Regional Health Agency Research Articles

Prevalence of problematic drug use in Martinique in 2006: The NEMO study

ObjectivesSubstance use disorders are of worldwide public health interest. Local estimates of problematic drug use provide useful indicators to regional public health agencies in developing prevention and treatment programs. The purpose of the current study was to estimate the prevalence of problematic drug use in Martinique. MethodsThe capture-recapture method was applied to a multisource data collection (eight specialized drug and two law enforcement sources) to provide an estimate of drug use (opiates, cocaine hydrochloride, crack (cocaine base), stimulants and/or hallucinogens). Data collection was organized over a period of six consecutive months (September 2005 to March 2006) and concerned all persons residing in Martinique longer than three months and who had consumed at least one of the studied drugs in the month prior to the study. ResultsWe identified 287 cases (86% male; mean age 36.1±9.6 years), 98% of whom had used crack. Comorbid use of illicit drugs other than alcohol and cannabis was 4%. Our study showed that patients with problematic drug use in Martinique is estimated to be 1.936 [95% CI: 964,2907] in a total population of 380.863 (INSEE, 1999). Prevalence rates were 5.0 per thousand among the global population and 7.7 per thousand in the adult population aged 15–64 years. ConclusionsOur study is the first to provide relevant data on the extent of problematic drug use in Martinique for health policies and decision-makers.

Data Resource Profile: The Danish National Hospital Medicine Register.

The Danish National Hospital Medicine Register (SMR) was established in 2018 to centralize and standardize medication use data across Danish hospitals. This task was previously managed by individual hospital registration systems across the five regions. This initiative addresses the need for a unified, detailed understanding of hospital medication use to monitor healthcare delivery, improve patient outcomes, and support research. The SMR has comprehensive coverage of medication use in hospitals in Denmark, offering a national overview that was previously missing. It features high-quality data, with efforts to ensure completeness and accuracy. The data collected encompasses key categories such as types of medications, doses, administration times and practices, and specific treatment indications. The SMR facilitates collaboration among Danish regional health authorities and national health agencies, enhancing decision-making and planning across the regions. The establishment of the SMR has provided a centralized and standardized database for medication use across Danish hospitals. This unification replaces the previously fragmented systems, allowing for better monitoring of healthcare delivery and supporting improvements in patient outcomes and research. The upcoming version of the SMR will include data on dispensed outpatient medications, covering most medication use across all hospitals. This expansion will further enhance the register's utility for health authorities, clinicians, and researchers by providing a more comprehensive understanding of medication use in Denmark.

Planetary health in action: developing a heatwave vulnerability tool for primary care.

Heatwaves are becoming longer and more frequent. Despite the availability of open environmental data, little is operable and formatted for primary care use. Create a user-friendly online mapping tool to assess the vulnerability of communities to heatwaves for use by primary care practitioners. This study questioned what knowledge needed to be deployed, who needed to participate and how the knowledge should be shared. A participatory action-research project based on knowledge mobilization in France as part of the Green Data for Health Challenge. Knowledge was summarized on the factors most affecting heatwave vulnerability in a collaborative process, enabling a consensus on data variables and mobilised content for the online tool. Purposive sampling included primary care stakeholders with Regional Health Agencies (ARS), Public Health France, and data scientists. Nineteen participants participated in ten co-construction workshops, a brainstorming carousel strategy and five weekly co-design meetings between December 2022 and June 2023. The heatwave vulnerability variable was constructed using surface temperature, social deprivation, vegetation coverage, and presence of air conditioning equipment. Identified experts mobilized data on the national composite indicator at the communal level for heatwave morbidity. There is no standard platform for sharing environmental data in France. This co-creation study offers a new approach to incorporating environmental data on heatwaves into primary care consultations. We demonstrate the importance of knowledge mobilisation in primary care to bridge the research-practice gap. Integrating primary care records with environmental data may promote broader applications for planetary health research.

