Theme: Epidemiology & Public Health Research Year: 2019
Background: France’s harm reduction model is generally considered efficient, with high OST
coverage, HAART treatment for PWIDs, and facilitated access to HCV treatment. In this study, we
aimed to describe current HCV exposure among PWIDs and to contextualize epidemiological data
using a sociological analysis of the French harm reduction model.
Method: Our study combined data from ANRS-Coquelicot cross-sectional seroprevalence surveys.
These studies were based on a time-location random sampling design and blood testing. Fingerstick
blood samples were collected on dried blood spots (DBS). We estimated HCV incidence in two ways:
first by using a statistical comparison method between the two cross-sectional surveys; second by
using biological data to measure the presence of HCV-RNA among people testing negative for antiHCV antibodies.
Results: The ANRS-Coquelicot studies show that needle sharing has increased significantly, from
13.3% in 2004 to 23.6% in 2013. Multivariate analysis shows that the time period is only significantly
associated with needle sharing among the most precarious PWID (IRR=4.2). In the same time span,
we noticed a relative decrease in HCV seroprevalence, from 72.6% in 2004 to 66.7% in 2013, but this
figure is not significant.
In 2013, HCV incidence was estimated at 11% a year based on the statistical comparative method.
We made another estimation with a biological method and found a very high HCV incidence (22%).
Knowledge of HCV status was quite low: 39% of PWID declared being HCV negative and tested
positive; and 33% of PWID said they face difficulties when trying to obtain sterile syringes.
Conclusion: ANRS-Coquelicot is the only French study that provides HCV estimates based on
biological methods. The estimated HCV incidence and the increase in at-risk practices in France were
among the highest observed in all high-income countries. This critical epidemiological situation may
be partly explained by France’s delay in implementing a strong harm reduction model and its
persisting criminalisation of drug use.
Disclosure of interest statement: Dr Jauffret-Roustide received grants from the French National
Agency of HIV and Hepatitis Research. No conflict of interest to declare.