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[ABSTRACT]. Objectives. To summarize available data on unit costs for human immunodeficiency virus (HIV) testing, prevention, and care interventions in Latin America and the Caribbean. Methods. We conducted a systematic literature review of costing studies published between 2012 and 2024, and selected those reporting empirically measured costing data. The available data were categorized according to predefined intervention categories and compared by time and place. We also explored variations in unit costs by intervention type. Results. Of 1 746 studies identified, 22 met the inclusion criteria, which provided 103 unique unit cost estimates from nine countries. About 50% of the included studies were published between 2019 and 2021. Antiretroviral therapy services had the most cost data available (39% of unit costs), followed by inpatient care (27%) and HIV testing (24%). Considerable cost variations were observed both within and between interventions. Conclusions. Our analysis underscores the need for accurate and reliable cost data to support HIV budgeting and decision-making efforts. We identified several gaps in the availability of cost data and emphasize the importance of presenting results more effectively by incorporating key contextual variables. Given the challenges of shrinking budgets and sustainability risks, robust evidence is indispensable to inform priority setting and budget allocation for HIV services.
[RESUMEN]. Objetivos. Resumir los datos disponibles sobre los costos unitarios de las intervenciones en materia de pruebas de detección, prevención y atención de salud relacionadas con el virus de la inmunodeficiencia humana (VIH) en América Latina y el Caribe. Métodos. Se realizó una revisión bibliográfica sistemática de los estudios sobre costos publicados entre el 2012 y el 2024, y se seleccionaron los estudios que presentaban datos de costos determinados de manera empírica. Los datos disponibles se clasificaron en categorías de intervención predefinidas y se compararon en función del tiempo y el lugar. También se examinaron las variaciones en los costos unitarios según el tipo de intervención. Resultados. De los 1746 estudios encontrados, 22 cumplían los criterios de inclusión; y en ellos se obtuvieron 103 estimaciones distintas de costos unitarios procedentes de nueve países. Alrededor del 50% de los estudios incluidos se publicaron entre el 2019 y el 2021. Los servicios de tratamiento antirretroviral eran los que disponían de más datos sobre costos (39% de los costos unitarios), seguidos de los de atención hospitalaria (27%) y los de pruebas de detección del VIH (24%). Se observaron variaciones considerables en los costos en una misma intervención y entre distintas intervenciones. Conclusiones. En este análisis se subraya la necesidad de disponer de datos de costos exactos y fiables para brindar apoyo a los esfuerzos de elaboración de presupuestos y la toma de decisiones en materia de infección por el VIH. Detectamos varias brechas en cuanto a la disponibilidad de datos sobre costos y hacemos hincapié en la importancia de presentar los resultados de manera más eficaz mediante la incorporación de variables contextuales clave. Ante los desafíos que plantean la reducción presupuestaria y los riesgos para su sostenibilidad, es indispensable contar con evidencia sólida para fundamentar la determinación de prioridades y la asignación de presupuestos a los servicios relacionados con la infección por el VIH.
[RESUMO]. Objetivos. Sintetizar os dados disponíveis sobre os custos unitários de testagem, prevenção e intervenções de saúde relacionados ao vírus da imunodeficiência humana (HIV) na América Latina e Caribe. Métodos. Foi realizada uma revisão sistemática da literatura de estudos de custeio publicados entre 2012 e 2024, com a seleção de estudos que apresentavam dados de custeio medidos empiricamente. Os dados foram classificados em categorias predefinidas de intervenção e comparados por tempo e lugar. Variações nos custos unitários por tipo de intervenção também foram examinadas. Resultados. Dos 1746 estudos identificados, 22 preencheram os critérios de inclusão, fornecendo 103 estimativas de custos unitários em nove países. Cerca de 50% dos estudos incluídos na análise foram publicados entre 2019 e 2021. A maior parte dos dados de custo se referiam a serviços de terapia antirretroviral (39% dos custos unitários), serviços de atenção hospitalar (27%) e serviços de testagem de HIV (24%). Foram observadas variações de custo consideráveis para uma mesma intervenção e entre diferentes intervenções. Conclusões. Esta análise aponta a necessidade de se dispor de dados de custo exatos e confiáveis para apoiar o processo decisório e a alocação de recursos orçamentários relacionados ao HIV. Foram identificadas várias lacunas na disponibilidade de dados de custo. Enfatiza-se a importância de apresentar os resultados com mais eficiência, incorporando as principais variáveis contextuais. Diante dos desafios impostos pela retração orçamentária e pelos riscos à sustentabilidade, é imprescindível dispor de evidências robustas para subsidiar o processo de estabelecimento de prioridades e alocação de recursos orçamentários para serviços de HIV.
