Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study

Abstract Background In 2007–2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013–2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Still, late HIV diagnosis is a major concern in Mexic...

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Autores principales:	Amilcar Azamar-Alonso, Sergio A. Bautista-Arredondo, Fiona Smaill, Lawrence Mbuagbaw, Andrew P. Costa, Jean-Eric Tarride
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	HIV Late diagnosis Mexican SALVAR Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/4574e5930c8447a899222fcbbc6c4b0c
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spelling	oai:doaj.org-article:4574e5930c8447a899222fcbbc6c4b0c2021-11-14T12:08:13ZPatient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study10.1186/s12981-021-00409-01742-6405https://doaj.org/article/4574e5930c8447a899222fcbbc6c4b0c2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12981-021-00409-0https://doaj.org/toc/1742-6405Abstract Background In 2007–2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013–2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Still, late HIV diagnosis is a major concern in Mexico due to its association with the development of AIDS development and mortality. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013–2017 National HIV program. Methods Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. Results The study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45 to 43% (P < 0.001) between 2008 and 2012 and 2013–2017 (i.e. before and after the implementation of the 2013–2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013 and 2017 (odds ratio [OR] = 0.96 [95% Confidence interval [CI] [0.93, 0.98]) or in health facilities specialized in HIV care (OR = 0.64 [95% CI 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis. Conclusions The results of this study indicate that the 2013–2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico. We identified several predictors of late diagnosis which could help establishing health policies. The main determinants for late diagnosis were being male, older than 29 years old, and being diagnosed in a Hospital or National Institute.Amilcar Azamar-AlonsoSergio A. Bautista-ArredondoFiona SmaillLawrence MbuagbawAndrew P. CostaJean-Eric TarrideBMCarticleHIVLate diagnosisMexican SALVARImmunologic diseases. AllergyRC581-607ENAIDS Research and Therapy, Vol 18, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	HIV Late diagnosis Mexican SALVAR Immunologic diseases. Allergy RC581-607
spellingShingle	HIV Late diagnosis Mexican SALVAR Immunologic diseases. Allergy RC581-607 Amilcar Azamar-Alonso Sergio A. Bautista-Arredondo Fiona Smaill Lawrence Mbuagbaw Andrew P. Costa Jean-Eric Tarride Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study
description	Abstract Background In 2007–2012 the Mexican government launched the National HIV program and there was a major change in HIV policies implemented in 2013–2018, when efforts focused on prevention, increase in early diagnosis and timely treatment. Still, late HIV diagnosis is a major concern in Mexico due to its association with the development of AIDS development and mortality. Thus, the objectives of this study were to identify the determinants of late HIV diagnosis (i.e. CD4 count less than 200 cells/mm3) in Mexico from 2008 to 2017 and to evaluate the impact of the 2013–2017 National HIV program. Methods Using patient level data from the SALVAR database, which includes 64% of the population receiving HIV care in Mexico, an adjusted logistic model was conducted. Main study outcomes were HIV late diagnosis which was defined as CD4 count less than 200 cells/mm3 at diagnosis. Results The study included 106,830 individuals newly diagnosed with HIV and treated in Mexican public health facilities between 2008 and 2017 (mean age: 33 years old, 80% male). HIV late diagnosis decreased from 45 to 43% (P < 0.001) between 2008 and 2012 and 2013–2017 (i.e. before and after the implementation of the 2013–2017 policy). Multivariable logistic regressions indicated that being diagnosed between 2013 and 2017 (odds ratio [OR] = 0.96 [95% Confidence interval [CI] [0.93, 0.98]) or in health facilities specialized in HIV care (OR = 0.64 [95% CI 0.60, 0.69]) was associated with early diagnosis. Being male, older than 29 years old, diagnosed in Central East, the South region of Mexico or in high-marginalized locality increased the odds of a late diagnosis. Conclusions The results of this study indicate that the 2013–2017 National HIV program in Mexico has been marginally successful in decreasing the proportion of individuals with late HIV diagnosis in Mexico. We identified several predictors of late diagnosis which could help establishing health policies. The main determinants for late diagnosis were being male, older than 29 years old, and being diagnosed in a Hospital or National Institute.
format	article
author	Amilcar Azamar-Alonso Sergio A. Bautista-Arredondo Fiona Smaill Lawrence Mbuagbaw Andrew P. Costa Jean-Eric Tarride
author_facet	Amilcar Azamar-Alonso Sergio A. Bautista-Arredondo Fiona Smaill Lawrence Mbuagbaw Andrew P. Costa Jean-Eric Tarride
author_sort	Amilcar Azamar-Alonso
title	Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study
title_short	Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study
title_full	Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study
title_fullStr	Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study
title_full_unstemmed	Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study
title_sort	patient characteristics and determinants of cd4 at diagnosis of hiv in mexico from 2008 to 2017: a 10-year population-based study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/4574e5930c8447a899222fcbbc6c4b0c
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Patient characteristics and determinants of CD4 at diagnosis of HIV in Mexico from 2008 to 2017: a 10-year population-based study

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