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OBJECTIVES The lack of validated instruments assessing vaccine hesitancy/confidence among health care professionals (HCPs) for themselves, and their patients led us to develop and validate the Pro-VC-Be instrument to measure vaccine confidence and other psychosocial determinants of HCPs’ vaccination behavior among diverse HCPs in different countries.METHODS Cross-sectional survey in October-November 2020 among 1,249 GPs in France, 432 GPs in French-speaking parts of Belgium, and 1,055 nurses in Quebec (Canada), all participating in general population immunization. Exploratory and confirmatory factor analyses evaluated the instrument’s construct validity. We used HCPs’ self-reported vaccine recommendations to patients, general immunization activity, self-vaccination, and future COVID-19 vaccine acceptance to test criterion validity.RESULTS The final results indicated a 6-factor structure with good fit: vaccine confidence (combining complacency, perceived vaccine risks, perceived benefit-risk balance, perceived collective responsibility), trust in authorities, perceived constraints, proactive efficacy (combining commitment to vaccination and self-efficacy), reluctant trust, and openness to patients. The instrument showed good convergent and criterion validity and adequate discriminant validity.CONCLUSIONS This study found that the Pro-VC-Be is a valid instrument for measuring psychosocial determinants of HCPs’ vaccination behaviors in different settings. Its validation is currently underway in Europe among various HCPs in different languages.

High rates of sexually transmitted infections (STIs) have been reported among pre-exposure prophylaxis (PrEP) users. We wished to assess the incidence and risk factors for recurrent STIs.The ANRS IPERGAY trial was a prospective study investigating PrEP among MSM and transgender women in outpatient clinics in France and Canada. In all, 429 participants were enrolled, offered up to 4 years of PrEP and screened for bacterial STIs (syphilis, chlamydia and gonorrhea) at baseline and every 6 months.STIs incidence was calculated yearly. Cox proportional hazards model regression was used to explore associations between participants characteristics at baseline and recurrent STI during follow-up.Over a median follow-up of 23 months, bacterial STI incidence was 75, 33, 13, 32 and 30 per 100 person-years for all STIs, rectal STIs, syphilis, gonorrhea and chlamydia, respectively. STI incidence significantly increased from the first year to the fourth year of the study (55 vs. 90 per 100 person-years, P 0.001). During the study period, 167 participants (39%) presented with more than one bacterial STIs which accounted for 86% of all STIs. Baseline risk factors associated with recurrent STIs in a multivariate analysis were an STI at baseline [hazards ratio: 1.48 (95% confidence interval (CI): 1.06-2.07), P = 0.02], more than eight sexual partners in prior 2 months [hazards ratio: 1.72 (95% CI: 1.21-2.43), P = 0.002] and the use of gamma-hydroxybutyrate [hazards ratio: 1.66 (95% CI: 1.16-2.38), P = 0.005].STI incidence was high and increased over time. Most STIs were concentrated in a high-risk group that should be targeted for future interventions.

Background: Vaccine confidence among health care professionals (HCPs) is a key determinant of vaccination behaviors. We validate a short-form version of the 31-item Pro-VC-Be (Health Professionals Vaccine Confidence and Behaviors) questionnaire that measures HCPs’ confidence in and commitment to vaccination.Research design and methods: A cross-sectional survey among 2,696 HCPs established a long-form tool to measure ten dimensions of psychosocial determinants of vaccination behaviors. Confirmatory factor analysis (CFA) models tested the construct validity of 69,984 combinations of items in a 10-item short form tool. The criterion validity of this tool was tested with four behavioral and attitudinal outcomes using weighted modified Poisson regressions. An immunization resources score was constructed from summing the responses of the dimensions that can influence HCPs’ pro-vaccination behaviors: vaccine confidence, proactive efficacy, and trust in authorities.Results: The short-form tool showed good construct validity in CFA analyses (RMSEA = 0.035 [0.024; 0.045]; CFI = 0.956; TLI = 0.918; SRMR 0.027) and comparable criterion validity to the long form tool. The immunization resources score showed excellent criterion validity.Conclusions: The Pro-VC-Be short-form showed good construct validity and criterion validity similar to the long-form, and can therefore be used to measure determinants of vaccination behaviors among HCPs.

International audience; No abstract available

Background Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but their SIV rates remain far below public health targets. We aimed to identify temporal trajectories of SIV uptake over a 10-year period among French people with diabetes and describe their clinical characteristics. Methods We identified patients with diabetes in 2006 among a permanent, representative sample of beneficiaries of the French National Health Insurance Fund. We followed them up over 10 seasons (2005/06–2015/16), using SIV reimbursement claims and group-based trajectory modelling to identify SIV trajectories and to study sociodemographic, clinical, and healthcare utilization characteristics associated with the trajectories. Results We identified six trajectories. Of the 15,766 patients included in the model, 4344 (28%) belonged to the “continuously vaccinated” trajectory and 4728 (30%) to the “never vaccinated” one. Two other trajectories showed a “progressive decrease” (2832, 18%) or sharp “postpandemic decrease” (1627, 10%) in uptake. The last two trajectories (totalling 2235 patients, 14%) showed an early or delayed “increase” in uptake. Compared to “continuously vaccinated” patients, those in the “progressively decreasing” trajectory were older and those in all other trajectories were younger with fewer comorbidities at inclusion. Worsening diabetes and comorbidities during follow-up were associated with the “increasing” trajectories. Conclusions Most patients with diabetes had been continuously vaccinated or never vaccinated and thus had stable SIV behaviours. Others adopted or abandoned SIV. These behaviour shifts might be due to increasing age, health events, or contextual factors (e.g., controversies about vaccine safety or efficacy). Healthcare professionals and stakeholders should develop tailored strategies that take each group’s specificities into account. Electronic supplementary material The online version of this article (10.1186/s12889-019-7209-z) contains supplementary material, which is available to authorized users.

