RESUMEN
BACKGROUND: HIV incidence can be estimated with cross-sectional studies using clinical, serological, and molecular data. Worldwide, HIV incidence data in only men who have sex with men (MSM) are scarce and principally focus on those with healthcare or under treatment. However, better estimates can be obtained through studies with national representativeness. The objective was to estimate the prevalence, incidence, and factors associated with acquiring HIV in a national sample of MSM who attend meeting places, considering geographical regions. METHODS: A nationally representative survey of MSM attending meeting places was performed in Mexico. Participants answered a questionnaire, and a dried blood spot (DBS) was collected. Samples were classified as recent infections using an algorithm with HIV status, antiretroviral therapy, and the result of BED-EIA assay. Parameters were analysed considering regions and demographic and sexual behaviour characteristics. RESULTS: The national HIV prevalence was 17.4% with regional differences; the highest prevalence (20.7%) was found in Mexico City, and the lowest prevalence was found in the West region (11.5%). The incidence was 9.4 per 100 p/y, with regional values from 6.2 to 13.2 for the Northeast and the Centre regions, respectively. Age, age at sexual debut, low wealth index, and rewarded sex were associated with HIV prevalence. Centre region, use of private clinics as health services, and having sex exclusively with men were associated with recent HIV infections. CONCLUSIONS: The incidence and prevalence showed regional differences, suggesting a difference in the dynamics of HIV transmission; some regions have a greater case accumulation, and others have a greater rate of new infections. Understanding this dynamic will allow developing health programs focused on HIV prevention or treating people already living with HIV.
Asunto(s)
Infecciones por VIH , Minorías Sexuales y de Género , Estudios Transversales , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Humanos , Incidencia , Masculino , Prevalencia , Conducta SexualRESUMEN
OBJECTIVE: In 2007, the Ministry of Health (MoH) in Mexico implemented a multidisciplinary health-care model (MHC) for patients with type-2 diabetes (T2D), which has proven more effective in controlling this condition than the conventional health-care model (CHC). RESEARCH DESIGN AND METHODS: We compared the cost-effectiveness of the MHC vs. the CHC for patients with T2D using a quasi-experimental, retrospective design. Epidemiologic and cost data were obtained from a randomly selected sample of health-care units, using medical records as well as patient- and facility-level data. We modelled the cost-effectiveness of the MHC at one, 10 and 20 years using a simulation model. RESULTS: The average cumulative costs per patient at 20 years were US$4,225 for the MHC and US$4,399 for the CHC. With a willingness to pay one gross domestic product (GDP) per capita per quality-adjusted life year (QALY) (US$8,910), the incremental net benefits per patient were US$1,450 and US$3,737 at 10 and 20 years, respectively. The MHC was cost-effective from the third year onward; however, increasing coverage to 500 patients per year rendered it cost-effective at year one. CONCLUSIONS: The MHC is cost-effective at 10 and 20 years. Cost-effectiveness can be achieved in the short term by increasing MHC coverage.
Asunto(s)
Atención a la Salud/economía , Diabetes Mellitus Tipo 2/epidemiología , Sector Público , Adulto , Anciano , Análisis Costo-Beneficio , Diabetes Mellitus Tipo 2/economía , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Modelos Teóricos , Años de Vida Ajustados por Calidad de Vida , Estudios RetrospectivosRESUMEN
In Mexico, the combined prevalence of overweight and obesity among Mexican women increased from 64% in 2000 to 72% in 2006. In this paper, we report our findings on the relation of women's body mass index (BMI) with income and lifestyles choices using data from a cross-sectional survey conducted in 2006. The two following approaches were executed. First, we estimated a two-stage least-squares regression to control for the potential endogeneity of income stratified by urban or rural residency. The second approach was aimed at exploring whether the determinants of weight varied among different weight levels using latent class models. Our findings from the two-stage least-squares regression show a positive non-significant association between income and BMI in the overall and urban samples but a significant positive relationship among rural women. Our results suggest that one unit increase in income is associated with 4.1% increase in body weight in rural areas. Estimates from the latent class model (LCM) show a positive but marginally significant association between income and BMI in the overall sample only in the class where there is a greater likelihood that women have normal weight or overweight compared to the class with a higher probability of being obese, but we also found a large association in rural areas for both classes. Lifestyle choices were associated with BMI. Results from the two-stage least-squares regressions reveal that more hours sitting per day and a higher percentage of expenditures in sugary beverages were associated with higher BMI levels. In the LCM, for women who eventually belong to the higher body weight class, lifestyles seem to matter more. Findings from this research suggest that policies to tackle the obesity epidemic among adult women should be different for women living in urban and rural areas and women with different weight levels.