the 1555 MSM followed in ANRS-PREVENIR in February 2023 with baseline data, 879 (57%) answered the NewPrEP questionnaire. Median age and follow-up time were 38 and 4.7 years, respectively; 37% and 22% were on daily- and event-driven oPrEP, respectively; 41% used a combination of both regimens. 64% had heard of CAB-LA PrEP, and 43% were WtP in a related study. Multivariate results showed that willing participants were younger and more likely to have heard of CAB-LA, to use daily oPrEP exclusively or in combination, to find it difficult to adhere to their regimen, to engage in chemsex, to trust their doctor and to be more interested in PrEP effectiveness than in the administration mode. They were less likely to perceive the obligatory 2-monthly hospital visits for CAB-LA PrEP as constraining, to be scared of injections and to fear long-acting medications.ConclusionsWtP in a CAB-LA study among MSM oPREP users was moderate but concentrated among those with the greatest need. This highlights the need to enable free distribution. Future studies should evaluate adherence and retention in long-acting iPrEP.

Background Although Senegal’s Universal Health Coverage (UHC) program has improved access to care, it has sometimes led to overuse of health services. Moreover, the program’s substantial financial debt to health facilities (HFs) has exposed them to organizational and financial problems, making it difficult to renew drug stocks and pay salaries on time. The multiple effects of the UHC program, both on individuals and on HFs, may discourage individuals from seeking for care in HFs. This study analyzed structural and individual factors associated with healthcare-seeking behavior in the context of Senegal’s UHC program. Methods We used data from six HFs in the mostly rural Fatick region that participated in two different two surveys: ANRS 12399 Soignants Sénégal and CMUtuelleS. We performed a multilevel logistic regression model to identify individual and structural factors influencing healthcare-seeking behavior. Results Among the 313 individuals included, 63.3% were female and median age was 52 years (IQR [41⎯63]). Half the participants (50.5%) sought health services after experiencing a health problem in the two months prior to the survey. HFs, which the National Agency managing the UHC program (33.3%) owed most to, were better equipped and staffed, but also the most negatively affected by UHC implementation. Despite this, individuals sought care in these facilities just as frequently as in others, suggesting that being better equipped and staffed helped them to be more resilient to the negative effects of the UHC program. Individuals were less likely to seek care in smaller HFs. Instead, they were more likely to seek care in HFs providing HIV and tuberculosis care. Voluntary (i.e., paying) members (vs. other members) of community-based health insurance organizations, and individuals with a chronic illness (vs. without), were more likely to seek care. Persons with a disability (vs. without) and those experiencing food insecurity (vs. no food insecurity) were less likely to seek care. Conclusion Both the financial support provided to individuals by the UHC program and structural characteristics of the healthcare system were associated with seeking healthcare. Taking greater account of these structural aspects when implementing UHC could enhance the program’s effectiveness and help achieve its objectives.

Introduction This study aims to provide a landscape of the global antiretroviral (ARV) market by analyzing the transactional data on donor‐funded ARV procurement between 2003 and 2015, and the ARV price determinants. Design The data were obtained from the Global Price Reporting Mechanism (GPRM) managed by the AIDS Medicines and Diagnostics Service of the WHO, and it consists of information that covers approximately 80% of the total donor‐funded adult ARV transactions procurement. Methods ExWorks prices and procured quantities were standardized according to the guidelines in terms of yearly doses. Descriptive statistics on quantities and prices show the main trends of the ARV market. Ordinary least squares estimation was carried out for the whole sample, then stratified according to the type of supplier (originator and generic) and controlled for time and geographical fixed‐effects. Given that analyses were carried out on a public dataset on ARV transactional prices from the GPRM, ethics are respected and consent was not necessary. Results Originator medicines are on average the least expensive in the sub‐Saharan Africa region, where at the same time, generic medicines are on average the most expensive. By contrast, originator medicines are the most expensive in Europe and Central Asia, and generic medicines are the least expensive. In fact, the data suggest mixed strategies by ARV suppliers to exploit opportunities for profit maximization and to adapt to the specific conditions of market competition in each region. Our results also suggest that the expiration of patents is not sufficient to boost additional developments in generic competition (at least in the ARV market) and that formal or informal agreements between generic firms may de facto slow down or even reverse long‐term trends towards price decreases. Conclusions Our findings provide an improved understanding of the ARV market that can help countries strengthen policy measures to increase their bargaining power in price negotiations and the use of TRIPS flexibilities, with a special emphasis on negotiations with generic manufacturers.

Background Besides the high prevalence of HIV and HCV infections, people who inject drugs (PWID) have a cumulative risk of acquiring skin and soft tissue infections (SSTI) from, among other things, social precariousness, homelessness/unstable housing, and unhygienic injecting practices. We propose to evaluate whether a two-component educational hand hygiene intervention which combines training in hand-washing with the supply of a single-use alcohol-based hand rub, called MONO-RUB, is effective in reducing injection-related abscesses in the PWID population. Specifically, we shall implement a nationwide, two-arm, multi-centre, cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of this intervention in PWID. Methods HAWA is a community-based participatory research study to be conducted in 22 harm reduction centres (HR) in France (not yet recruiting); the latter will be randomised into two clusters: centres providing standard HR services and the intervention (i.e., intervention group) and those providing standard HR services only (i.e., control group). After randomization, each cluster will include 220 PWID, with an inclusion period of 12 months and an individual follow-up period of 6 months. For each participant, we will collect data at M0, M3 and M6 from photos of injection sites on the participant’s body, a face-to-face injection-related SSTI questionnaire, and a CATI questionnaire. The primary outcome is the reduction in abscess prevalence between M0 and M6, which will be compared between the control and intervention arms, and measured from observed (photographs) and self-declared (SSTI questionnaire) data. We will also assess the cost-effectiveness of the intervention. Discussion The HAWA trial will be the first cluster randomized controlled trial to improve hand hygiene among PWID with a view to reducing SSTI. If effective and cost-effective, the intervention combined with the distribution of MONO-RUBs (or a similar cleaning product) may prove to be an important HR tool, helping to reduce the enormous burden of infection-related deaths and diseases in PWID. Trial Registration NCT06131788, received on 2 January 2024.

ObjectivesThis study investigated the acceptability by gay men, bisexual men and other men who have sex with men (GBMSM) of French public health information and prevention measures implemented during the 2022 Mpox outbreak.MethodsANRS-MPX-SHS \"Mpox: perception of risks, health measures and vaccination\" is a cross-sectional survey conducted in GBMSM between July and September 2022. Online questionnaires collected information about Mpox-related awareness, perceptions and prevention behaviours. Multiple correspondence analysis identified participant profiles according to their level of acceptability of the information and prevention measures implemented during the 2022 outbreak. The study outcome was a variable grouping participants into three profiles: ‘strong endorsers’, ‘uninformed hesitant endorsers’ and ‘indifferent objectors’. Multinomial logistic regression was used to estimate factors associated with each profile.ResultsOf the 5688 participants, 5320 (93.5%) had available data for the outcome. The latter were mostly cisgender men (98%), aged between 35 and 54 years (54.5%), with tertiary education (82%); 44% were living in the Greater Paris region. Strong endorsers, uninformed hesitant endorsers and indifferent objectors accounted for 77.8%, 14.4% and 7.8% of the sample, respectively. Participants with tertiary education, those who had sex exclusively with men, those taking pre-exposure prophylaxis (ie, HIV-negative participants), HIV-positive participants and individuals living in the Greater Paris region, were all less likely to be uninformed hesitant endorsers or indifferent objectors. Participants with no lifetime HIV/sexually transmitted infection (STI) screening and those with infrequent screening were, respectively, more likely to belong to these two profiles.ConclusionsParticipants’ acceptability of the information and prevention measures implemented during the 2022 Mpox outbreak in France depended on the perceived capability of public health authorities to effectively diversify information targets, representations and communication channels. In order to prevent the transmission of Mpox (and other STIs) in the general population in future outbreaks, information and measures adopted must take into account the needs, perceptions and experiences of persons never or not regularly screened for HIV/STIs.