Background The outbreak of the Covid-19 pandemic and the lockdown measures have had a major impact on societies around the world. This led to sleep problems for a large part of the population. In order to assess the sustainability of sleeping troubles related to the sanitary crisis, it was crucial to measure its prevalence after the end of the Covid-19 confinement. Method As a part of an epidemiological survey on Covid and Confinement (Coconel), we enquired on sleep disorders with two items in 4 repetitive cross sectional surveys. The first during the first week of the confinement (March 31 to April 2; N= 1,005 participants). The second in the middle of this period (April 15-17; N= 1,005). The two lasts at the end of the confinement (May 7 -10; N= 2,003) and one month after the end (June 10-12; N= 1,736). Using random constant, the mixed model took into account the longitudinal character of the last two waves (intra-individual correlations for individuals surveyed in waves 3 & 4). Results The prevalence of sleep problems significantly decreased during the last weeks of the confinement, and this trend was confirmed one month after it was over. A quarter of the population reported that their sleep was better one month after the end of the confinement. Women and people aged less than 65 reported more often sleep improvement. Such improvement was less frequent among those who were still highly exposed to the pandemic’s media coverage after the end of the confinement. Conclusion The possibility of recovering a good sleep largely depends on the type of sleep disorder. The decrease of sleep problems occurred mainly among people with mild sleep problems during the confinement. further research is needed to assess the long term effect of the Covid-19 pandemic and of the confinement period on the quality of sleep of the population., Highlights • The prevalence of sleep problems was high during the confinement. • This prevalence significantly decreased during the last weeks of the confinement. • This trend was confirmed one month after it was over. • The prevalence of sleep problems was higher in women and in young adults.

International audience

International audience; HIV cure-related clinical trials (HCRCT) with analytical antiretroviral treatment interruptions (ATIs) have become unavoidable. However, the limited benefits for participants and the risk of HIV transmission during ATI might negatively impact physicians' motivations to propose HCRCT to patients. Between October 2016 and March 2017, 164 French HIV physicians were asked about their level of agreement with four viewpoints regarding HCRCT. A reluctance score was derived from their answers and factors associated with reluctance identified. Results showed the highest reluctance to propose HCRCT was among physicians with a less research-orientated professional activity, those not informing themselves about cure trials through scientific literature, and those who participated in trials because their department head asked them. Physicians' perceptions of the impact of HIV on their patients' lives were also associated with their motivation to propose HCRCT: those who considered that living with HIV means living with a secret were more motivated, while those worrying about the negative impact on person living with HIV's professional lives were more reluctant. Our study highlighted the need to design a HCRCT that minimizes constraints for participants and for continuous training programs to help physicians keep up-to-date with recent advances in HIV cure research.

Achieving a HIV cure has become a research priority. As any improvement of knowledge, which could help scientists design new HIV cure-related clinical trials (HCRCT) depends on the risks potential participants are willing to accept, it is important to understand who will agree or refuse to participate and in which proportions. By providing insights into factors associated with reluctance toward HCRCT participation, our results may help clinicians in patient recruitment.

Background Health care worker vaccine uptake rates are below official targets, and studies demonstrate some are vaccine hesitant. We assessed self-vaccination behavior, vaccine hesitancy (VH), and associated factors in a representative sample of nurses. Methods Cross-sectional questionnaire survey in 2017–18 in southeastern France (5 million inhabitants): community nurses were randomly selected from a list provided by the Inter-Regional Nurses' Council (stratified by gender and district of practice) and interviewed by telephone. Because no such list exists for hospital nurses (74% of all nurses in southeastern France), we randomly selected hospitals, taking their size into account and stratifying by district. Hospital nurses practicing in medicine, surgery, obstetrics, and gynecology departments and present at the time of the survey were included and interviewed face-to face. We measured VH according to the WHO definition (refusal, delay, or acceptance with doubts about at least one vaccine). Interviewers administered the questionnaires. We used multivariable logistic regression to analyze potential associations between VH, vaccine risk perceptions and trust in health authorities. Results Interviews were completed with 1539 nurses (response rate: 85%). Self-reported vaccine coverage ranged from 27% (seasonal influenza vaccine, recommended, 2016/17 season) to 96% (Bacillus Calmette–Guerin vaccine, mandatory). The VH prevalence rate was 44% (95% confidence interval: 38.7–48.4) and most often concerned seasonal influenza or A(H1N1) vaccines (54%) and the hepatitis B vaccine (18%). VH was significantly more frequent among nurses with low trust in health authorities or high vaccine risk perceptions. Conclusion Nurses in southeastern France have low levels of self-vaccination acceptance for most recommended vaccines. In addition, they have a high VH prevalence focused on the same vaccines as among the general population. These are important findings given that nurses are in regular contact with patients vulnerable to vaccine-preventable diseases and their VH could negatively influence patients’ vaccination acceptance.

