title: CD4 Counts at Entry to HIV Care in Mexico for Patients under the "Universal Antiretroviral Treatment Program for the Uninsured Population," 2007-2014.
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.
authors.affiliation: Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.|Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America.
authors.forename: Alfonso C
authors.initials: AC
authors.lastname: Hernández-Romieu
authors.affiliation: Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.|Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America.|Center for AIDS Research, Emory University, Atlanta, GA, United States of America.
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.affiliation: National Institute of Public Health (INSP), Cuernavaca, Mexico.
authors.forename: Juan Eugenio
authors.initials: JE
authors.lastname: Hernández-Ávila
authors.affiliation: National Institute of Public Health (INSP), Cuernavaca, Mexico.
authors.forename: Hugo
authors.initials: H
authors.lastname: Lopez-Gatell
authors.affiliation: National Center for Prevention and Control of HIV/AIDS (CENSIDA), Mexico City, Mexico.|Joint United Nations Programme on HIV/AIDS (UNAIDS), Evaluation and Economics Division, Geneva, Switzerland.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Izazola-Licea
authors.affiliation: Joint United Nations Programme on HIV/AIDS (UNAIDS), Evaluation and Economics Division, Geneva, Switzerland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Uribe Zúñiga
authors.affiliation: National Institute of Public Health (INSP), Cuernavaca, Mexico.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Hernández-Ávila
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008800:Mexico; D008875:Middle Aged; D009313:National Health Programs; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents