Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study.

BACKGROUND: In 2007-2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013-2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Still, late HIV diagnosis is a major concern in Mexico due to its association with the development of AIDS development and mortality. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013-2017 National HIV program. METHODS: Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. RESULTS: The study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45 to 43% (P < 0.001) between 2008 and 2012 and 2013-2017 (i.e. before and after the implementation of the 2013-2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013 and 2017 (odds ratio [OR] = 0.96 [95% Confidence interval [CI] [0.93, 0.98]) or in health facilities specialized in HIV care (OR = 0.64 [95% CI 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis. CONCLUSIONS: The results of this study indicate that the 2013-2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico. We identified several predictors of late diagnosis which could help establishing health policies. The main determinants for late diagnosis were being male, older than 29 years old, and being diagnosed in a Hospital or National Institute.

The Covid-19 cascade of care in Mexico: symptoms, positivity, and health care seeking decisions amid the pandemic.

OBJECTIVE: The study describes health care services utilization contextualized by the needs of the Mexican population during the Covid-19 pandemic. MATERIALS AND METHODS: We used data from the National Health and Nutrition Survey, Covid-19. Among the population with symptoms compatible with Covid-19, we describe the proportion who sought care, received care, were tested, were diagnosed positive, and survived, and whether they received care in public or private services. We estimated factors associated with the probability of seeking and receiving care. RESULTS: Out of 7.1% of the population with symptoms compatible with Covid-19, 64.4% received care, and 15.4% tested positive; 74.5% received care in the private sector, even among the population with social security. Those with social security, in contact with a suspected or confirmed Covid-19 case, and with at least one comorbidity had a higher probability of seeking and receiving care. CONCLUSIONS: The most relevant finding of our study is the large proportion of the population with Covid-19 symptoms who sought and received care in private facilities an essential aspect for decision-makers to consider as the current health reform moves forward in Mexico.

Health care utilization during the Covid-19 pandemic in Mexico: the cascade of care.

OBJECTIVE: The objective of the study is to describe trends in selected services offered at public health facilities and utilization patterns during the Covid-19 epidemic in Mexico. MATERIALS AND METHODS: We used administrative data and the National Health and Nutrition Survey Covid-19, 2020. RESULTS: We found a reduction in the rates of diabetes and detection screening during 2020 compared to 2014-2019. From the demand side, we found that 18.6% of the population reported health needs, and only 34% of them received care in public health facilities. The use of private health services was extensive even among the population with social security. The uninsured and the population with high and medium socioeconomic status had a lower probability of receiving care in public health facilities. CONCLUSION: We document trends in selected services, as well as the cascade of care during the Covid-19 epidemic in Mexico and its potential impact on displaced health care.

Migration Decision-Making among Mexican Youth: Individual, Family, and Community Influences.

We explored migration decisions using in-depth, semi-structured interviews with male and female youth ages 14 to 24 (n=47) from two Mexican communities, one with high and one with low U.S. migration density. Half were return migrants and half were non-migrants with relatives in the U.S. Migrant and non-migrant youth expressed different preferences, especially in terms of education and their ability to wait for financial gain. Reasons for migration were mostly similar across the two communities; however, the perceived risk of the migration journey was higher in the low density migration community while perceived opportunities in Mexico were higher in the high density migration community. Reasons for return were related to youths' initial social and economic motivations for migration. A greater understanding of factors influencing migration decisions may provide insight into the vulnerability of immigrant youth along the journey, their adaptation process in the U.S., and their reintegration in Mexico.

Virologic failure in people living with HIV in 1st line ART: A 10-year Mexican population-based study.

BACKGROUND: In Mexico, the number of people living with HIV (PLWH) receiving antiretroviral therapy (ART) has increased in the last 20 years. The elimination of a CD4 threshold to initiate publicly funded ART was a major policy implemented in 2014. The study objective was to assess the determinants of Virologic Failure (VF) in Mexican PLWH on first-line ART between 2008 and 2017 and to evaluate the effects of changes following the 2014 policy. METHODS: A 10-year patient-level data analysis was conducted using the Mexican SALVAR database. The main outcome was the proportion of PLWH with VF. A multivariable logistic regression was conducted to identify the association between covariates and VF before and after the 2014 policy implementation. RESULTS: We found a lower proportion of people with VF in 2014-2017 compared with 2008-2013 (50% vs 33%, p<0.001). The multivariable analysis showed a reduction in the odds of virologic failure after 2014 (Odds ratio: 0.50 [95% CI: 0.48-0.51]). Place of treatment and level of deprivation were significant predictors of VF in during 2014-2017, but not before. CONCLUSION: This study indicates that, by lowering threshold levels of CD4 required for treatment initiation in Mexico, a higher number of PLWH initiated treatment during 2014-2017, compared to 2008-2013 and the odds of VF were reduced.