To assess the self-reported vaccination behavior of general practitioners (GPs) when asked whether they would recommend the vaccination of a child presenting with a febrile uncomplicated common cold.We performed a cross-sectional survey in 2014 on a national sample of GPs. GPs were randomly assigned to one of eight clinical vignettes, all describing a child presenting with an uncomplicated febrile common cold, but differing by age (4 or 11 months), temperature (38°C or 39°C), and the mother's emotional state (calm or worried). GPs were asked whether they would recommend immediate vaccination of the child with a hexavalent vaccine (diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type b, and hepatitis B), or postpone it. We investigated the relation between the GPs' recommendation to vaccinate, the clinical vignette's variables, and the GPs' perceptions, attitudes, and practices toward vaccination in a multivariate model.Among the 1582 participating GPs, 6% recommended immediate vaccination. This behavior was more frequent with a temperature of 38°C rather than 39°C (10% vs. 3%, P0.001). GPs who felt comfortable giving explanations about vaccine safety were more likely to recommend immediate vaccination of the febrile child (P=0.045), but none of the other GPs' characteristics were associated with their vaccination behavior.Almost all GPs postponed the hexavalent vaccination of the febrile child presenting with an uncomplicated viral disease; fever being the major factor affecting their decision. More research is needed on vaccination responses in sick children, as well as clearer guidelines.

Objectives The objectives of our study were to describe the vaccination recommendations by general practitioners (GPs) for their patients and practices for their children, and to identify any discrepancies between them. Methods Applying multiple correspondence analysis and agglomerative hierarchical cluster analysis to data from a 2014 cross-sectional survey of a national sample of GPs, we constructed a typology based on the patterns of associations between GPs' vaccine recommendations to their patients and practices to their own children's vaccinations. Results This study includes the 1038 GPs who reported that they had at least one child aged 2–25 years. Nearly half (47%, 482/1021) reported that all of their children were vaccinated against hepatitis B but that they did not always recommend that vaccine to patients; the same discordance was observed among 36% (369/1027) for the measles–mumps–rubella vaccine, 19% (194/1013) to 28% (290/1019) for routine and catch-up meningococcal C vaccination, and 27% (136/496) for the human papillomavirus vaccine. Cluster analysis showed that 37% (95% CI 33%–39%) of GPs reported an above-average rate of systematic vaccine recommendations for their patients, and most reported that all their children were vaccinated (low level of discordance), whereas 60% (95% CI 58%–64%) had a high level of discordance, that is, most reported that their children were vaccinated, but did not always recommend the same vaccines to their patients. Conclusions Many GPs do not report the same attitude concerning the vaccination of their children and their patients. The reasons underlying these discrepancies, possibly including vaccine hesitancy, should be investigated.

Objectives Enrolling people living with HIV with undetectable viral load into HIV cure-related clinical trials (HCRCT) is challenging. Few data are currently available about the individual factors that influence willingness to participate in HCRCT (WPHCRCT). We hypothesised that WPHCRCT would be more frequent among people living with HIV considering themselves HIV activists. The objective of this study was to investigate the individual characteristics associated with both WPHCRCT and self-identification as an HIV activist. Methods The study enrolled 195 long-term ART-treated and virologically suppressed people living with HIV, followed-up in 19 French HIV services, 2016–2017. A Bayesian model averaging approach was used to assess correlates of both outcomes i.e. WPHCRCT and self-identified HIV activism. Results WPHCRCT was reported by 43% of participants and was positively associated with self-identification as an HIV activist (adjusted odds ratio [aOR] 2.90 95% confidence interval [CI] 2.17–3.63], P0.75, indicating strong evidence. Conclusions WPHCRCT is strongly related to HIV activism, and also to positive psychosocial characteristics as a person living with HIV, especially regarding relationships with others. The desire to contribute to the fight against HIV for the sake of the HIV community and society should be taken into account to improve participation in upcoming HCRCT.

Objectif La crise de la COVID-19 a perturbe les habitudes de milliards de personnes dans le monde. Pour de nombreux pays, le confinement a la maison est obligatoire et les familles sont forcees de vivre ensemble en permanence, dans des environnements souvent petits, avec leurs propres habitudes de sommeil et de veille. Le sommeil est essentiel pour nos vies et crucial pour equilibrer leur systeme immunitaire, la sante physique et psychologique. Methodes Pour evaluer les problemes de sommeil et l’utilisation des somniferes, nous avons realise une etude transversale d’un echantillon representatif de la population generale en France (1005 sujets). Nous avons utilise les memes elements autodeclares de plaintes de sommeil au cours des 8 derniers jours, tires de l’echelle du Duke Health Profile, que ceux utilises depuis 1995 dans les Barometres de la sante francais, une serie d’enquetes transversales sur diverses questions de sante publique. Resultats Apres deux semaines de confinement, 74 % des participants ont signale des plaintes de sommeil, comparativement a des taux de prevalence de 44 % a 49 % au cours des 25 dernieres annees. Les femmes ont declare plus de problemes de sommeil que les hommes : 31 % contre 16 %. Les jeunes (18-35 ans) plus frequemment que leurs aines (79 % contre 72 % des 35 ans et plus) : 60 % ont declare que ces problemes augmentaient avec le confinement, contre 51 % de leurs aines. Enfin, 16 % des participants ont declare avoir pris des somniferes au cours des 12 derniers mois et 41 % d’entre eux ont declare avoir consomme ces medicaments depuis le debut du confinement. Conclusion Ces resultats suggerent que la crise de la COVID-19 est associee a de graves troubles du sommeil au sein de la population francaise, en particulier chez les jeunes.