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Infecções por HIV , Custos de Cuidados de Saúde , Política de Saúde , América Latina , Região do Caribe , Infecções por HIV , Custos de Cuidados de Saúde , Política de Saúde , América Latina , Região do Caribe , Infecções por HIV , Custos de Cuidados de Saúde , Política de Saúde , Região do CaribeRESUMO
This study aimed to evaluate the interest in event-driven PrEP (ED-PrEP) among men who have sex with men (MSM) using daily PrEP in Mexico's PrEP demonstration project between 2019 and 2020. We compared participants interested or not in ED-PrEP during their first-month visit and identified associated factors. Of 1,021 MSM attending their first-month visit, 7% had previous knowledge of ED-PrEP, but 40% were interested in ED-PrEP. However, over 50% perceived the scheme as less protective than daily PrEP. Having doubts about ED-PrEP's level of protection was related to less interest in the scheme (aOR = 0.11; CI = 0.07-0.18), just like reporting perceived barriers such as having frequent sex (aOR = 0.06; CI = 0.03-0.14), unplanned sex (aOR = 0.17; CI = 0.11-0.27), forgetting the medicine (aOR = 0.06; CI = 0.03-0.12), or difficulty carrying the medicine (aOR = 0.13; CI = 0.07-0.25). Finally, reporting not taking PrEP for >20 days in the last month (aOR = 0.05; CI = 0.01-0.27) diminished interest in ED-PrEP. In conclusion, few MSM daily PrEP users knew about ED-PrEP yet many were interested in it, suggesting the importance of awareness campaigns regarding ED-PrEP's effectiveness. The lack of interest in ED-PrEP among participants with poor adherence to daily PrEP indicates that they might prefer long-acting PrEP or HIV prevention strategies without medication.
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BACKGROUND: There are limited population-representative data that describe the potential burden of Post-COVID conditions (PCC) in Mexico. We estimated the prevalence of PCC overall and by sociodemographic characteristics among a representative sample of adults previously diagnosed with COVID-19 in Mexico. We additionally, characterized the PCC symptoms, and estimated the association between diagnosed type-2 diabetes and hypertension with PCC. METHODS: We used data from the 2021 National Health and Nutrition Survey in Mexico, a nationally and regionally representative survey, from August 1st to October 31st, 2021. Using the WHO definition, we estimated the prevalence of PCC by sociodemographics and prevalence of PCC symptoms. We fit multivariable log-binomial regression models to estimate the associations. RESULTS: The prevalence of PCC was 37.0%. The most common persistent symptoms were fatigue (56.8%), myalgia or arthralgia (47.5%), respiratory distress and dyspnea (42.7%), headache (34.0%), and cough (25.7%). The prevalence was higher in older people, women, and individuals with low socioeconomic status. There was no significant association between hypertension and PCC or diabetes and PCC prevalence. CONCLUSIONS: About one-third of the adult Mexican population who had COVID-19 in 2021 had Post-COVID conditions. Our population-based estimates can help assess potential priorities for PCC-related health services, which is critical in light of our weak health system and limited funding.
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COVID-19 , Sobreviventes , Humanos , COVID-19/epidemiologia , México/epidemiologia , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Adulto , Prevalência , Idoso , Sobreviventes/estatística & dados numéricos , Adulto Jovem , Hipertensão/epidemiologia , Adolescente , Diabetes Mellitus Tipo 2/epidemiologia , Fatores Sociodemográficos , SARS-CoV-2RESUMO
PURPOSE: Cost containment and efficiency in the provision of health care are primary concerns for health systems that aim to provide affordable, high-quality care. Between 2005 and 2015, Seguro Poplar's Fund against Catastrophic Expenditures (FPGC) funded ALL treatment in Mexico. Before January 1, 2011, FPGC reimbursed a fixed amount per patient according to risk. In 2011, the per capita reimbursement method changed to fee for service. We used this natural experiment to estimate the impact of the reimbursement policy change on average expenditure and quality of care for ALL treatment in Mexico. METHODS: We used nationwide reimbursement data from the Seguro Poplar's FPGC from 2005 to 2015. We created a patient cohort to assess 3-year survival and estimate the average reimbursement before and after the fee-for-service policy. We examined survival and expenditure impacts, controlling for patients' and providers' characteristics, including sex, risk (standard and high), the volume of patients served, type of institution (federally funded v other), and level of care. To quantify the impact, we used a regression discontinuity approach. RESULTS: The average reimbursement for standard-risk patients in the 3-year survival cohort was $16,512 US dollars (USD; 95% CI, 16,042 to 17,032) before 2011 and $10,205 USD (95% CI, 4,659 to 12,541) under the fee-for-service reimbursement scheme after 2011. The average annual reimbursement per patient decreased by 136% among high-risk patients. The reduction was also significant for the standard-risk cohort, although the magnitude was substantially smaller (34%). CONCLUSION: As Mexico's government is currently restructuring the health system, our study provides evidence of the efficiency and effectiveness of the funding mechanism in the Mexican context. It also serves as a proof of concept for using administrative data to evaluate economic performance and quality of care of publicly funded health programs.
