Impact of COVID19 pandemic on HIV care in Mexico City
Brenda Crabtree Ramírez
Assistant Professor. Infectious Diseases Department Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
September 10, 2020
[email protected] Twitter @BrendaCrabtreeR
❖No disclosures for this presentation to declare
Content
1. Mexican Health System
2. HIV epidemic in Mexico
3. HIV testing and new HIV cases
4. COVID-19 pandemic in Mexico
5. Actions taken
6. Conclusions and Perspectives
MEXICAN HEALTH SYSTEM
Mexican Health System
PublicSocial Security Ministry of Health
Private
Government WorkerEmployerFederal
Government
States
Government
IMSS ISSSTE
PEMEX SEDENA
MARINA
Workers RetireeWorker’s
family
Ministry of Health
Self-employed and unemployed
Informal sector workers
Private insurance
Sector
Funds
Buyers
Users
Households Employer
Dantés OG, et al. (2011). Sistema de salud de México. Salud pública de México, 53, s220-s232.
People who can afford
private insurance
Mexican Health System
PublicSocial Security Ministry of Health
Private
Government WorkerEmployerFederal
Government
States
Government
IMSS ISSSTE
PEMEX SEDENA
MARINA
Workers RetireeWorker’s
family
Ministry of Health
Self-employed and unemployed
Informal sector workers
Private insurance
Dantés OG, et al. (2011). Sistema de salud de México. Salud pública de México, 53, s220-s232.
Sector
Funds
Buyers
Users
Households Employer
PLWH who
know their
status
26% 73% <1%
People who can afford
private insurance
Mexican Health System
PublicSocial Security Ministry of Health
Private
Government WorkerEmployerFederal
Government
States
Government
IMSS ISSSTE
PEMEX SEDENA
MARINA
Workers RetireeWorker’s
family
Ministry of Health
Self-employed and unemployed
Informal sector workers
Private insurance
Dantés OG, et al. (2011). Sistema de salud de México. Salud pública de México, 53, s220-s232.
Sector
Funds
Buyers
Users
Households Employer
Mexico City
providers
Condesa Specialized Clinics (CSC)
National Institutes
(INCMNSZ and INER)
People who can afford
private insurance
HIV EPIDEMIC IN MEXICO
• 99,811 people with ART with active status in the Ministry of Health
2º trimester 2020.
102,288 people with ART with active status in the Ministry of Health
1º trimester 2020
NATIONAL179,640 people living with HIV
registered by Ministry of Health 100,409 people with ART with active status in the Ministry of Health
2019
2.27%
2.42%
56% withART
54% withART
Boletín de Atención Integral de Personas que viven con VIH. Volumen 6 N. 1/Enero-Marzo 2020. CENSIDA. México
Boletín de Atención Integral de Personas que viven con VIH. Volumen 7 N. 2/Abril-Junio 2020. CENSIDA. México
Current situation of the HIV epidemic in Mexico
Late ART initiation 36%
*Epidemic concentrated in MSM, Sex workers, TG population
HIV TESTING AND NEW CASES
HIV testing and New HIV cases: Mexico
413,416
818,385 803,719
732,975
340,485
161,383
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1st T 2nd T 3rd T 4th T
HIV tests in Mexico per trimester
2019 2020
Boletín de Atención Integral de Personas que viven con VIH. Volumen 6 N. 1/Enero-Marzo 2020. CENSIDA. México
Boletín de Atención Integral de Personas que viven con VIH. Volumen 7 N. 2/Abril-Junio 2020. CENSIDA. México
14,180
17,172
12,064
4,547
0
5,000
10,000
15,000
20,000
2017 2018 2019 2020
New HIV cases: Mexico
2019
3rd trimester: 4,366
4th trimester: 3,619
2020
1st trimester: 2,808
2nd trimester: 1,739
HIV testing and New HIV cases: Mexico City
Boletín de Atención Integral de Personas que viven con VIH. Volumen 6 N. 1/Enero-Marzo 2020. CENSIDA. México
Boletín de Atención Integral de Personas que viven con VIH. Volumen 7 N. 2/Abril-Junio 2020. CENSIDA. México
Vigilancia Epidemiológica de casos de VIH/SIDA en México Registro Nacional de Casos de SIDA Actualización al Cierre de 2019.
3950 4397 4316
917
0
5000
10000
15000
20000
2017 2018 2019 2020*
Mexico City
*Data up to March 13th, 2020
* Includes HIV testing at Condesa Clinics
HIV tests in Mexico City per year
COVID19 IN MEXICO
Geoint COVID-19 Tablero CDMX. https://cdmx.dash.covid19.geoint.mx/ Accessed Sept 6, 2020.
