HIV epidemic and needs beyond fast-track cities: a transmission network analysis to study the dynamics of HIV clusters in a French region near Paris

< 0.01). Molecular epidemiology showed that MSM were part of local transmission networks but not heterosexual migrants, suggesting distinct epidemic features and needs.IMPORTANCETo end the HIV epidemic, it will also be necessary to halt the spread of the virus beyond large metropolitan areas, where resources are more limited and epidemiological trends are more difficult to grasp. In this study, we showed how molecular epidemiology could be used at the regional level to inform HIV surveillance and support decision-making for an appropriate local response. This could be especially helpful when national databases are lacking. We investigated the role and characteristics of transmission clusters in the HIV dynamics of the Centre-Loire Valley region, a low-density demographic and medical region near Paris, with a focus on migrants. We found that men who have sex with men (MSM) were part of local transmission clusters but not heterosexual migrants, suggesting distinct HIV epidemics and needs. Epidemic control would require further implementation of pre-exposure prophylaxis and treatment as prevention for MSM to slow the dynamics of HIV clusters locally, and generalized access to HIV screening for migrants.