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Number, type and cost of microbiological tests during HIV Pre-Exposure Prophylaxis: The experience of a French
M Morgat1, K Bouiller2, J B Vuillemenot3
1Virology Laboratory, CHU Besançon, Besançon, France.
Background:
Microbiological tests are required for individuals on HIV Pre-Exposure Prophylaxis (PrEP), but their real-life numbers, types and cost are poorly described.
Methods:
Number, type, and results of microbiological tests performed in a Besançon Hospital-associated laboratory, France, from 2016 to 2019, in the setting of PrEP consultations were retrospectively collected. Costs were estimated by the current reimbursement rate set by the French national protection system.
Results:
756 consultations for PrEP initiation or follow-up of 135 persons were performed over 4 years. Among 3434 tests performed in the institution-associated laboratory, 1083 and 2351 were virological and bacteriological tests, respectively. Serology was predominant in virology (98% of virological tests), with HIV, HCV, and HBV screening as the 3 more frequent assays, whereas molecular biology was predominant in bacteriology (63.1% of bacteriological tests) with N. gonorrhoeae and C. trachomatis screening as leader assays. Agar-based culture accounted for 1% of bacterial tests. The global cost of microbiological tests was 45,983.20 euros, corresponding to a mean cost of 60.80 euros per consultation. Virological and bacteriological tests accounted for 37.7% and 62.3% of this budget, respectively. No seroconversion was observed for HIV or HCV. N. gonorrhoeae and C. trachomatis were detected at least once in 39.3% and 22.4% of individuals, respectively, with 15% of symptomatic episodes in both cases. Active syphilis infection was detected in 15.4% of individuals.
Conclusions:
Since numerous microbiological tests are required during PrEP, the availability of specific technical platforms should not be neglected by centers wishing to set up PrEP consultations.
Insights
Microbiological testing is crucial for HIV Pre-Exposure Prophylaxis (PrEP) patients, with virological and bacteriological assays being most common. High prevalence of infections like gonorrhea and syphilis necessitates robust laboratory support for PrEP programs.
Area of Science:
- Infectious Diseases
- Public Health
- Clinical Microbiology
Background:
- Microbiological testing is essential for individuals on HIV Pre-Exposure Prophylaxis (PrEP).
- The real-world utilization, types, and costs of these tests are not well-documented.
- Understanding these aspects is crucial for effective PrEP program management.
Purpose of the Study:
- To retrospectively analyze the number, types, and costs of microbiological tests used in PrEP consultations.
- To assess the prevalence of key infections within this patient population.
- To inform resource allocation and service provision for PrEP programs.
Main Methods:
- Retrospective collection of data on microbiological tests from a hospital laboratory (2016-2019).
- Analysis of virological and bacteriological tests, including serology and molecular biology.
- Cost estimation based on French national reimbursement rates.
Main Results:
- Over 4 years, 3434 tests were performed for 135 individuals during 756 PrEP consultations.
- Virological tests (HIV, HCV, HBV screening) and bacteriological tests (N. gonorrhoeae, C. trachomatis) were predominant.
- High prevalence of N. gonorrhoeae (39.3%), C. trachomatis (22.4%), and syphilis (15.4%) was observed; no HIV/HCV seroconversions.
Conclusions:
- Numerous microbiological tests are integral to PrEP management.
- Centers offering PrEP must ensure adequate laboratory infrastructure and testing platforms.
- Effective management of STIs is critical within PrEP services.
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