HIV in Mexico: A 10-Year Population-Based Analysis to Evaluate Policy Changes in Diagnosis, Treatment, and Early Mortality on PLWH 2008-2017

Abstract

The last twenty years have been dynamic and relevant for the HIV/AIDS epidemic worldwide. Compared to the beginning of the HIV epidemic, People Living with HIV (PLWH) are living longer and better lives because of increased understanding of the disease, awareness, access to treatments and better quality of health care. In Mexico, since 2007 there was a major initiative that provided universal access to antiretroviral treatment and care for all PLWH, regardless their insurance status. The last two major health policy changes were implemented in 2013, and 2014. First expanding actions to increase early diagnosis and treatment. Second, modifying clinical guidelines (in 2014) to expand universal antiretroviral treatment access, irrespective of their baseline CD4 cell count and symptoms. This dissertation examined the relationship of the two HIV policy changes in Mexico on diagnosis, treatment, and early mortality of people living with HIV using data from Mexican individuals receiving antiretroviral treatment from 2008 to 2017. The three original papers also identify the key determinants for the same three indicators. Results from the first study indicated that actions implemented in 2013 decreased the proportion of individuals with a late HIV diagnosis. The second article highlighted the importance of removing clinical indicators for treatment initiation, as this increases the number of PLWH initiating antiretroviral treatment and reduces the number of PLWH who develop virological failure. The last article showed that that being male, being older, showing worse biomarker levels at the time of diagnosis, and being diagnosed in a region other than Mexico City were factors associated with early mortality. While the descriptive data showed that the proportion of individuals experiencing early mortality decreased after the HIV policy changes implemented in Mexico in 2014. The entire work tells a complete story for understanding the HIV epidemic in Mexico, based on three main indicators.