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Estimation de prévalences et d’incidences à partir d’enquêtes épidémiologiques transversales répétées auprès de populations difficiles d’accès : Application au virus de l’hépatite C chez les usagers de drogues en France.

Abstract : Hepatitis C virus (HCV) is a public-health issue that drug users (DU) remain the major source of contamination in France. Conducting seroepidemiological surveys among this population to assess the HCV dynamic is difficult particularly due to their illicit practices. This population can be accessible through survey locations or can be hidden (who does not visit any location). To survey each part, we presented time-location sampling (TLS) and respondent-driven sampling. We presented TLS in the context of an indirect sampling and proposed a design-based inference taking into account the frequency of venue attendance (FVA) to estimate a total or a proportion. We recommend this method for estimating the prevalence of a disease in surveys among hard-to-reach populations, even if errors occur in the FVA reported by the participants. The ANRS-Coquelicot survey carried out in 2004 among DU attending centres providing services to drug users, then repeated in 2011, allowed us to estimate the HCV prevalence at 43.7%. Using these two surveys, we estimated age- and time-dependent HCV incidence from a mathematical model linking prevalence and incidence. This model consisted in combining a compartmental model with a regression model. The HCV incidence was thus estimated at 4.4/100 person-years in 2011. This method is an alternative approach to estimate incidence of a disease from cross-sectional epidemiological data in the absence of cohort or biological tests to identify acute infections. The decline in HCV incidence is to be expected given decreasing prevalence, recent developments in harm reduction measures and new therapeutic approaches despite a potential increase of at-risk behaviors.
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Lucie Léon. Estimation de prévalences et d’incidences à partir d’enquêtes épidémiologiques transversales répétées auprès de populations difficiles d’accès : Application au virus de l’hépatite C chez les usagers de drogues en France.. Santé publique et épidémiologie. Université Paris-Saclay, 2016. Français. ⟨NNT : 2016SACLS440⟩. ⟨tel-01635287⟩

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