Limits...
CD4 Counts at Entry to HIV Care in Mexico for Patients under the "Universal Antiretroviral Treatment Program for the Uninsured Population," 2007-2014.

Hernández-Romieu AC, del Rio C, Hernández-Ávila JE, Lopez-Gatell H, Izazola-Licea JA, Uribe Zúñiga P, Hernández-Ávila M - PLoS ONE (2016)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.

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.

Show MeSH
CD4e counts at health care program entry decline after 2011.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4814060&req=5

pone.0152444.g001: CD4e counts at health care program entry decline after 2011.

Mentions: Fig 1 summarizes the estimations derived from a non-interaction sex-specific adjusted log linear model to predict the annual geometric mean of the CD4e cell count. During the study period, the annual CD4e cell count displayed a U-inverted shape, with a turning point in 2011. The magnitude of the increase and decrease varied by sex (Fig 1). For women, the annual geometric mean CD4e cell count increased by 1.8% (95% CI: 0.2%, 3.4%), from 178 cells/μl in 2007 to 191 cells/μl in 2011; afterward, CD4e declined annually by 3.4% (95% CI: 1.4%, 5.4%) reaching an annual geometric mean CD4e of 171 cells/μl in 2014. A larger increase in geometric mean CD4e cell counts was observed among men, with an annual increase of 5.6% (95% CI: 4.6%, 6.5%). The CD4e was135 cells/μl in 2007 and 167 cells/μl in 2011; the decrease after 2011 was 4% (95% CI: 2.9%, 5.1%) annually, with a geometric annual CD4e mean of 148 cells/μl in 2014.


CD4 Counts at Entry to HIV Care in Mexico for Patients under the "Universal Antiretroviral Treatment Program for the Uninsured Population," 2007-2014.

Hernández-Romieu AC, del Rio C, Hernández-Ávila JE, Lopez-Gatell H, Izazola-Licea JA, Uribe Zúñiga P, Hernández-Ávila M - PLoS ONE (2016)

CD4e counts at health care program entry decline after 2011.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4814060&req=5

pone.0152444.g001: CD4e counts at health care program entry decline after 2011.
Mentions: Fig 1 summarizes the estimations derived from a non-interaction sex-specific adjusted log linear model to predict the annual geometric mean of the CD4e cell count. During the study period, the annual CD4e cell count displayed a U-inverted shape, with a turning point in 2011. The magnitude of the increase and decrease varied by sex (Fig 1). For women, the annual geometric mean CD4e cell count increased by 1.8% (95% CI: 0.2%, 3.4%), from 178 cells/μl in 2007 to 191 cells/μl in 2011; afterward, CD4e declined annually by 3.4% (95% CI: 1.4%, 5.4%) reaching an annual geometric mean CD4e of 171 cells/μl in 2014. A larger increase in geometric mean CD4e cell counts was observed among men, with an annual increase of 5.6% (95% CI: 4.6%, 6.5%). The CD4e was135 cells/μl in 2007 and 167 cells/μl in 2011; the decrease after 2011 was 4% (95% CI: 2.9%, 5.1%) annually, with a geometric annual CD4e mean of 148 cells/μl in 2014.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.

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.

Show MeSH