Gobierno de México. Informe Epidemiológico de la Situación de COVID-19. https://www.gob.mx/salud/documentos/
Current situation of the COVID-19 pandemic
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
50000
Mexico
Mexico City
February 27th
1st case reported
No
. o
f ca
se
s p
er
we
ek
March 23rd
Local
transmission
Mid-march
INCMNSZ and INER
COVID-19 only
hospitals
May 30th
Country
reopening
Paid leave for
high risk
employees’
Presidential
order
March 16th
CEC
temporary
suspension
of consults
April 21st
Country
lockdown
As of 09/06/2020:
Mexico
CONFIRMED
634,023
DEATHS
67,558
ACTIVE
29,776
Last update: September 6, 2020. https://coronavirus.gob.mx/datos/
Current situation of the COVID-19 pandemic: Mexico City
Confirmed SARS-CoV-2 infection in PLWH: 524 (0.49%) Deaths: 61 (12%)
MoH: 291 cases with 18 deaths
0
1000
2000
3000
4000
5000
6000
7000
Mexico City
CONFIRMED
104,981
DEATHS
8,701
ACTIVE
5,247
As of 09/06/2020:
Mexico City
No
. o
f ca
se
s p
er
we
ek
ACTIONS TAKEN
HIV care: actions taken since March 2020
ART multi month dispensing (4-6 months)
Prioritize admission and re-admission of patients
Temporary suspension of viral load and CD4 count determination, except in specific cases (pregnancy, VF, coinfection)
Temporal stop of consults to patients with undetectable VL and CD4 cell counts >200; initiated virtually in July.
Situation of HIV patients in Mexico City: CEC
1625 patients 14781 patients
661 patients
Condesa Specialized Clinics
Data from SALVAR data base, includes: Condesa specialized Clinic, Condesa Iztapalapa Clinic, Manuel Gea González General Hospital, National Cancer Institute, National Institute of Neurology and Neurosurgery
2019
2020 1813 patients
New admissions Re-admissions
294 patients
535 patients
Active cases
16444 patients
Lost to follow
up
654 patients
12% 82% 11%
Designated COVID-19 hospital only
Outpatient facilities were closed
ART multi month dispensing (3 months)
Temporary suspension of VL and CD4 determination, except in certain patients
Optional mental health virtual consults
Clinical visits re-opened in August for certainpatients
HIV care: actions taken since March 2020
Designated COVID-19 hospital only
Outpatient facilities were closed
ART multi month dispensing (3 month)
Those with CD4 <200 were referred to Clínicas Condesa
End of June, the collection of samples by appointment
Start of telemedicine care (August 2020)
• 2056 patients
Active cases
• 12 patients
New admissions
917 patients with VL (2020),
5% are no longer undetectable
• 62 patients
Lost to follow up
*2019 new admissions: 110 patients
Situation of HIV patients in Mexico City: INCMNSZ and CIENI
• 1344 patients 2019: 1528 patients
Active cases
• 101 patients 2019: 50 patients
•73 for stopping treatment
•16 suspensions due to change of site
•8 deaths
Lost to follow up (January-June 2020)
Impact of the COVID-19 pandemic on other programs
• Temporary suspension of the program (March 2020)
• The ImPrEP Project and the "Let's Talk about PrEP" dialogue were suspended
HCV care program
• Temporary suspension of the program (March 2020)• Re-opening this September
• Diagnostic testing were suspended
Courtesy of Dr. María Gómez Palacio
33 hospitalized patients (CSC 21, INER 5, INCMNSZ 5)
• Characteristics:
• Median age: 36 years
• Sex: 28 (90.3%) male, 2 (6.4%) TG female
• CD4 cell count (n=28):
• <200: 22 (79%)
• Diagnosis: non-COVID-19 pneumonia (TB, PCP, Histo),
fever (MAC, TB), diahrrea, UTI, SNC infection (Cripto, TB,
VHS, neurosyphilis, toxoplasmosis), malignancy (KS,
NHL)
• Deaths: 6 (19%)
HIV care: actions taken during COVID-19 pandemic in Mexico City
Collaboration CEC-INER-INCMNSZ
*Carso Foundation
CONCLUSIONS AND PERSPECTIVES
We will have to evaluate the impact of COVID19 pandemic in the HIV care in Mexico City in the short and long term
We will need to think about creative strategies to increase the HIV testing (self-testing, community level, etc.) in the context of COVID19
Active tracing: for patients LTFU
Despite the health crisis, prevention programs need to be implemented. We need PREP!
Virtual consult and telemedicine are now part of the new a reality
Collaboration of all three institutions was very successful and will need to continue, to improve HIV care in Mexico City
Acknowlegements
• Andrea González
• Eduardo Rodríguez
• Ricardo Samuel Niño
• Raul Adrián Cruz
• Diana Molina
• Clinical staff CEC
• Aldo Yannelli
• Juan Sierra Madero
• Lorena Guerrero Torres
• Alvaro López
• Yanin Caro
• Yamilé Serrano
• Cristian Espejo
• Karla Romero
• María Gómez Palacio
• Santiago Ávila Ríos
• Akio Murakami
• Rafael Rodríguez
• Clinical staff CIENI
• Florentino Badial
• Alicia Piñaeirúa
• All our Patients
Adela López Lugo
Jaime Montejo
Dedicated to all HCW in Mexico City that we have lost because of COVID19