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Planos de Pagamento por Serviço Prestado , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , México/epidemiologia , Planos de Pagamento por Serviço Prestado/economia , Masculino , Feminino , Leucemia-Linfoma Linfoblástico de Células Precursoras/economia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/mortalidade , Adolescente , Adulto , Criança , Gastos em Saúde/estatística & dados numéricos , Pré-Escolar , Adulto JovemRESUMO
OBJECTIVE: Estimate COVID-19 vaccine booster uptake and identify sociodemographic profiles associated with vaccine booster uptake in Mexican adults aged 60 and older. METHODS: Using data from the 2022 National Health and Nutrition Survey, we estimated COVID-19 booster uptake in Mexican adults 60 and older. We conducted a latent class analysis using sociodemographic characteristics and then estimated group-specific booster prevalence. RESULTS: Adults aged 60 and older with a completed vaccination schedule had 80.3% booster coverage. Two groups showed the lowest coverage: 1) unemployed and informal working men with elementary education with low socioeconomic status (73.8% boosted), and 2) female homekeepers with elementary education or less living in rural areas (77.0% boosted). CONCLUSIONS: Our analysis points to the need to reach out to men and women with elementary education or less who live in rural areas to strengthen booster campaigns in the future.
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Vacinas contra COVID-19 , COVID-19 , Imunização Secundária , Análise de Classes Latentes , Humanos , Masculino , Feminino , México/epidemiologia , Pessoa de Meia-Idade , COVID-19/epidemiologia , COVID-19/prevenção & controle , Idoso , Vacinas contra COVID-19/administração & dosagem , Imunização Secundária/estatística & dados numéricos , SARS-CoV-2/imunologia , Cobertura Vacinal/estatística & dados numéricos , População Rural/estatística & dados numéricos , Idoso de 80 Anos ou mais , Esquemas de Imunização , Inquéritos NutricionaisRESUMO
OBJECTIVES: Screening tools in which participants self-report sexual behaviors can identify people at risk of HIV acquisition for enrollment in preexposure prophylaxis (PrEP). We compared enrollment outcomes (ie, receiving PrEP vs being excluded by a counselor or declining PrEP) in Mexico's PrEP demonstration project and evaluated the validity of a 4-criteria PrEP eligibility tool in which participants self-reported risk behavior-having condomless anal sex, transactional sex, a partner living with HIV, or a sexually transmitted infection-as compared with PrEP eligibility assessed by a counselor. METHODS: We recruited men who have sex with men and transwomen who were offered PrEP services in Mexico. We characterized participants according to enrollment outcome and identified underlying factors through logistic regression analyses. We calculated the sensitivity and specificity of the self-reported risk criteria, using the counselor's risk assessment as the point of reference. RESULTS: Of 2460 participants, 2323 (94%) had risk criteria of HIV acquisition according to the 4-criteria tool; 1701 (73%) received PrEP, 247 (11%) were excluded by a counselor, and 351 (15%) declined PrEP despite being considered eligible by the counselor. Participants who were excluded or who declined PrEP were less likely to report HIV risk behaviors than those who received PrEP, and participants who declined PrEP were more likely to be transwomen (vs men who have sex with men) and aged ≤25 years (vs >25 y). The 4-criteria risk tool had high sensitivity (98.6%) and low specificity (29.8%). CONCLUSION: The screening tool identified most participants at risk of HIV acquisition, but counselors' assessment helped refine the decision for enrollment in PrEP by excluding those with low risk. Public health strategies are needed to enhance enrollment in PrEP among some groups.
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Infecções por HIV , Profilaxia Pré-Exposição , Humanos , Infecções por HIV/prevenção & controle , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Masculino , Profilaxia Pré-Exposição/estatística & dados numéricos , México/epidemiologia , Adulto , Feminino , Homossexualidade Masculina/estatística & dados numéricos , Adulto Jovem , Programas de Rastreamento/estatística & dados numéricos , Programas de Rastreamento/métodos , Medição de Risco/métodos , Adolescente , Comportamento Sexual/estatística & dados numéricos , Pessoas Transgênero/estatística & dados numéricos , Pessoa de Meia-Idade , Autorrelato , Assunção de Riscos , Minorias Sexuais e de Gênero/estatística & dados numéricosRESUMO
We conducted a parallel-group randomized controlled trial in three HIV clinics in Mexico to evaluate a user-centred habit-formation intervention to improve ART adherence among MSM living with HIV. We randomized 74 participants to the intervention group and 77 to the control group. We measured adherence at one, four, and ten months through medication possession ratio and self-reported adherence. Additionally, we measured viral load, CD4 cell count, major depression disorder symptoms, and alcohol and substance use disorder at baseline, fourth and tenth months. We found no statistically significant effect on adherence between groups. However, the intervention demonstrated positive results in major depression disorder symptoms (21% vs. 6%, p = 0.008) and substance use disorder (11% vs. 1%, p = 0.018) in the fourth month. The latter is relevant because, in addition to its direct benefit, it might also improve the chances of maintaining adequate adherence in the long term. This trial was retrospectively registered at ClinicalTrials.gov (trial number NCT03410680) on 8 January 2018.Trial registration: ClinicalTrials.gov identifier: NCT03410680.
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Fármacos Anti-HIV , Infecções por HIV , Homossexualidade Masculina , Adesão à Medicação , Carga Viral , Humanos , Masculino , México , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adulto , Homossexualidade Masculina/psicologia , Adesão à Medicação/estatística & dados numéricos , Adesão à Medicação/psicologia , Fármacos Anti-HIV/uso terapêutico , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias , Contagem de Linfócito CD4 , Transtorno Depressivo Maior/tratamento farmacológicoRESUMO
OBJECTIVES: This study aims to evaluate the disruption in HIV screening and diagnoses due to the coronavirus disease 2019 (COVID-19) pandemic and to investigate the pandemic's subsequent influence on the HIV epidemic. DESIGN: A retrospective examination of testing and confirmed diagnoses time series was undertaken from 2011 to 2022. The analysis encompassed testing, positive tests, positivity rates, and diagnosis outcomes, including new HIV diagnoses, asymptomatic HIV diagnoses, and symptomatic HIV diagnoses. METHODS: We used Autoregressive Integrated Moving Average (ARIMA) models to estimate the COVID-19 epidemic's impact on screening and diagnosis outcomes. We gauged the pandemic's effect between January 2020 and December 2022 by comparing modeled predicted results with actual outcomes. RESULTS: The advent of COVID-19 prompted a reduction of 50.7% in HIV testing, followed by a monthly escalation in testing afterward, estimated at 30.2 and 65.1% for 2021 and 2022, respectively. Although new diagnoses reported between 2020 and 2022 gradually increased to prepandemic levels, we estimate a gap of 13â207 new diagnoses, with symptomatic detections increasing more than proportionally in 2021 and 2022. CONCLUSION: Our results suggest that the COVID-19 pandemic resulted in missed HIV diagnoses and a rise in late HIV diagnoses. Implementing tailored post-COVID-19 strategies to accelerate timely HIV testing and prevention is needed to avert additional burdens and remain on track toward achieving the 2030 HIV management goals.
