Abstract
In Mexico, public health services have provided universal access to antiretroviral therapy (ART) since 2004. For individuals receiving HIV care in public healthcare facilities, the data are limited regarding CD4 T-lymphocyte counts (CD4e) at the time of entry into care. Relevant population-based estimates of CD4e are needed to inform strategies to maximize the impact of Mexico’s national ART program, and may be applicable to other countries implementing universal HIV treatment programs. For this study, we retrospectively analyzed the CD4e of persons living with HIV and receiving care at state public health facilities from 2007 to 2014, comparing CD4e by demographic characteristics and the marginalization index of the state where treatment was provided, and assessing trends in CD4e over time. Our sample included 66,947 individuals who entered into HIV care between 2007 and 2014, of whom 79% were male. During the study period, the male-to-female ratio increased from 3.0 to 4.3, reflecting the country's HIV epidemic; the median age at entry decreased from 34 years to 32 years. Overall, 48.6% of individuals entered care with a CD4≤200 cells/μl, ranging from 42.2% in states with a very low marginalization index to 52.8% in states with a high marginalization index, and from 38.9% among individuals aged 18–29 to 56.5% among those older than 50. The adjusted geometric mean (95% confidence interval) CD4e increased among males from 135 (131,142) cells/μl in 2007 to 148 (143,155) cells/μl in 2014 (p-value<0.0001); no change was observed among women, with a geometric mean of 178 (171,186) and 171 (165,183) in 2007 and 2014, respectively. There have been important gains in access to HIV care and treatment; however, late entry into care remains an important barrier in achieving optimal outcomes of ART in Mexico. The geographic, socioeconomic, and demographic differences observed reflect important inequities in timely access to HIV prevention, care, and treatment services, and highlight the need to develop contextual and culturally appropriate prevention and HIV testing strategies and linkage programs.
Highlights
Mexico is an upper-middle income country with a concentrated HIV epidemic.[1]
CENSIDA provided the authors with an anonymized de-duplicated set of demographic data as well as biometric and antiretroviral therapy (ART) prescription data that included the dates of biometric measurements and initiation of ART therapy
Our data suggest that the HIV epidemic in Mexico continues to grow, as indicated by the number of new patients entering into Seguro Popular (SP)-HIV care programs each year
Summary
Mexico is an upper-middle income country with a concentrated HIV epidemic.[1]. In 2012, the estimated number of people living with HIV (PLHIV) aged 15–49 was 147,137, with a mean estimated prevalence of 0.15% (0.07% among women and 0.24% among men).[2]. Diagnosis of HIV, prompt linkage and retention in care, and initiation of antiretroviral therapy (ART) are crucial in achieving optimal health outcomes among persons living with HIV. PLHIV who enter care and initiate ART with lower CD4+ lymphocyte counts (CD4) have increased morbidity and mortality, are less likely to achieve viral suppression, and have slower CD4 recovery.[5,6,7,8,9,10] Late diagnosis, delayed entry into care, and late initiation of ART are associated with increased transmission of HIV.[11, 12] entering care with high CD4 counts results in fewer quality-adjusted life-years lost for PLHIV and lower HIV related treatment expenditures.[13, 14]
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