Evaluating young people's listening practices: a public health issue

Listening to music through headphones or earphones has become commonplace with the development of new technologies. If this listening is prolonged over long periods and at high noise levels, it exposes young people to risks to their hearing systems. The WHO (2021) indicates that one person in four is expected to have hearing problems by 2050, and 1.1 billion young people worldwide could be at risk of hearing loss due to dangerous listening habits. Three French organizations (Le RIF, Bruitparif and CidB) have joined forces, with the support of the regional health agency of Ile de France, to coordinate their hearing risk prevention campaign and carry out a study ahead of the campaign to find out about listening practices using headphones or earphones, concert attendance and the precautions taken by teenagers to protect themselves from hearing risks. The results, based on a sample of 2,685 teenagers (secondary school), will provide a snapshot of practices so that prevention messages can be adapted during awareness campaigns.

Étude capacité théranostique 2023–2024 – Modélisation sur la base de la RIV-PSMA. Radiothérapie interne vectorisée (RIV), une approche théranostique à laquelle le patient doit avoir accès. Partie II : analyse approfondie

This in-depth analysis highlights the issues and perspectives regarding the deployment and optimization of vectorized internal radiotherapy (VIR), based on the VIR-PSMA model, which is the first theranostic modality that changes the scale of clinical management in nuclear medicine. It made it possible to confirm a characterization of health establishments based on their experience and their ability to integrate this new treatment modality into their care offering. Here are 8 key points and recommendations highlighted in the following pages: 1. Current and future reception capacity: “experienced” and “initiated” establishments have the greatest short-term reception capacity, while “medium-term future” and “long-term future” establishments will come, in the medium and long term respectively, strengthen the provision of care. They will be able to strengthen the healthcare offer and the territorial network if the award of a B rating allows them to do so. 2. Discrepancy between capacity and need: a gap is already observed between the number of patients who can be treated and the real needs of patients eligible for VIR-PSMA, even though capacity projections are voluntarily restricted to “experienced” and “initiated” services only (the “future” services in the medium and long term are not to date uniform in obtaining the necessary authorizations). This gap between capacity and need can be considered initially by optimizing the use of existing resources (in particular thanks to available land capacity), which remains mainly limited by the shortage of professionals. Secondly, the granting of authorizations to “future” services will make it possible to complete the system, and in particular to promote the regional distribution of care provision which shows disparities that could be sources of inequitable access to care in France. 3. Clinical pathway and harmonization of practices: the clinical pathway for patients benefiting from a VIR requires harmonization of practices and the making of recommendations by the SFMN (from the assessment of eligibility to post-dose monitoring, including the organization of treatments and the reception of patients). 4. Training and recruitment needs: the anticipated growth in demand for VIR requires strengthening teams through the recruitment of all staff involved in the patient's journey, as well as the creation of cooperation protocols between all health professionals by strengthening the initial and continuing training of all professionals involved. 5. Investments and adaptation of infrastructure: significant investments in specialized infrastructure and in the upgrading of “up-and-coming” establishments are necessary to support the increase in VIR-related activity. 6. Define a valuation model allowing these care activities to be sustained while meeting specific constraints in terms of operation, infrastructure, and regulations. 7. Role of regional health agencies (ARS): the ARS play a crucial role in coordinating the deployment of the VIR, requiring adaptation of the offer to local needs and a coherent national policy to face the challenges, particularly in the awarding of B grades, but also by ensuring that the teams of professionals are sufficient and trained and that the service meets logistical and security requirements. 8. Short, medium and long term strategies: to respond to the anticipated saturation of reception capacities, strategic actions are necessary in the short-term (less than 2 years), in the medium-term (less than 5 years), and long-term (more than 5 years), including the structuring of the organization, the expansion of recruitment, the harmonization of practices, and the strengthening of reception capacities.