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COVID-19 , Diagnóstico Tardio , Infecções por HIV , Teste de HIV , Humanos , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Estudos Retrospectivos , México/epidemiologia , Teste de HIV/estatística & dados numéricos , Programas de Rastreamento/métodos , Pandemias , SARS-CoV-2 , Masculino , FemininoRESUMO
PURPOSE: To estimate the cost-effectiveness of adding a CDK4/6 inhibitor to standard endocrine therapy in the first-line setting for advanced HR+/HER2- breast cancer in postmenopausal and premenopausal women, from the perspective of the Mexican public healthcare system. METHODS: We used a partitioned survival model to simulate relevant health outcomes in a synthetic cohort of patients with breast cancer derived from the PALOMA-2, MONALEESA-2, MONARCH-3 trials for postmenopausal patients, and from the MONALEESA-7 study for premenopausal patients. Effectiveness was measured in life years gained. Cost-effectiveness is reported through incremental cost-effectiveness ratios (ICER). RESULTS: In postmenopausal patients, palbociclib led to an increase of 1.51 life years, ribociclib of 1.58 years, and abemaciclib of 1.75 years, compared to letrozole alone. The ICER was 36,648 USD, 32,422 USD, and 26,888 USD, respectively. In premenopausal patients, ribociclib led to an increase of 1.82 life years when added to goserelin and endocrine therapy, with an ICER of 44,579 USD. In the cost minimization analysis, for postmenopausal patients, ribociclib was the treatment with the highest costs due to follow-up requirements. CONCLUSION: Palbociclib, ribociclib, and abemaciclib demonstrated a significant increase in effectiveness in postmenopausal patients, and ribociclib in premenopausal patients, when added to standard endocrine therapy for patients with advanced HR+/HER2- breast cancer. At the national stablished willingness to pay, only the addition of abemaciclib to standard endocrine therapy in postmenopausal women would be considered cost-effective. However, differences on results between therapies for postmenopausal patients were not statistically significant.
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Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Análise Custo-Benefício , México , Aminopiridinas/uso terapêutico , Proteínas Inibidoras de Quinase Dependente de Ciclina/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica , Receptor ErbB-2 , Quinase 4 Dependente de CiclinaRESUMO
OBJECTIVE: To estimate vaccine uptake and assess sociodemographic conditions associated with vaccination barriers and refusal and to explore the effect of a monetary incentive to overcome them. MATERIALS AND METHODS: We used data from adults from the 2021 National Continuous Health and Nutrition Survey conducted during August-October 2021. We evaluated if an hypothetical monetary incentive between 50-650 MXN (~2.5-31 USD) would overcome barriers or refusal. RESULTS: 73.9% were vaccinated with at least one dose, 7.5% refused, 4.8% reported barriers and 13.8% were ineligible at the time of the survey. Refusal and barriers were more frequent in men, older age, lower education and socioeconomic status, unemployed and informal workers. In people with barriers and refusal, the hypothetical incentive increased the acceptance in 57.6% (95%CI 50.7,64.4%) and 17.4% (95%CI 13.2,21.7%) in people with barriers and refusal, respectively. CONCLUSION: Understanding the reasons for barriers and refusal is crucial for future Covid-19 vaccination campaigns or epidemics. A monetary incentive might increase vaccination uptake, although, cost-effectiveness analyses are needed.
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Vacinas contra COVID-19 , COVID-19 , Masculino , Adulto , Humanos , Motivação , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinação , Inquéritos e QuestionáriosRESUMO
OBJETIVO: Presentar la metodología de la Encuesta Nacional de Salud y Nutrición 2023 (Ensanut 2023) y describir los procedimientos de inferencia para conjuntar la información colectada por la Ensanut Continua 2020-2024. Material y métodos. La Ensanut 2023 es la cuarta encuesta de la serie Ensanut Continua. Se describe el alcance de la Ensanut 2023 junto con sus procedimientos de muestreo, estimación, medición y organización logística. Además, se discute el procedimiento básico de estimación para analizar la integración de las encuestas Ensanut Continua 2020-2024. RESULTADOS: La Ensanut 2023 obtendrá a nivel nacional al menos 11 720 entrevistas completas de hogar y 13 378 cuestionarios completos de adulto. La unión de las Ensanut Continua 2020-2023 permitirá, en general, estimar a nivel estatal prevalencias p≥5% en adultos, con confiabilidad tolerable según las recomendaciones del Instituto Nacional de Estadística y Geografía. CONCLUSIONES: El análisis de la unión de la Ensanut Continua 2020-2023 permitirá iniciar la generación de estimaciones nacionales y estatales sobre el estado de salud y nutrición de la población mexicana.
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OBJETIVO: Describir la prevalencia de anticuerpos contra SARS-CoV-2, vacunación, barreras y rechazo a la vacunación Covid-19 en población mexicana. Material y métodos. Se utilizó información de los integrantes del hogar de uno y más años, incluidos en la Encuesta Nacional de Salud y Nutrición Continua 2022 (Ensanut Continua 2022) realizada de agosto-noviembre. Se estimó la prevalencia de anticuerpos antiproteínas N y S de SARS-CoV-2 en muestras de sangre capilar, dosis reportadas de vacunación a Covid-19 y las razones de barreras y rechazo a la vacunación. RESULTADOS: La prevalencia de anticuerpos anti-N fue de 94.4% y de anti-S 98.1%. La prevalencia de anticuerpos anti-S fue mayor en personas vacunadas con una, dos o tres o más dosis que en no vacunadas. Dentro de la población elegible a vacunación, 20.2% no estaba vacunada, 16.2% tenía una dosis, 30% dos dosis y 33.6% tres dosis o más. El 11.2% de la población elegible rechazó la vacunación, 5.5% reportó una barrera y 3.2% reportó que la vacuna no había llegado a su localidad. Conclusión. La prevalencia de anticuerpos por infección natural y por vacunación Covid-19 es alta en México. Las variaciones de rechazo y barreras a la vacunación entre grupos de edad y regiones deben tomarse en cuenta para intensificar esfuerzos específicos para la vacunación.