Introduction Adherence to sun-protection guidelines in developed countries is low, especially among people of low SES. Mechanisms underlying this social differentiation are poorly understood. This study aimed to examine the social differentiation of sun-protection behaviors and of two cognitive factors (knowledge about both sun health and behavioral risk factors for cancer) and to determine if these cognitive factors mediate the association between SES and sun-protection behaviors. Methods Data came from the 2010 Barometre Cancer survey (analyzed in 2014), a random cross-sectional telephone survey conducted among the French general population ( n =3,359 individuals aged 15−75 years). First, bivariate associations between a composite individual SES indicator (based on education level, occupation, and income) and both sun-protection behaviors and cognitive factors were tested with chi-square tests and ANOVA. Then, confirmatory factor analysis and structural equation modeling were used to test the mediating role of cognitive factors with a multiple mediation model including four latent variables. Results In bivariate analyses, the individual SES indicator was positively associated with sun-protection behaviors and both cognitive factors. Multiple mediation analyses showed that both cognitive factors partially mediated the effect of individual SES on sun-protection behaviors. The overall proportion of mediated effects was 48%. The direct effect of SES remained significant. Conclusions These results suggest that interventions aimed at modifying the knowledge and perceptions of people of low SES might help to reduce social differentiation of sun-protection behaviors. Further qualitative research is needed to better understand these cognitive factors and develop suitable prevention messages.

International audience; Background: Chemsex-the use of psychoactive substances during sexual encounters-among men who have sex with men is a growing concern. On-demand HIV pre-exposure prophylaxis (PrEP) may be a suitable tool to prevent HIV transmission among "chemsexers." We used the open-label extension study of the ANRS-IPERGAY trial to describe chemsexers and their PrEP use. Methods: Among the 361 men who have sex with men enrolled in ANRS-IPERGAY's open-label extension study, we selected the 331 with available data on drug use. A 2-monthly web questionnaire on sociobehavioral data was used to compare sexual behaviors between questionnaires where chemsex was reported and those where it was not. Using a generalized estimating equation logistic regression, we studied whether practicing chemsex was associated with correct PrEP use. Results: Among the 331 participants, 30% reported chemsex practice at least once during follow-up and were considered chemsexers. Chemsex was reported in 16% of all questionnaires. Chemsexers were not significantly different from nonchemsexers regarding sociodemographic characteristics, although they reported greater use of anxiolytics and more sensation-seeking. Reporting chemsex was associated with more high-risk sexual practices and a higher perception of risk. After adjustment for other potential correlates, chemsex remained associated with correct PrEP use [odds ratio (95% confidence interval) = 2.24 (1.37 to 3.66)]. Conclusions: Our findings show that chemsexers were more likely to report high-risk sexual practices but also had a higher perception of risk. They were also more likely to use PrEP correctly when practicing chemsex. Consequently, PrEP may be a suitable tool to reduce HIV-risk transmission among chemsexers.

