1. www.ias2015.org HIV acquisition after arrival in France among sub-Saharan African migrants living with HIV in Paris area. Estimations from the ANRS PARCOURS study Annabel DESGREES du LOU 1, Julie PANNETIER 1, Andrainolo RAVALIHASY 1, Anne GOSSELIN 1, Virginie SUPERVIE 2,3,, Henri Panjo 2, Nathalie BAJOS 2, France LERT 2, Nathalie LYDIE 4, Rosemary DRAY-SPIRA 2,3 and the PARCOURS Study Group. (1) CEPED, IRD, Paris (annabel.desgrees@ird.fr); (2) CESP, INSERM, Paris ; (3) IPLESP, INSERM, Paris; (4) INPES, Paris

2. www.ias2015.org Background In France, 31% of new HIV diagnoses concern immigrants from sub-Saharan Africa (Cazein et al., 2015). Virological data suggest that among them, at least a fourth of HIV infection cases occured in France (Lucas et al., 2012), but a more precise estimation of HIV acquisition in France is needed. Objective: to estimate the proportion of sub-Saharan migrants who acquired HIV infection after their arrival in France using life-event and clinical data collected in the ANRS-PARCOURS study.

3. www.ias2015.org Methods The ANRS PARCOURS survey In 2012-2013, a cross-sectional study in Paris area among migrants from sub-Saharan Africa (aged 18-59 years) Study design A random sample of HIV- infected outpatients followed in 24 health care centers. A retrospective life-event questionnaire Clinical and laboratory data from medical records. A combined method mixing life- event and CD4 data to assign HIV acquisition in France We assumed that HIV infection had probably been acquired in France if at least one of the following life-event criterion was fulfilled: – HIV diagnosis ≥ 11 years after arrival in France, – ≥1 negative HIV test in France, – first sex after arrival in France. If none of these criteria was fulfilled, we estimated the duration from HIV infection to first CD4 count using a modelling of CD4 cell count decline.

4. www.ias2015.org Life event questionnaire- based method CD4-cell count method Final study sample N=898 (-133 HIV diagnosed before arrival in France) Left to be assigned: N=628 Left to be assigned: N=565 Left to be assigned: N=537 Estimated year of infection posterior to year of arrival in France N=197 HIV diagnosed more than 11 years after arrival in France N=137 At least one negative HIV testing after arrival in France N=63 Sexual debut after arrival in France N=28 HIV acquisition after arrival in France 49% [45-53] Results

5. www.ias2015.org Conclusion Almost half of sub-Saharan migrants living with HIV acquired HIV while living in France. Estimates for France are higher than in the UK: 49% (45–53%) versus 33% (26–39%) (Rice et al., 2012). Our findings highlight the need to improve focused HIV prevention in Sub-Saharan African migrants.

6. www.ias2015.org Acknowledgements We thank the ANRS PRIMOCI group (PI A. Minga and X. Anglaret) who accepted to share with us the data on natural decline in CD4 among the PRIMO CI Ivoirian cohort of seroconverters. The PARCOURS survey was funded by the French National Agency for Research on Aids and Viral Hepatitis (ANRS). We thank all patients who agreed to participate in the PARCOURS survey, all medical staff members in the participating hospitals, as well as the community-based organisations who supported the survey. The PARCOURS Study Group included A. Desgrées du Loû, F.Lert, R. Dray Spira, N. Bajos, N.Lydié (scientific coordinators) ; J. Pannetier, A. Ravalihasy, A. Gosselin, E. Rodary, D. Pourette, J. Situ, P. Revault, P. Sogni, J. Gelly, Y le Strat, N Razafindrasitma. www.parcours-sante-migration.com