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OBJETIVO: Presentar un panorama descriptivo de las elecciones de la población mexicana frente a una necesidad de salud en 2022. Material y métodos. Se utilizaron datos de la Encuesta Nacional de Salud y Nutrición Continua 2022. RESULTADOS: De 24.6% de la población que informó haber tenido una necesidad de salud en los últimos tres meses, 44% recibió atención en servicios públicos. El uso de servicios privados es extensivo a toda la población, pero fue más elevado en aquellos sin derechohabiencia. Se encontró que 71% de los motivos por los que las personas no se atendieran en el lugar que les correspondía de acuerdo con su derechohabiencia tuvo que ver con el acceso y 21% con la percepción de calidad. Entre los motivos de acceso para elegir el lugar donde se atendieron destacan la afiliación, la cercanía y el costo. En cuanto a la calidad, resaltan la atención rápida y la satisfacción con la atención. CONCLUSIONES: Con el fin de reducir la desigualdad de acceso y el gasto de bolsillo asociado con un mayor uso de servicios privados, sobre todo entre la población sin seguridad social, mejorar el acceso (como la distancia, los horarios de atención, las barreras burocráticas) puede ayudar a avanzar en este objetivo.
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OBJETIVO: Medir el acceso a través de la intermitencia en el suministro de agua potable en hogares mexicanos. Material y métodos. A través de la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022), se recolectó información sobre intermitencia en días por semana y horas por día durante las últimas cuatro semanas y el suministro de agua durante el año para la temporada de mayor escasez. RESULTADOS: 31.5% de los hogares recibieron agua los siete días de la semana, las 24 horas del día. De estos, 17.4% no tuvo escasez en los últimos 12 meses. La intermitencia es más común entre hogares de las regiones en el sur del país y entre los más pobres. El 81% de las familias almacena agua y 16% almacena en contenedores portátiles como cubetas. Conclusión. En este artículo se presentan por primera vez patrones de intermitencia en el suministro de agua a nivel nacional en México. La gran mayoría de las familias no reciben agua de forma continua y tienen que almacenar agua. El almacenamiento podría disminuir la calidad del agua y la falta de confianza para su consumo con consecuencias para la salud. La conexión al sistema potable no refleja el acceso real de las familias al agua.
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OBJECTIVE: To assess the impact of a vaccination campaign that administered five different technologies in a middle-income country with one of the largest Covid-19 epidemics. MATERIALS AND METHODS: Using data from Mexico's Epidemiological Surveillance System for Viral Respiratory Disease (Sisver) and the design of the vaccine policy in Mexico as a natural experiment, we applied difference-in-differences econometric methods to assess the strategy's effectiveness on transmission, hospitalizations, and mortality rates among adults 60 to 64 years old in Mexico between April and June 2021. RESULTS: We estimated average effectiveness levels of 60.9% against confirmed cases of Covid-19. Vaccination also decreased hospitalizations and deaths by 62.7 and 62.6%, respectively. After adjusting for vaccination coverage, we found an impact of 79.1, 80.9, and 81.3% reduction in new cases, hospitalizations, and deaths among the vaccinated. CONCLUSION: Despite the significant progress in our knowledge of Covid-19 vaccination effectiveness, the available evidence relies mostly on experiences from high-income countries. This study contributes to the scientific literature of Covid-19 vaccination effectiveness in a middle-income country with a multi-vaccine scheme.