dans revue; International audience; IntroductionSeasonal influenza vaccine (SIV) is recommended in France for people aged 65 years or older and those with clinical risk factors, including diabetes. The French National Health Insurance Fund (NHIF) can identity these individuals and send them a voucher so they can obtain the vaccine free of charge. Despite this, SIV coverage remains below the target of 75% and has progressively decreased since the 2009 pandemic. We aimed to identify temporal trajectories (T) over a 10-year period of SIV uptake (SIVU) among patients with diabetes and to describe their correlates.MethodsWe identified patients with diabetes in 2006 (n = 17,259) among a representative sample of French NHIF beneficiaries. We followed them from 2006 through 2015, using SIV reimbursement claims and group-based trajectory modeling to identify SIVU-T and drug reimbursement claims to assess diabetes severity and comorbidity status. A multinomial logistic regression allowed us to study characteristics associated with the SIVU-T.ResultsWe found 6 SIVU-T: (1) “never” T (prevalence: 32%): people with quasi null SIVU probabilities (≤ 5%); (2) “late increasing” T (4%): SIVU probability varying from ≤ 10% before 2011/12 to 85% in 2015/16; (3) “early increasing” T (8%): probability varying from ≤ 10% in 2006/07 to ≥ 80% starting in 2009/10; (4) “regular” T (33%): probability always ≥ 95%; (5) “progressively non-vaccinated” T (14%): probability decreasing from 90% in 2006/07 to 20% in 2015/16; (6) “post-pandemic decreasing” T (9%): probability decreasing right after the 2009/10 season.Overall, compared to the “never” T group, people in all other trajectories had poorer health at inclusion and/or over the study period (severe diabetes, high comorbidity score), people in the “late increasing” T group were more likely to have received newly free vaccination vouchers and/or changed general practitioners (GPs) during follow-up, and those in the “early increasing” T more likely to have received newly free vaccination vouchers and to have been hospitalized for an influenza-like illness during the follow-up. Those with “regular” T were slightly older than those with “never” T and less likely to have been hospitalized due to diabetes; those with a “progressively non-vaccinated” T were oldest (mean age at inclusion = 80 ± 7 years versus 65 ± 14 in the study population). Finally, people with a “post-pandemic decreasing” T were more frequently women, more likely to have been hospitalized due to an influenza-like illness, and to have changed GPs during the follow-up.ConclusionsSIVU behavior was stable in most people with diabetes over the study period: one third were vaccinated regularly and another third never. The latter were globally healthier than the other groups and may feel less vulnerable to it, despite their clinical risk. About 25% became less inclined toward vaccination in one of two different patterns: the “progressively non-vaccinated” T may reflect the patient and/or healthcare professional's doubts about the benefits of SIV after a certain age (in part due to immunoscenescence); those in the “post-pandemic decreasing” T may have lost confidence in SIV after controversies in France during the 2009 mass vaccination campaign against the pandemic. About 10% became more likely to be vaccinated during the study period; our results suggest that receiving free vouchers for the first time might have triggered or fostered this behavioral change. Changing GPs and hospitalization for an influenza-like illness were associated with both increasing and decreasing trajectories. These events may represent key opportunities to foster or prevent behavioral changes toward SIV. Further research is needed to better understand the chronology of these events and potential causal pathways. These results should help stakeholders to adapt public health interventions to specific subgroups.

While vaccination is globally accepted, ‘vaccine hesitancy’ (VH) is a notion increasingly invoked to refer to the reluctance to various vaccines observed in many countries [1]. The World Health Organization’s Strategic Advisory Group of Experts (SAGE) on Immunization provides the following definition of VH: ‘VH refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. VH is complex and context specific, varying across time, place and vaccines. It is influenced by factors such as complacency, convenience and confidence.’ [2]. VH depends on many factors including (i) contextual factors, (ii) individual and group influences (e.g. people’s trust in health authorities and in healthcare workers; self-perception of health), and (iii) perceived risks associated with vaccine-preventable diseases and trust in their corresponding vaccines [3,4]. The last 20 years in France have seen continued controversy about vaccines: unfavourable opinions towards vaccination in general have increased [5] and a study in 2015 involving 67 countries found that, among these, the French population had the least confidence in vaccine safety [1]. To identify vaccine concerns early, quantify their prevalence and evaluate the impact of strategies designed to address these concerns, measuring VH and following its evolution over time is essential. However, with the exception of the 18-item Parent Attitudes about Childhood Vaccines (PACV) scale, designed by Opel [6] in 2011 to identify vaccine-hesitant parents, and an eight-item vaccine confidence scale designed to identify parents at risk of refusing adolescent vaccines [7], concise tools for measuring VH prevalence in various groups in the general population and data on VH prevalence are lacking. The Health Barometer (Barometre sante) 2016 is the eighth in a series of French national cross-sectional surveys addressing health issues in representative population samples. It was designed and conducted by the French Public Health Agency (Sante publique France). One section of the questionnaire of the 2016 survey concerned vaccination issues. The goals of this study were (i) to estimate the prevalence of VH in parents of children, parents of adolescent girls and elderly people, (ii) to determine VH’s socio-demographic correlates, (iii) to both understand in each concerned sub-group, which specific vaccine-related behaviours and perceptions VH captures, and to study associations between VH and both self-reported behaviours and the perceived risk–benefit balance (RBB) for the measles, hepatitis B (HBV), human papillomavirus (HPV), and seasonal influenza (SI) vaccines.

Background and aims Seasonal influenza vaccination (SIV) uptake (SIVU) rates in France are below target. We (i) describe trends in French SIVU over 10 consecutive seasons among different target groups and (ii) examine the effects of the 2009 influenza A(H1N1) pandemic and the publication of new SIV recommendations in 2011 and 2013. Methods Our study was based on records of vaccines delivered in community pharmacies for a permanent, representative sample of 805,000 beneficiaries of the French National Health Insurance Fund. For the first objective, we analysed SIVU rate trends among ≥ 65 year olds as well as among Results After the 2009 pandemic, except for the target group with liver diseases, where the difference was not statistically significant, SIVU fell significantly in all groups during the 2010/11 season, remaining relatively stable until 2015/16 in groups not targeted by new recommendations. Crude SIVU rates in 2015/16 were 48% (43,950/91,794) for ≥ 65 year olds and between 16% (407/2,565) and 29% (873/3,056) for Conclusions Our results suggest: (i) a prolonged confidence crisis in SIV, initially impelled by the 2009 pandemic vaccination campaign; (ii) that new recommendations are ineffective without additional measures. Interventional research in this field is a priority.

