Abstract Epidemic transition, sustained costs and health workforce shortage challenges have led numerous countries to strengthen primary care (PC) and implement new models of care. Faced with declining numbers of general practitioners (GPs), France has introduced medical assistants (MAs) in 2019 to guarantee access to care and maintain workforces in deprived areas. Trained to perform administrative and clinical tasks delegated by a physician, MAs are expected to optimize medical time and improve working conditions in practices. How does French model of MAs impact quality and productivity in GPs’ practices and articulate with other policies? We conducted a qualitative case study in 6 pilot practices to explore the effects of MAs’ work (interviews with 12 GPs, 6 MAs, collection of tasks performed by 6 MAs), complemented with views from public policy makers and health professional unions (9 interviews). MA was defined as a function centered on physicians’ needs, accessible both to administrative staff and nursing professions. MAs with a clinical profile performed a wider range of tasks, were more prone to perform clinical tasks and build developed interactions with patients, and seemed better fitted for chronic disease care management. Recruitment of MAs by physicians is supported with grants that decrease yearly while practice productivity is expected to rise. In general, a gain of efficiency in daily workload enabled GPs to slightly increase their productivity. However, for most GPs, it primarily helped them to maintain high workload without burning out. Although MAs with clinical background seem better suited for patients’ needs, recent figures have shown that more than half of MAs employed are former secretaries. If in-person secretaries could be endorsed with further administrative duties, MAs could hold a more clinical role in PC teams including physicians and allied health professionals. Other aspects than productivity must be taken into account in a support policy. Key messages • Regardless of productivity objectives to attain, hiring MAs can relieve physicians’ workload and stress, preventing them from burning out and guarantee access to care in deprived areas. • MA’s clinical profile could have a stronger impact on public health issues such as chronic disease care management.

Pre-exposure prophlaxis (PrEP) is the use of antiretroviral drugs by uninfected people to prevent human immunodeficiency virus (HIV) infection. PrEP is used by people who are at substantial risk of being exposed to HIV. Numerous clinical trials have confirmed its effectiveness in reducing HIV acquisition and PrEP has been approved and allowed in several countries including France. However, PrEP uptake remains low as concerns about increase in sexual risk behaviour with PrEP use in the wake of a growing epidemic of sexually transmitted infections, and fear of drug resistance have been expressed. As a result, the difference between the proportion of people on PrEP and the proportion of people who would be very likely to use PrEP if they could access it -otherwise known as the PrEP gap- remains high. Nowadays, studies continue to explore long-term effects of PrEP as well as expand the array of available technologies and regimens. (C) 2020 Societe Nationale Francaise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

La prophylaxie préexposition (PrEP) au virus de l’immunodéficience humaine (VIH) consiste en la prise d’antirétroviraux chez des personnes non infectées afin de prévenir le risque d’acquisition du virus. Elle s’adresse aux personnes les plus exposées au VIH. Son efficacité préventive, démontrée dans le cadre d’essais cliniques, a permis sa mise à disposition et son déploiement dans plusieurs pays, dont la France. Cependant, des freins à sa prescription subsistent en raison de craintes liées à une moindre utilisation des autres moyens de prévention ou à une augmentation des prises de risque dans un contexte d’augmentation de l’incidence des autres infections sexuellement transmissibles, et à l’émergence de résistance. Ainsi, demeure encore une différence importante entre la proportion de PrEPeurs et la proportion d’individus qui sont éligibles à la PrEP. La PrEP fait également l’objet d’études complémentaires sur ses effets à long terme, et sur des modalités différentes d’administration et de prise.