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COVID-19 , Vacinas , Adulto , Humanos , Pessoa de Meia-Idade , México/epidemiologia , Vacinas contra COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , VacinaçãoRESUMO
BACKGROUND: Little is known about the potential impacts of visible and up-to-date health warning labels on alcoholic beverage containers on a range of outcomes in low- and middle-income countries. We conducted an experimental study to test the potential impacts of visible health warning labels (on the principal panel of the package) on thinking about health risks, product attractiveness, visual avoidance, and intention to change alcohol use among students in Mexico aged 18-30 years. METHODS: A double-blind, parallel-group, online randomized trial was conducted from November 2021 to January 2022 in 11 states in Mexico. In the control group, participants were presented with the image of a conventional beer can with a fictional design and brand. In the intervention groups, the participants observed pictograms with a red font and white backgrounds (health warning label in red-HWL red) or with a black font and yellow backgrounds (health warning label in yellow-HWL yellow), located at the top, covering around one-third of the beer can. We used Poisson regression models -unadjusted and adjusted for covariates- to assess differences in the outcomes across study groups. RESULTS: Using intention-to-treat analysis (n = 610), we found more participants in groups HWL red and HWL yellow thought about the health risks from drinking beer compared to the control group [Prevalence Ratio (PR) = 1.43, CI95%:1.05,1.93 for HWL red; PR = 1.25, CI95%: 0.91, 1.71 for HWL yellow]. A lower percentage of young adults in the interventions vs control group considered the product attractive (PR 0.74, 95%CI 0.51, 1.06 for HWL red; PR 0.56, 95%CI 0.38, 0.83 for HWL yellow). Although not statistically significant, a lower percentage of participants in the intervention groups considered buying or consuming the product than the control group. Results were similar when models were adjusted for covariates. CONCLUSIONS: Visible health warning labels could lead individuals to think about the health risks of alcohol, reducing the attractiveness of the product and decreasing the intention to purchase and consume alcohol. Further studies will be required to determine which pictograms or images and legends are most contextually relevant for the country. TRIAL REGISTRATION: The protocol of this study was retrospectively registered on 03/01/2023: ISRCTN10494244.
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Bebidas Alcoólicas , Rotulagem de Produtos , Humanos , Adulto Jovem , Rotulagem de Produtos/métodos , México , Projetos Piloto , ÁlcooisRESUMO
BACKGROUND: Lead can affect early childhood development (ECD) differentially due to nutritional deficiencies that lead to stunted growth, defined as being at least two standard deviations below the average height-for-age. These deficiencies are more frequent among children living in rural locations or with lower socioeconomic status (SES); however, studies at a population level are scarce worldwide. Early childhood development plays a crucial role in influencing a child's health and wellbeing throughout life. Therefore, the aim of this study was to analyze how stunted growth can modify the association between lead exposure and ECD in children from disadvantaged communities. METHODS: Data were analyzed from the 2018 National Health and Nutrition Survey in localities with fewer than 100,000 inhabitants in Mexico (ENSANUT-100K). Capillary blood lead (BPb) levels were measured using a LeadCare II device and dichotomized as detectable (cutoff point ≥ 3.3 µg/dL) and non-detectable. As a measure of ECD, language development was assessed in n = 1394 children, representing 2,415,000 children aged 12-59 months. To assess the association between lead exposure and language z-scores, a linear model was generated adjusted by age, sex, stunted growth, maternal education, socioeconomic status, area, region (north, center, south), and family care characteristics; afterwards, the model was stratified by stunted growth. RESULTS: Fifty percent of children had detectable BPb and 15.3% had stunted growth. BPb showed a marginal inverse association with language z-scores (ß: -0.08, 95% CI: -0.53, 0.36). Children with detectable BPb and stunted growth had significantly lower language z-scores (ß: -0.40, 95% CI: -0.71, -0.10) than those without stunted growth (ß: -0.15, 95% CI: -0.36, 0.06). CONCLUSIONS: Children with stunted growth are more vulnerable to the adverse effects of lead exposure. These results add to previous research calling for action to reduce lead exposure, particularly in children with chronic undernutrition.