International audience; Objectives: We aimed to study general practitioners' (GPs') perceptions of vaccines that have been a subject of controversy in France. Methods: A cross-sectional survey in 2014 asked a representative national sample of GPs, randomly selected from the exhaustive database of health professionals in France, about their perceptions of the likelihood of serious adverse events potentially associated with six different vaccines: for two of them the association was based on some scientific evidence, whereas for the other four this is not the case. We performed a cluster analysis to construct a typology of GPs' perceptions about the likelihood of these potential six associations. Factors associated with certain clusters of interest were identified using logistic regression models. Results: Overall, 1582 GPs participated in the questionnaire survey (1582/1712 GPs who agreed to participate, 92%). Cluster analysis identified four groups of GPs according to their susceptibility to vaccine controversies: 1) limited susceptibility to controversies (52%); 2) overall unsure, but rejected the association between hepatitis B vaccine and multiple sclerosis (32%); 3) highly susceptible to controversies (11%); and 4) unsure (5%). We found that GPs who occasionally practised alternative medicine (OR 2.71, 95% CI 1.65-4.45), and those who considered information provided by mass media as reliable (OR 2.04, 95% CI 1.65-3.99) were more susceptible to controversies. Conclusions: GPs had different profiles of susceptibility to vaccination controversies, and most of their perceptions of these controversies were not based on scientific evidence.

International audience; People with disabilities use various preventive health services less frequently than others, notably because of a lower socioeconomic status (SES). We examined variations of seasonal influenza vaccine uptake according to type/severity of disability and SES. We analyzed (in 2016) data from the 2008 French national cross-sectional survey on health and disability (n=12,396 adults living in the community and belonging to target groups for seasonal influenza vaccination). We defined seasonal influenza vaccine uptake during the 2007–2008 season by the self-reporting of a flu shot between September 2007 and March 2008. We built scores of mobility, cognitive, and sensory limitations, and an SES score based on education, occupation, and income. We performed bivariate analyses and then multiple log-binomial regressions. The prevalence of vaccine uptake was 23% in the 18–64 group and 63% in the ≥65 group. In bivariate analyses, it was higher among people in both age groups who had mobility and/or cognitive limitations and in the ≥65 group among those with sensory limitations. In the multiple regression analyses, only the presence of major mobility limitations in the18–64 group remained significant. The probability of vaccine uptake was higher in the highest SES category than in the lowest. Among at-risk groups, people with disabilities were more frequently vaccinated than others, mainly because of their higher levels of morbidity and healthcare use. Socioeconomic inequalities in access to vaccination persist in France. Future research is needed to monitor the trend in vaccine uptake in institutions.

ObjectivesPartner notification (PN) is a useful public health approach to enhance targeted testing of people at high risk of HIV and other STIs, and subsequent linkage to care for those diagnosed. In France, no specific PN guidelines exist and information about current practices is scarce. We used the ANRS-IPERGAY PrEP trial to investigate PN in HIV-negative men who have sex with men (MSM) reporting a bacterial STI.MethodsThis substudy included 275 participants who completed a specific online PN questionnaire during the open-label extension study of the ANRS-Intervention Préventive de l’Exposition aux Risques avec et pour les Gays (IPERGAY) trial. Variables used as proxies of at-risk practices were defined using data collected at the previous follow-up visit about participants’ most recent sexual encounter and preventive behaviours. χ2 or Fisher’s exact test helped select variables eligible for multiple logistic models.ResultsOf the 275 participants, 250 reported at least one previous STI. Among the latter, 172 (68.8%) had informed their partner(s) of their most recent STI. Of these, 138 (80.2%) and 83 (48.3%) had notified their casual and main partners, respectively. Participants were less likely to notify their main partner when their most recent sexual encounter involved unsafe anal sex with a casual partner (adjusted OR (aOR) (95% CI) 0.18 (0.06 to 0.54), P=0.02). Older participants were less likely to inform casual partners (aOR (95% CI) 0.44 (0.21 to 0.94), P=0.03), while those practising chemsex during their most recent sexual encounter were more likely to inform their casual partners (aOR (95% CI) 2.56 (1.07 to 6.09), P=0.03).ConclusionUnsafe sexual encounters with people other than main partners and street drugs use were two sociobehavioural factors identified, respectively, as a barrier to main PN and a motivator for casual PN, in a sample of high-risk MSM. These results provide an insight into current PN practices regarding STI in France and might inform future decisions about how to define feasible and acceptable PN programmes.

BACKGROUND Meningococcal C glycoconjugate vaccine (MenCV) has been recommended in France since 2010, but its uptake remains low (64% coverage among 2-year-olds in 2014). Because general practitioners (GPs) are the cornerstone of the French vaccination program, we sought to assess their perceptions, attitudes, practices and recommendations to patients for this vaccine. METHODS A cross-sectional survey in 2014 asked a national sample of 1582 GPs if they would recommend MenCV for patients 12 months of age (routine vaccination) and 2-24 years of age (catch-up vaccination) and explored the barriers to vaccination. RESULTS Overall, 52% of GPs (800/1547) reported they always recommend routine MenCV vaccination and 33% (523/1572), catch-up vaccination. The most frequently reported barriers to vaccination were that parents have never heard of this vaccine (72%, 1094/1523), underestimate the risk of contracting meningococcal disease (69%, 1049/1514) and are unaware of its seriousness (55%, 838/1537). In multivariate analyses, GPs recommended routine and catch-up vaccination significantly more often when they had no doubt about the utility and safety of this vaccine, when they thought that the official MenCV recommendation was clear and when their own children were vaccinated. GPs who reported that their patients either were unaware of the severity of bacterial meningitis (P = 0.012) or had no doubts about the efficacy of MenCV recommended catch-up vaccination more often (P = 0.015). CONCLUSIONS GPs did not appear to recommend MenCV often enough. Our results suggest that clearer recommendations and a better communications campaign directed at patients and healthcare workers could be useful.