URSAVS – histoire et politique d’une intercontenance réussie

The regional unit for the care of perpetrators of sexual violence (URSAVS) was established in Lille in 2009, under to the impetus of Doctor Tiphaine Séguret, and under the aegis of the Regional Health Agency of the department of Hauts-de-France. It is hosted by the University Hospital of Lille. This unit was born out of the urgent need to establish and coordinate specific care services including psycho- and sex-criminological dimensions, at the crossroads of mental health service and judicial entities. Originally destined for those who had been convicted of sexual offences and who were being released from prison, this unit has diversified in many ways, as the many cases and problems entrusted to it were discovered. Operating today in the realms of pediatrics, care of the elderly, and including the National Education system, URSAVS has paved the way for a fundamental reflection on the methods and practices of care specific to perpetrators of sexual violences. Its results in the prevention of recidivism after 5 years (1%), demonstrate the lasting effectiveness of its paradigm of care, especially when compared to national statistics on recidivism over the same period (15% for rape, 11% for sexual assault, 12% for sexual harassment, according to the French Ministry of Justice).

Physicians, pharmacists and take-home naloxone: What practices? The SINFONI study

For several years, both the French Addictovigilance Network and French health authorities have consistently emphasized the need to provide opioid users with take-home naloxone (THN), the specific antidote for opioid overdoses. In March 2022, the French Health Authority recommended systematically assessing the appropriateness of prescribing THN to all opioid users, regardless of the context, and identified 8 high-risk situations. However, at present, THN distribution remains limited, particularly among primary care healthcare professionals. This study, conducted by the Pays de la Loire Centre for Evaluation and Information on Drug Dependence-Addictovigilance and supported by the Regional Health Agency, aims to explore healthcare professionals' practices and perceptions of these high-risk situations. An ad-hoc questionnaire was distributed via mail by the project's regional institutional partners to the target healthcare professionals: pharmacists, general practitioners (GPs), physicians practicing in specialities other than general medicine (SPs: algologists, psychiatrists and addictologists). It was completed online from 20/10/2022 to 30/12/2022. Out of the 355 participants (158 pharmacists, 167 GPs and 30 SPs), nearly all were managing patients on opioids. In total, 47.7% of physicians and 27.8% of pharmacists reported experiencing difficulties in dealing with the risk of overdose when prescribing or dispensing opioids to their patients. In the 12months preceding the study, only 8 pharmacists and 34 physicians had prescribed/dispensed THN, primarily due to a lack of awareness of its existence (52% of pharmacists and 72% of physicians) and challenges in addressing the eight overdose risk situations listed by the HAS (ranging from 54% to 83% for all professionals). The best-trained healthcare professionals were those who prescribed the most THN (P<0.001). The identification of barriers related to THN distribution in the regional SINFONI study, conducted among primary care healthcare professionals managing patients on opioids, highlights the need to develop a training tool specifically tailored for these professionals.

The role of health mediation in investigation of Hantavirus cases among informal settlements inhabitants of Cayenne area, French Guiana, 2022-2023.

In 2022, four severe cases of Hantavirus pulmonary syndrome (HPS) were reported in patients from informal settlements around Cayenne, the main city in French Guiana. Regional Health Agency (RHA) was commissioned by the French Public Health Agency to estimate the seroprevalence of Hantavirus infections in the neighborhoods of confirmed cases of HPS. RHA then commissioned the French Red Cross (FRC) mobile public health team, providing support in environmental health issues to the population living in informal settlements by health mediators, to facilitate the investigation. The objective of this study was to describe the health mediators' activities set up to improve the efficiency of the investigation. The health mediators' team was specifically trained by virologist and infectiologist specialized in HPS. They helped the investigating team and health workers at various steps of the investigation. These interventions are then described in the results section. The investigation took place between Nov. 2022 and March 2023 in three neighborhoods. During the pre-investigation activities, the mediators raised awareness about HPS of 343 people, among whom 319 (93%) planned to participate in the investigation. Altogether, 274 people finally participated in the investigation, including, i.e., 30.8% of the estimated population living in the three concerned settlements. The global proportion of patients with positive IgG anti-Hantavirus was 5.1%. The health mediators team supported the following steps: preliminary meetings and training modules, identification of resource persons, field visits and awareness and information campaigns (pre-investigation); on field data collection in informal settlements (per-investigation) and communication of individual results, public feedback meeting (post-investigation). The involvement of mediators was probably a factor in the success of the public health response to socially vulnerable people living in the investigated neighborhoods. The preliminary prevention activities helped to raise awareness of the health risk and to enroll participants. Health mediation and outreach activities seem relevant tools of epidemiological field investigations in diseases affecting inhabitants of informal settlements.