Assuntos
Desenvolvimento Infantil , Chumbo , Criança , Humanos , Pré-Escolar , Lactente , México/epidemiologia , Chumbo/toxicidade , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Classe SocialRESUMO
BACKGROUND: Nigeria has been consistently targeted in sub-Saharan Africa as an HIV-priority country. Its main mode of transmission is heterosexual, and consequently, a key population of interest is female sex workers (FSWs). While HIV prevention services are increasingly implemented by community-based organizations (CBOs) in Nigeria, there is a paucity of evidence on the implementation costs of these organizations. This study seeks to fill this gap by providing new evidence about service delivery unit cost for HIV education (HIVE), HIV counseling and testing (HCT), and sexually transmitted infection (STI) referral services. METHODS: In a sample of 31 CBOs across Nigeria, we calculated the costs of HIV prevention services for FSWs taking a provider-based perspective. We collected 2016 fiscal year data on tablet computers during a central data training in Abuja, Nigeria, in August 2017. Data collection was part of a cluster-randomized trial examining the effects of management practices in CBOs on HIV prevention service delivery. Staff costs, recurrent inputs, utilities, and training costs were aggregated and allocated to each intervention to produce total cost calculations, and then divided by the number of FSWs served to produce unit costs. Where costs were shared across interventions, a weight proportional to intervention outputs was applied. All cost data were converted to US dollars using the mid-year 2016 exchange rate. We also explored the cost variation across the CBOs, particularly the roles of service scale, geographic location, and time. RESULTS: The average annual number of services provided per CBO was 11,294 for HIVE, 3,326 for HCT, and 473 for STI referrals. The unit cost per FSW tested for HIV was 22 USD, the unit cost per FSW reached with HIV education services was 19 USD, and the unit cost per FSW reached by STI referrals was 3 USD. We found heterogeneity in total and unit costs across CBOs and geographic location. Results from the regression models show that total cost and service scale were positively correlated, while unit costs and scale were consistently negatively correlated; this indicates the presence of economies of scale. By increasing the annual number of services by 100 percent, the unit cost decreases by 50 percent for HIVE, 40 percent for HCT, and 10 percent for STI. There was also evidence that indicates that the level of service provision was not constant over time across the fiscal year. We also found unit costs and management to be negatively correlated, though results were not statistically significant. CONCLUSIONS: Estimates for HCT services are relatively similar to previous studies. There is substantial variation in unit costs across facilities, and evidence of a negative relationship between unit costs and scale for all services. This is one of the few studies to measure HIV prevention service delivery costs to female sex workers through CBOs. Furthermore, this study also looked at the relationship between costs and management practices-the first of its kind to do so in Nigeria. Results can be leveraged to strategically plan for future service delivery across similar settings.
Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Profissionais do Sexo , Infecções Sexualmente Transmissíveis , Feminino , Humanos , HIV , Nigéria/epidemiologia , Serviços de Saúde Comunitária , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções Sexualmente Transmissíveis/prevenção & controleRESUMO
BACKGROUND: This article describes perceptions and experiences related to the preexposure prophylaxis (PrEP) care continuum of Mexican men who have sex with men (MSM) and transwomen (TW). METHODS: Between June and July 2020, we applied 24 online semistructured interviews regarding PrEP use with 10 PrEP users, 6 ex-users, and 8 potential users (at risk, not enrolled). RESULTS: Awareness: TW did not always receive the information they needed from trusted people. Acceptability: Potential users were reluctant to use PrEP because of fear of adverse effects, and only a few participants worried about stigma. Uptake: Potential users missed their enrollment visit and did not know how to reschedule. Adherence: Barriers included routine changes interfering with PrEP-taking habits (arriving home later, traveling, etc.), whereas feeling protected was reported as a facilitator. Retention: Ex-users quit PrEP services, mostly without reducing their HIV risk, because of difficulties keeping appointments and fearing long-term effects. CONCLUSION: Inclusive awareness activities, tackling misbeliefs regarding adverse effects, and more flexible services may improve PrEP usage and enhance its impact.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Masculino , Humanos , Homossexualidade Masculina , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Pesquisa Qualitativa , Continuidade da Assistência ao Paciente , Fármacos Anti-HIV/uso terapêuticoRESUMO
OBJETIVO: Estimar la asociación entre la elección de pro-veedores de servicios de atención y las necesidades de salud de la población. Material y métodos. Se utilizaron datos de la Encuesta Nacional de Salud y Nutrición 2021 sobre Covid-19. RESULTADOS: Las necesidades agudas (infeccio-nes respiratorias, diarrea y Covid-19) representan 48% del total; 21% crónicas (control, seguimiento o diagnóstico de diabetes, hipertensión, gastritis, cáncer); 12% necesidades de prevención (vacunación, chequeo, control prenatal); 7% eventos agudos no infecciosos que incluyen lesión física, dolor de cabeza, fiebre, y 4% el resto. La población elige atención privada o pública de forma diferenciada dependiendo del tipo de necesidad de salud. Para necesidades agudas sólo 25% se atiende en el sector público. Para enfermedades crónicas, agudas no infecciosas y de prevención, la proporción que se atiende en sector público es mayor, incluida la población sin seguridad social. CONCLUSIONES: Los resultados de este estudio serán de utilidad para que la reforma en el sistema de salud pueda reforzar los servicios públicos que requieran más recursos.