International audience; OBJECTIVES:To determine the impact of hospital caseload size on HIV virological success when taking into account individual patient characteristics.METHODS:Data from the ANRS-VESPA2 survey representative of people living with HIV in France was used. Analyses were carried out on the 2612 (86.4% out of 3022) individuals receiving antiretroviral (ARV) treatment for at least one year. Outcomes correspond to two definitions of virological success (VS1 and VS2 respectively) and were analyzed under a multi-level modeling framework with a special focus on the effect of the caseload size on VS.RESULTS:Structures with caseloads

In recent years, vaccine hesitancy among health professionals has emerged as an important issue on public health agendas. However, we do not yet know very much about whether, and if so how, trust in institutions affects their practices.A path analysis model explaining the influence of trust on GPs' vaccine hesitancy was applied to a cross-sectional survey of 1,582 French GPs performed in 2014. We hypothesized that distrust in public health institutions influences GPs' concerns about the safety of various vaccines, their perceptions about the importance of vaccination, their self-efficacy in the doctor-patient relationship, and ultimately their vaccination recommendations to patients.GPs' trust in institutions was found to be significantly associated with lower vaccine hesitancy, an association mediated to a large extent by the vaccine's perceived safety (β = 0.09, P 0.01) and the importance of vaccination (β = 0.46, P 0.001).These results suggest that restoration of high vaccination coverage may require the re-establishment of a significant degree of trust in the public health system among health professionals.

Background Suicide risk is high among people living with HIV (PLHIV). This study aimed to identify major correlates of suicide risk in a representative sample of PLHIV in France, in order to help target individuals who would benefit from suicide risk screening and psychiatric care. Methods The ANRS VESPA2 cross-sectional survey (April 2011-January 2012) collected socio-demographic, medical and behavioral data from 3,022 PLHIV recruited in 73 French HIV hospital departments. The study sample comprised the 2,973 participants with available self-reported data on suicide risk (defined as having either thought about and planned to commit suicide during the previous 12 months or attempted suicide during the same period of time) and medical data on comorbidities. Weighted Poisson models adjusted for HCV co-infection and significant clinical variables were used to estimate the relationship between suicide risk and HIV transmission groups, experience with HIV disease and other psychosocial factors. Results Suicide risk was reported by 6.3% of PLHIV in the study sample. After adjustment for HIV immunological status and HCV co-infection, women (IRR [95%CI]:1.93 [1.17; 3.19]) and men who have sex with men (MSM) (1.97 [1.22; 3.19]) had a higher suicide risk than the rest of the sample. Moreover, the number of discrimination-related social contexts reported (1.39 [1.19; 1.61]), homelessness (4.87 [1.82; 13.02]), and reporting a feeling of loneliness (4.62 [3.06; 6.97]) were major predictors of suicide risk. Conclusions Reducing the burden of precarious social conditions and discrimination is an important lever for preventing suicide risk among PLHIV in France. Comprehensive care models involving peer/community social interventions targeted at women and MSM need to be implemented to lower the risk of suicide in these specific subgroups of PLHIV.

Objective General practitioners (GPs) play a crucial role in human papillomavirus (HPV) vaccine acceptance in France. We sought to study: (1) GPs’ perceptions of its risks and efficacy and their recommendation behavior; (2) the relative importance of factors associated with the frequency of their recommendations. Methods Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France (response rate: 92.4%). We used model averaging to analyze the associations of self-reported frequency of GPs’ HPV vaccine recommendations with their perception of its risk-benefit balance and their opinions about the utility of vaccines in general. Results Overall, 72% of participants reported frequently recommending HPV vaccination; 60% considered that not enough is known about its risks. The model averaging showed that the factors most associated with infrequent recommendation of this vaccine by GPs were: unfavorable perceptions of its risk-benefit balance (OR = 0.13; 95%CI = 0.09–0.21; partial R 2 = 0.10), a decision not to vaccinate one's own daughter(s) with this vaccine (OR = 0.13; 95%CI = 0.07–0.24; partial R 2 = 0.05), and doubts about vaccine utility in general (OR = 0.78; 95%CI = 0.71–0.86; partial R 2 = 0.03). Conclusion Although nearly three-quarters of French GPs frequently recommended the HPV vaccine, our findings indicate that a substantial percentage of them are hesitant about it. Doubts about its risks and efficacy strongly influence their recommendation behavior. More research is warranted to help design and evaluate tailored tools and multicomponent intervention strategies to address physician's hesitancy about this vaccine.

