Six voluntary and well-distributed pharmacies in the Alpes-Maritimes department are currently embarking on HIV screening using a rapid diagnostic orientation test (TROD). At the origin of this initiative, the Regional Committee for the fight against HIV and STIs (Corevih Paca-Est) and the territorial professional health community (CPTS) French Riviera* which covers the municipalities of Menton, Roquebrune-Cap- Martin and Cap-d’Ail. They established a local cooperation protocol. But why this territory? It is active in the fight against HIV (experiments with pre-exposure prophylaxis or PrEP from 2012, HIV testing without a prescription in biology laboratories from 2019) and the CPTS French Riviera is recognized for its dynamism, underlines its president, general practitioner Jean-Louis Gerschtein. “We are in a border area with Italy which receives a lot of tourists. There is also a flow of cross-border migrants. For different reasons, these two populations are considered at risk,” explains Kathleen Waeytens, CPTS coordinator.
Risk behaviors identified
In practice, pharmacists need to identify people eligible for HIV TROD and carry it out in the confidentiality area of the pharmacy. This could be a woman picking up a morning-after pill or a man buying condoms, presenting a prescription for sildenafil and discussing a situation with multiple partners. In general, people who engage in risky behavior know it and are eager to talk about it.”testifies Cyril Colombani, vice-president of the CPTS and pharmacist participating in the screening. According to him, the objective is not only measured by the number of tests carried out but by the number of people made aware and directed to the appropriate structures. “ The test can be postponed but the information will be passed. Likewise, if it turns out to be negative, the person is not released into the wild. She receives a prevention kit and a directory of recourse solutions. An appointment can also be made with Corevih”adds the pharmacist. The interview he carries out therefore makes it possible to provide information on situations of exposure to HIV, to raise awareness of the various prevention solutions and to offer, if necessary, a booster vaccination (hepatitis B, HPV, etc.).
Take ownership of a decision tree
To get involved, pharmacists received theoretical training and another with practical elements, half a day for each of them. It is essential to understand the decision tree and the exclusion criteria. “These include deterioration of general condition, a young person under 16 years old with risky behavior and without the presence of a legal representative, a known HIV infection, post-exposure treatment to HIV or PrEP in course “, lists Kathleen Waeytens. If necessary, the person can be referred for a medical consultation, particularly if there is doubt about symptomatic HIV preinfection. After training, the announcement interview is mastered, particularly in its psychological dimension: the pharmacist approaches the report whatever the result. An infected person then contacts Corevih Paca-Est. There are three doctors specializing in infectious diseases and attached to this structure who are delegated to the pharmacists. The tests provided by the AAZ-LMB laboratory are optimal in terms of quality and reliability, underlines Cyril Colombani.
A possible duplication
To publicize this initiative, a poster and flyers are put up in the sales area, announcing confidential, anonymous screening, without a prescription and without advance payment. Medical offices, town halls and the local press relay the operation. On the financial side, the pharmacist receives €12.50 for each treatment. A sum taken from the CPTS fund which could be increased by obtaining other financing. Ultimately, this local protocol could be duplicated in other territories.
* With the “Objective AIDS Zero” association, Nice and the Alpes-Maritimes are committed! »
