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 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.

Below:  CD4e counts at health care program entry decline after 2011

Full article at:   http://goo.gl/PYlXy0

By:  

Alfonso C. Hernández-Romieu, Carlos del Rio 
Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America

Alfonso C. Hernández-Romieu, Carlos del Rio 

Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States of America

Carlos del Rio 

Center for AIDS Research, Emory University, Atlanta, GA, United States of America

Juan Eugenio Hernández-Ávila, Hugo Lopez-Gatell, Mauricio Hernández-Ávila 

National Institute of Public Health (INSP), Cuernavaca, Mexico

José Antonio Izazola-Licea 

National Center for Prevention and Control of HIV/AIDS (CENSIDA), Mexico City, Mexico

José Antonio Izazola-Licea, Patricia Uribe Zúñiga 

Joint United Nations Programme on HIV/AIDS (UNAIDS), Evaluation and Economics Division, Geneva, Switzerland

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Open Enrollment Timeline for 2016 Marketplace Coverage

Via:  https://goo.gl/Mqc0Yj

Ryan White HIV/AIDS Program Assistance and HIV Treatment Outcomes

The Ryan White HIV/AIDS Program (RWHAP) provides persons infected with human immunodeficiency virus (HIV) with services not covered by other healthcare payer types. Limited data exist to inform policy decisions about the most appropriate role for RWHAP under the Patient Protection and Affordable Care Act (ACA).

METHODS:

We assessed associations between RWHAP assistance and antiretroviral therapy (ART) prescription and viral suppression. We used data from the Medical Monitoring Project, a surveillance system assessing characteristics of HIV-infected adults receiving medical care in the United States. Interview and medical record data were collected in 2009-2013 from 18 095 patients.

RESULTS:

Nearly 41% of patients had RWHAP assistance; 15% relied solely on RWHAP assistance for HIV care. Overall, 91% were prescribed ART, and 75% were virally suppressed. Uninsured patients receiving RWHAP assistance were significantly more likely to be prescribed ART (52% vs 94%; P < .01) and virally suppressed (39% vs 77%; P < .01) than uninsured patients without RWHAP assistance. Patients with private insurance and Medicaid were 6% and 7% less likely, respectively, to be prescribed ART than those with RWHAP only (P < .01). Those with private insurance and Medicaid were 5% and 12% less likely, respectively, to be virally suppressed (P ≤ .02) than those with RWHAP only. Patients whose private or Medicaid coverage was supplemented by RWHAP were more likely to be prescribed ART and virally suppressed than those without RWHAP supplementation (P ≤ .01).

CONCLUSIONS:

Uninsured and underinsured HIV-infected persons receiving RWHAP assistance were more likely to be prescribed ART and virally suppressed than those with other types of healthcare coverage.

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By:   Bradley H1, Viall AH1, Wortley PM1, Dempsey A2, Hauck H2, Skarbinski J1.

• 1Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
• 2HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland. 

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Percentage of Uninsured Persons Aged < 65 Years with No Health Insurance Coverage Because of Cost, by Race/Ethnicity, US, 2004 & 2014

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We Mapped the Uninsured, You'll Notice a Pattern

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Continuing Need for Sexually Transmitted Disease Clinics After the Affordable Care Act

We assessed the characteristics of sexually transmitted disease (STD) clinic patients, their reasons for seeking health services in STD clinics, and their access to health care in other venues.

In 2013, we surveyed persons who used publicly funded STD clinics in 21 US cities with the highest STD morbidity.

Of the 4364 STD clinic patients we surveyed, 

• 58.5% were younger than 30 years, 
• 72.5% were non-White, 
• and 49.9% were uninsured. 

They visited the clinic for 

• STD symptoms (18.9%), 
• STD screening (33.8%), 
• and HIV testing (13.6%). 

Patients chose STD clinics because of 

• walk-in, same-day appointments (49.5%), 
• low cost (23.9%), 
• and expert care (8.3%). 

Among STD clinic patients, 

• 60.4% had access to another type of venue for sick care, 
• and 58.5% had access to another type of venue for preventive care. 
• Most insured patients (51.6%) were willing to use insurance to pay for care at the STD clinic.

Despite access to other health care settings, patients chose STD clinics for sexual health care because of convenient, low-cost, and expert care. 

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By: Hoover KW1, Parsell BW1, Leichliter JS1, Habel MA1, Tao G1, Pearson WS1, Gift TL1.

• 1Karen W. Hoover, Jami S. Leichliter, Melissa A. Habel, Guoyu Tao, William S. Pearson, and Thomas L. Gift are with the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Bradley W. Parsell is with the National Opinion Research Center, Chicago, IL.  

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