CD4 Counts at Entry to HIV Care in Mexico for Patients under the "Universal Antiretroviral Treatment Program for the Uninsured Population," 2007-2014
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 est...
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| creator | Hernández-Romieu, Alfonso C del Rio, Carlos Hernández-Ávila, Juan Eugenio Lopez-Gatell, Hugo Izazola-Licea, José Antonio Uribe Zúñiga, Patricia Hernández-Ávila, Mauricio |
| description | 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 |
| doi_str_mv | 10.1371/journal.pone.0152444 |
| format | Article |
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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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0152444</identifier><identifier>PMID: 27027505</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; AIDS ; Anti-HIV Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Biology and Life Sciences ; Biometrics ; CD4 antigen ; CD4 Lymphocyte Count ; CD4 lymphocytes ; Confidence intervals ; Consent ; Demographics ; Drug therapy ; Epidemics ; Female ; Genetic aspects ; Health care ; Health care facilities ; Health facilities ; Health surveillance ; Highly active antiretroviral therapy ; HIV ; HIV infections ; HIV Infections - drug therapy ; HIV Infections - immunology ; Human immunodeficiency virus ; Humans ; Informal economy ; Lymphocytes ; Lymphocytes T ; Male ; Males ; Medical diagnosis ; Medical tests ; Medically Uninsured ; Medicine ; Medicine and Health Sciences ; Mexico ; Middle Aged ; National Health Programs ; Patient outcomes ; People and places ; Physiological aspects ; Prevention ; Public health ; Sex Distribution ; Systematic review ; Trends ; Uninsured people ; Womens health ; Young Adult</subject><ispartof>PloS one, 2016-03, Vol.11 (3), p.e0152444</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Hernández-Romieu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2016 Hernández-Romieu et al 2016 Hernández-Romieu et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-2b5e263ca59a1b5622568e3c85ba90bb7ac2b4ff3d57f8e05c3a6317649e4a353</citedby><cites>FETCH-LOGICAL-c692t-2b5e263ca59a1b5622568e3c85ba90bb7ac2b4ff3d57f8e05c3a6317649e4a353</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814060/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814060/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27027505$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Pacheco, Antonio Guilherme</contributor><creatorcontrib>Hernández-Romieu, Alfonso C</creatorcontrib><creatorcontrib>del Rio, Carlos</creatorcontrib><creatorcontrib>Hernández-Ávila, Juan Eugenio</creatorcontrib><creatorcontrib>Lopez-Gatell, Hugo</creatorcontrib><creatorcontrib>Izazola-Licea, José Antonio</creatorcontrib><creatorcontrib>Uribe Zúñiga, Patricia</creatorcontrib><creatorcontrib>Hernández-Ávila, Mauricio</creatorcontrib><title>CD4 Counts at Entry to HIV Care in Mexico for Patients under the "Universal Antiretroviral Treatment Program for the Uninsured Population," 2007-2014</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>AIDS</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Biometrics</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count</subject><subject>CD4 lymphocytes</subject><subject>Confidence intervals</subject><subject>Consent</subject><subject>Demographics</subject><subject>Drug therapy</subject><subject>Epidemics</subject><subject>Female</subject><subject>Genetic aspects</subject><subject>Health care</subject><subject>Health care facilities</subject><subject>Health facilities</subject><subject>Health surveillance</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - immunology</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Informal economy</subject><subject>Lymphocytes</subject><subject>Lymphocytes T</subject><subject>Male</subject><subject>Males</subject><subject>Medical diagnosis</subject><subject>Medical tests</subject><subject>Medically Uninsured</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Mexico</subject><subject>Middle Aged</subject><subject>National Health Programs</subject><subject>Patient outcomes</subject><subject>People and places</subject><subject>Physiological aspects</subject><subject>Prevention</subject><subject>Public health</subject><subject>Sex Distribution</subject><subject>Systematic review</subject><subject>Trends</subject><subject>Uninsured people</subject><subject>Womens health</subject><subject>Young 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Uninsured Population," 2007-2014</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-03-30</date><risdate>2016</risdate><volume>11</volume><issue>3</issue><spage>e0152444</spage><pages>e0152444-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>27027505</pmid><doi>10.1371/journal.pone.0152444</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2016-03, Vol.11 (3), p.e0152444 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1777088733 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acquired immune deficiency syndrome Adolescent Adult AIDS Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences Biometrics CD4 antigen CD4 Lymphocyte Count CD4 lymphocytes Confidence intervals Consent Demographics Drug therapy Epidemics Female Genetic aspects Health care Health care facilities Health facilities Health surveillance Highly active antiretroviral therapy HIV HIV infections HIV Infections - drug therapy HIV Infections - immunology Human immunodeficiency virus Humans Informal economy Lymphocytes Lymphocytes T Male Males Medical diagnosis Medical tests Medically Uninsured Medicine Medicine and Health Sciences Mexico Middle Aged National Health Programs Patient outcomes People and places Physiological aspects Prevention Public health Sex Distribution Systematic review Trends Uninsured people Womens health Young Adult |
| title | CD4 Counts at Entry to HIV Care in Mexico for Patients under the "Universal Antiretroviral Treatment Program for the Uninsured Population," 2007-2014 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-02T09%3A44%3A32IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=CD4%20Counts%20at%20Entry%20to%20HIV%20Care%20in%20Mexico%20for%20Patients%20under%20the%20%22Universal%20Antiretroviral%20Treatment%20Program%20for%20the%20Uninsured%20Population,%22%202007-2014&rft.jtitle=PloS%20one&rft.au=Hern%C3%A1ndez-Romieu,%20Alfonso%20C&rft.date=2016-03-30&rft.volume=11&rft.issue=3&rft.spage=e0152444&rft.pages=e0152444-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0152444&rft_dat=%3Cgale_plos_%3EA453451831%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1777088733&rft_id=info:pmid/27027505&rft_galeid=A453451831&rft_doaj_id=oai_doaj_org_article_89e3a05ba4b045da9ea414a9bf1d9b1d&rfr_iscdi=true |