International audience; This article sought to estimate the prevalence of vaccine hesitancy (VH) among French general practitioners (GPs) and to study its demographic, professional and personal correlates. We conducted a cross-sectional telephone survey about GPs' vaccination-related attitudes and practices in 2014 in a national panel of 1,712 GPs in private practice, randomly selected from an exhaustive database of health professionals in France. A cluster analysis of various dimensions of VH (self-reported vaccine recommendations, perceptions of vaccine risks and usefulness) identified three clusters: 86% of GPs (95% confidence interval (CI): 84-88) were not or only slightly vaccine-hesitant, 11% (95% CI: 9-12) moderately hesitant and 3% (95% CI: 3-4) highly hesitant or opposed to vaccination. GPs in the latter two clusters were less frequently vaccinated and reported occasional practice of alternative medicine more often than those in the first cluster; they also described less experience with vaccine-preventable diseases and more experience with patients who they considered had serious adverse effects from vaccination. This study confirms the presence of VH among French GPs but also suggests that its prevalence is moderate. Given GPs' central role in vaccination, these results nevertheless call for a mobilisation of stake-holders to address VH among GPs.

Objectives France is currently facing a vaccine-hesitancy crisis. We conducted a questionnaire-based telephone interview with a large sample of general practitioners (GPs) as they play a crucial role in the vaccination process. Our main objectives were to study the GPs’ vaccination behaviors when it comes to their own vaccination and that of their relatives, and the vaccine recommendations made to their patients. We also aimed to understand their opinion related to the severity of vaccine-preventable diseases and to assess their trust in various sources of information. Finally, we enquired about their opinion in terms of vaccination-related tools that could help them in their daily practice. The article aimed to present the design of this panel and survey. Patients and methods Four samples of GPs (one national and three regional) were selected among all the French GPs (metropolitan France) using random sampling. Five cross-sectional surveys should be conducted with that panel. The mean targeted sample size is 2350 GPs for each survey. The survey dedicated to vaccination was conducted by telephone or on the Internet. Results GPs were included in the survey between December 2013 and February 2014. The national sample included 1582 GPs (response rate: 46%) and the three regional samples included 1297 GPs (response rate: 44%). The survey dedicated to vaccination was conducted between April and July 2014; the national sample response rate was 92% (1582/1712). Conclusion The results of the first wave of surveys, conducted on a large sample of French GPs, provide important information to guide the French vaccination policy.

Objective: The present paper investigates on lay people's beliefs regarding cancer risk factors' and their correlates, especially people's socioeconomic status (SES), as they may heavily contribute to social health inequalities. Methods: We used data from the 2010 Baromètre Cancer, a national representative telephone survey conducted in France (N = 3359, age 15–75, participation rate 52%). Results: Respondents differentiate behavioral factors (smoking, drinking, unprotected sun exposure, etc.), environmental risk factors (air pollution, chemicals in food, etc.) and psychosocial risk factors (stress, painful experiences, etc.) for cancer. Those with a higher SES were more likely to emphasize behavioral and psychosocial factors, while those with an intermediate SES were more likely to do so for environmental ones. Perceived financial vulnerability was associated to higher perceptions for both environmental and psychosocial factors. After adjustment on socio-demographic background and SES, respondents who emphasized behavioral risk factors were less prone to endorse fatalistic attitudes (considering that nothing can be done to avoid cancer), while those who emphasized environmental risk factors were more prone to do so, and were also more frequently daily smokers. Conclusion: These results suggest that lay people's beliefs regarding cancer risk factors are shaped by their conceptions regarding one's body and health, and especially their health locus of control, as the tendency to either emphasize behavioral or environmental factors was correlated to fatalistic attitudes. Prevention campaigns designed to tackle lay people's perceptions regarding cancer risk factors should not consider they simply reflect ignorance or misinformation, as they are embedded in social and cultural contexts., Highlights • Lay perceptions of cancer risk factors are embedded in social and cultural contexts. • These perceptions reflect people's conceptions of one's body, health & illness. • These perceptions are correlated to fatalistic attitudes and risk behaviors. • SES disparities in such perceptions are predictive of health inequalities.

Background In view of experts’ warnings about the potential negative mental health consequences of the sudden nationwide lockdowns implemented in many countries to limit the spread of the COVID-19 pandemic, we sought to study the incidence of posttraumatic stress disorder (PTSD) after traumatic events related to this unprecedented lockdown in the French general population. Methods This longitudinal study among adults (aged =18) consisted of two surveys: the first during the last days of the lockdown and the second a month later. We estimated PTSD incidence with the PCL-5 and ran multiple Poisson regression models to identify factors associated with PTSD. Results Among the 1736 participants, 30.1% reported at least one traumatic event. PTSD incidence was 17.5% (95% confidence interval CI = 15.7–19.3). It was higher in participants who reported multiple traumatic events, who had high COVID-19-related media use, who had general anxiety disorder (GAD-7) during the lockdown, and who had GAD, depression (PHQ-9), or sleep problems 1 month later. In addition, 43.1% of people with PTSD reported suicidal thoughts. Conclusions These results should help clinicians to target people who are at high risk of developing PTSD after a pandemic-related lockdown and could benefit from preventive measures. Collaboration between the media and mental health professionals could be envisioned to inform the population about care resources. Follow-up recommendations should also be disseminated to general practitioners to facilitate PTSD screening and ensure that they are aware of the appropriate management.