title: Late Diagnosis Due to Missed Opportunities and Inadequate Screening Strategies in HIV Infected Mexican Women.
abstract: Late diagnosis of HIV remains a public health issue in Mexico. Most national programs target high-risk groups, not including women. More data on factors associated with late diagnosis and access to care in women are needed. In 2012-2013, Mexican women recently diagnosed with HIV were interviewed. Socio-cultural background, household-dynamics and clinical data were collected. Of 301 women, 49 % had <200 CD4 cells/mm3, 8 % were illiterate, 31 % had only primary school. Physical/sexual violence was reported by 47/30 %; 75 % acquired HIV from their stable partners. Prenatal HIV screening was not offered in 61 %; 40 % attended consultation for HIV-related symptoms without being tested for HIV. Seeking medical care ≥3 times before diagnosis was associated with baseline CD4 <200 cells/mm3(adjusted OR 3.74, 95 % CI 1.88-7.45, p < 0.001). There were missed opportunities during prenatal screening and when symptomatic women seeked medical care. Primary care needs to be improved and new strategies implemented for early diagnosis in women.
authors.affiliation: Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Martin-Onraët
authors.affiliation: Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City, Mexico.
authors.forename: Patricia
authors.initials: P
authors.lastname: Volkow-Fernández
authors.affiliation: Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Delegación Tlalpan, 14000, Mexico City, DF, Mexico.
authors.forename: Victoria
authors.initials: V
authors.lastname: Alvarez-Wyssmann
authors.affiliation: Coordination Department, Clínica Especializada Condesa, Mexico City, Mexico.
authors.forename: Andrea
authors.initials: A
authors.lastname: González-Rodríguez
authors.affiliation: Coordination Department, Clínica Especializada Condesa, Mexico City, Mexico.
authors.forename: Jesús
authors.initials: J
authors.lastname: Casillas-Rodríguez
authors.affiliation: COESIDA-CAPASITS, Oaxaca, Mexico.
authors.forename: Lesvia
authors.initials: L
authors.lastname: Rivera-Abarca
authors.affiliation: Facultad de Medicina de la Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.|CAPASITS, Puebla, Mexico.
authors.forename: Indiana
authors.initials: I
authors.lastname: Torres-Escobar
authors.affiliation: Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Delegación Tlalpan, 14000, Mexico City, DF, Mexico. jsmadero@yahoo.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Sierra-Madero
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening; D008800:Mexico; D015999:Multivariate Analysis; D016017:Odds Ratio; D011296:Prenatal Diagnosis; D011320:Primary Health Care; D012725:Sexual Behavior; D012747:Sexual Partners
keywords: HIV-infected Mexican women; Late diagnosis; Missed diagnostic opportunities; Vulnerability of women