The Primary Care and Environmental Health e-Learning Course to Integrate Environmental Health in General Practice: Before-and-After Feasibility Study.

Environmental and behavioral factors are responsible for 12.6 million deaths annually and contribute to 25% of deaths and chronic diseases worldwide. Through the One Health initiative, the World Health Organization and other international health organizations plan to improve these indicators to create healthier environments by 2030. To meet this challenge, training primary care professionals should be the priority of national policies. General practitioners (GPs) are ready to become involved but need in-depth training to gain and apply environmental health (EH) knowledge to their practice. In response, we designed the Primary Care Environment and Health (PCEH) online course in partnership with the Occitanie Regional Health Agency in France. This course was used to train GP residents from the Montpelier-Nimes Faculty of Medicine in EH knowledge. The course was organized in 2 successive parts: (1) an asynchronous e-learning modular course focusing on EH knowledge and tools and (2) 1 day of face-to-face sessions. This study assessed the impact of the e-learning component of the PCEH course on participants' satisfaction, knowledge, and behavior changes toward EH. This was a pilot before-and-after study. Four modules were available in the 6-hour e-learning course: introduction to EH, population-based approach (mapping tools and resources), clinical cases, and communication tools. From August to September 2021, we recruited first-year GP residents from the University of Montpellier (N=130). Participants' satisfaction, knowledge improvements for 19 EH risks, procedure to report EH risks to health authorities online, and behavior change (to consider the possible effects of the environment on their own and their patients' health) were assessed using self-reported questionnaires on a Likert scale (1-5). Paired Student t tests and the McNemar χ2 test were used to compare quantitative and qualitative variables, respectively, before and after the course. A total of 74 GP residents completed the e-learning and answered the pre- and posttest questionnaires. The mean satisfaction score was 4.0 (SD 0.9) out of 5. Knowledge scores of EH risks increased significantly after the e-learning course, with a mean difference of 30% (P<.001) for all items. Behavioral scores improved significantly by 18% for the participant's health and by 26% for patients' health (P<.001). These improvements did not vary significantly according to participant characteristics (eg, sex, children, place of work). The e-learning course improved knowledge and behavior related to EH. Further studies are needed to assess the impact of the PCEH course on clinical practice and potential benefits for patients. This course was designed to serve as a knowledge base that could be reused each year with a view toward sustainability. This course will integrate new modules and will be adapted to the evolution of EH status indicators and target population needs.

Groundwaters in the Auvergne-Rhône-Alpes Region, France: Grouping Homogeneous Groundwater Bodies for Optimized Monitoring and Protection

The number and diversity of groundwater bodies (GWBs) in large French administrative regions pose challenges to their monitoring and protection by regional health agencies. To overcome this obstacle, we propose, for the Auvergne-Rhône-Alpes region (about 70,000 km2), a grouping of GWBs into homogeneous groups based on the sources of variability within a large dataset of groundwater physico-chemical and bacteriological characteristics (8078 observations and 13 parameters). This grouping involved a dimensional reduction in the data hyperspace by principal component analysis (PCA) and a clustering based on the mean values of each GWB on the factorial axes. The information lost when clustering from the sample point scale to the GWB scale and then to that of the GWB group was quantified by analysis of variance and showed that grouping GWBs is accompanied by a small loss of information. A discriminant analysis confirmed the high spatial and temporal variability within the dataset, as well as the effectiveness of the proposed method for establishing homogeneous sets. Some roadmaps for more targeted monitoring of water resources were briefly proposed.

Évaluation de la pratique pharmaceutique en établissement de santé : une étude exploratoire comparant les processus en France et au Québec

To ensure compliance with the legal and normative framework, the professional orders, which supervise the practice of pharmacy have established a professional inspection process. In addition to this process, other external organizations also require an accreditation, authorization, certification or validation process for professional practices. The main objective is to identify and compare the methods of evaluating pharmaceutical practice in hospitals in France and Quebec. In order to identify and compare the methods of evaluating pharmaceutical practice in hospitals in France and Quebec, our approach allowed us to identify more organizations in France (i.e., High Authority of Health, Regional Health Agencies, the National Order of Pharmacists, the Nuclear Safety Agency, the Biomedicine Agency and the National Agency for the Safety of Medicines and Health Products) than in Quebec (i.e., Accreditation Canada, Ordre des pharmaciens du Québec and Health Canada). The study highlights the legal framework and applicable standards, the surveyors, the evaluation methods and the particularities for the evaluation of the hospital, the pharmacy department and the members of the department. This study highlights the evaluation processes of pharmaceutical practice in hospitals. In France, as in Quebec, we recognize the importance of the drug circuit in the hospital, the development and operation of a pharmacy department and the practice of pharmacy. While there are more similarities for the assessment of the drug circuit in hospitals and pharmacy department, important differences are observed for the assessment of individuals. We believe that the publication of a comparative analysis can contribute to discussions and exchanges to benefit from the best practices of each country.

The deployment of advanced practice nurses in the French health system: From clinics to professional networks.

The aim of this study is to contribute to an understanding of the role deployment of advanced practice nurses (APNs) in French healthcare settings. The introduction of APNs was formalised in France by the decrees issued on 18 July 2018, which described the areas, activities and training of APNs. A qualitative study on the role implementation of APNs was conducted between July 2021 and May 2022 following a call for projects launched by the Île-de-France Regional Health Agency to evaluate the deployment of APNs in the area. Data were collected through field observations and semi-structured interviews in order to explore both the APNs deployment processes in nine healthcare structures and the roles played by APN networks and associations with regard to the deployment of APN activities in their working environments. The projects proved to be evolutionary, and their development was marked by various forms of APN isolation and multiple obstacles that were specific to their professional practice settings. Some APNs relied on a variety of forms of mutual assistance and advocacy deployed throughout APN networks and associations. The deployment of APNs' role was impacted by diverse configurations of professional power relations and the nature of the obstacles that were structural for APNs in primary care. Their experience of isolation derived from the novelty of their role, the challenge they posed to the cohesion of the nursing profession and a lack of supportive policies for their deployment. Their participation in APN networks and associations enabled them to access advocacy and manage the uncertainties and unknowns related to the deployment of their activities. The results suggest that the formalisation of schemes for mutual assistance among APNs and advocacy should be integrated into the guidelines for the implementation of their role. APN policy should strengthen a bottom-up approach, relying in particular on the development of different forms of collaboration and communication between APN networks and associations on the one hand and the public authorities on the other.

New Public Management, Austerity, and the Alienation of the Medical Profession in France.

In the last twenty years, France has gone through health policy changes that are perceived as paradigm shifts. After briefly describing the reforms driven by the new public management and the subsequent re-centralization of the French health system for budgetary purposes, it appears that those reforms had outcomes below expectations. The regrouping of policy decisions within the Regional Health Agencies and the rise of a French Welfare elite weakened the medical profession. Blame-shifting strategy, political dilution, and spatial inequality linger. The COVID-19 epidemic highlights those limitations. The negative societal and political impact of failed public reforms is increasingly evident.

Welcoming severely traumatized patients

Severe trauma accounts for around 15% of all traumas, but remains the leading cause of death in people under 45. The organization of networked care for severe trauma is becoming a necessity in France. Thanks to this kind of organization, it is possible to speed up the care of these patients, and optimize their referral to the most appropriate reception center. The Bicêtre University Hospital (CHU) is one of six trauma centers in the Île-de-France region, all working to the same specifications set out by the Île-de-France regional health agency.

Experiences of adolescents using sexual health services on Reunion Island: protocol for a qualitative phenomenological study

IntroductionAdolescence and early adulthood are often critical periods of sexual development. The discovery of sexual intercourse can lead to sexual risk-taking which may impact the incidence of sexually transmitted infections...

Factor’s influencing primary teacher practices in health education, life skills, health literacy

Abstract Background A health-promoting school (HPS) approach was introduced over 25 years ago and has been promoted globally since; however, the aspiration of a fully embedded, sustainable HPS system has not yet been achieved, and very few countries have implemented and sustained the approach at scale. The Alliance for health aims to enact and assess the impact of a comprehensive approach to health promotion at the school and community levels. This is an intersectoral project involving regional education authorities, regional public health agency, local policy makers, researchers, and local health promotion operators. The question arises as to how to identify factors influencing teachers’ activity in wellness (WB), health education (HE), life skills (LS) and health literacy (HL)? Methods This project involves 101 French primary schools and 97 associated municipalities in the AURA region randomly selected in an intervention and control groups. Primary school teachers were provided training, support, and resources to develop a health-promoting environment in school according to the Health-Promoting Schools framework. Primary school teachers were provided training, support, and resources to develop a health-promoting environment in school according to the Health-Promoting Schools framework. Each year, a questionnaire is distributed to teachers in order to monitor the development of their activity in the areas of WB, HE, LS and HL. 243 questionnaires are analyzed, collected from october 19 to March 20, 12 opening questions were analyzed (1591 items) in order to characterize their practices in the areas aboved. Based on this classification, factors contributing to activities were seeked by doing univariate, multivariate and exploratory factor analysis. Results: The descriptive analysis showed that factors are linked to institutional, contextual, individual and collective dimensions. The results are preliminary and the complex analysis are actually in process. Key messages • A better understanding linked to their practices in health education, health literacy, like skills and well-being is needed to develop appropriate training and support. • To develop adequate training and support in health promoting school, it's necessary to identify factors most linked to primary teacher practices in health education, like skills and health literacy.

Agencification, policy reversal and the reforms of the French health care system

PurposeOften linked to the New Public Management (NPM) doctrines, agencification has been on the priority list of policy makers for over two decades. This article proposes an analysis of the role of agencies in the French health system and the impact of government agency reform on physicians and the public.Design/methodology/approachThe research analyzes the perceived implementation of a re-concentration of decision-making powers within public agencies as the declared goal of agencification at the French health care system, specifically primary care providers and hospitals. The assessment relies on secondary sources from ministerial bodies such as the Ministry of Health and Social Affairs, the Ministry of Labor, the Social Security and the General Accounting Office, and specialized French technical agencies.FindingsDecentralization in France and the subsequent rise of public health care agencies had outcomes below expectations. Hence, a re-concentration of decision-making powers within the larger Regional Health Agencies; a streamlining of the public administration; and a re-appropriation of decision-making powers by the Ministry of Health are needed. The monitoring of health providers allows central health authorities to govern at a distance.Originality/valueThe analysis of health care agencies in France and of their use of efficiency-enhancing techniques may trigger a change of values within the medical profession.

Learning from serosurveillance for SARS-CoV-2 to inform pandemic preparedness and response

Learning from serosurveillance for SARS-CoV-2 to inform pandemic preparedness and response

C87 IMPACT OF THE COVID 19 PANDEMIC ON ADHERENCE TO PATIENT CARE PATHWAYS AFTER ACUTE CORONARY SYNDROME WITH ST ELEVATION (STEMI) IN FRIULI–VENEZIA–GIULIA (FVG). REGIONAL DIAGNOSTIC THERAPEUTIC PLANS INDICATORS

Abstract Background In recent years, the treatment of STEMI has made significant progress which has led to an increase in survival and age of patients who have become chronic heart disease. Management is a major problem especially in the post–acute and chronic phases, previously considered stable. Post–hospital morbidity and mortality are increased particularly in patients with high residual risk. Methods The purpose of this work is to evaluate adherence to patient care pathways after STEMI in FVG from 2018 to 2021. This evaluation must take into account the restrictive measures adopted since March 2020 to contain the COVID 19 pandemic. The data was collected by the Regional Health Agency (ARCS) thanks to the launch of the Heart Network and the regional Diagnostic Therapeutic Plans (PDTA). The indicators of care pathways were: cholesterol–lowering prescription at 30 days; antiplatelet prescription after 30 days; beta–blocker prescription after 30 days; cardiological visit 2 months after discharge; persistence of statin therapy 1 year after discharge; LDL dosage 1 year after discharge; target LDL 1 year after discharge; nursing counseling 1 year after discharge. Results Patients with STEMI in FVG in 2018 were 830, in 2019 were 834, in 2020 were 772 and in 2021 were 782. The populations do not differ significantly in terms of age and gender (with a predominance of males). Observing the data on the management of patients in the post–acute phase there are no significant differences between the populations. However, if we analyze the data indicative of the management of patients in the chronic phase, the results differ in the populations. The persistence of statin therapy at 1 year is 82.8% in 2018 and it is 80.4% in 2019 while it is 69.7% in 2020 and 62.2% in 2021. Nursing counseling at 1 year is 60.8% in 2018, 62.5% in2019 while it is 37% in 2020 and 51.9% in 2021. Conclusions The COVID 19 pandemic has impacted the post–STEMI patient care process in FVG not so much in the post–acute phase but in the chronic phase. According to international guidelines, Cardiology Rehabilitation (CR) is strongly recommended in STEMI. No treatment in heart disease has stronger scientific evidence or a significantly greater impact on survival. Despite this, the CR facilities in FVG have not been strengthened in recent years, on the contrary they have suffered more significantly from the COVID–related restrictions and the depletion of resources.

Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region.

Testing was the cornerstone of the COVID-19 epidemic response in most countries until vaccination became available for the general population. Social inequalities generally affect access to healthcare and health behaviors, and COVID-19 was rapidly shown to impact deprived population more drastically. In support of the regional health agency in Provence-Alpes-Côte d'Azur (PACA) in South-Eastern France, we analyzed the relationship between testing rate and socio-demographic characteristics of the population, to identify gaps in testing coverage and improve targeting of response strategies. We conducted an ecological analysis of SARS-CoV-2/COVID-19 testing rate in the PACA region, based on data aggregated at the finest spatial resolution available in France (IRIS) and by periods defined by public health implemented measures and major epidemiological changes. Using general census data, population density, and specific deprivation indices, we used principal component analysis followed by hierarchical clustering to define profiles describing local socio-demographic characteristics. We analyzed the association between these profiles and testing rates in a generalized additive multilevel model, adjusting for access to healthcare, presence of a retirement home, and the age profile of the population. We identified 6 socio-demographic profiles across the 2,306 analyzed IRIS spatial units: privileged, remote, intermediate, downtown, deprived, and very deprived (ordered by increasing social deprivation index). Profiles also ranged from rural (remote) to high density urban areas (downtown, very deprived). From July 2020 to December 2021, we analyzed SARS-CoV-2/COVID-19 testing rate over 10 periods. Testing rates fluctuated strongly but were highest in privileged and downtown areas, and lowest in very deprived ones. The lowest adjusted testing rate ratios (aTRR) between privileged (reference) and other profiles occurred after implementation of a mandatory healthpass for many leisure activities in July 2021. Periods of contextual testing near Christmas displayed the largest aTRR, especially during the last periods of 2021 after the end of free convenience testing for unvaccinated individuals. We characterized in-depth local heterogeneity and temporal trends in testing rates and identified areas and circumstances associated with low testing rates, which the regional health agency targeted specifically for the deployment of health mediation activities.