impact of covid19 pandemic on hiv care in mexico city · • andrea gonzález • eduardo...

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

mailto:[email protected]

❖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



Private


Government

States

Government

IMSS ISSSTE

PEMEX SEDENA

MARINA


family

Ministry of Health



Private insurance


Sector

Funds

Buyers

Users

Households Employer

PLWH who

know their

status

26% 73% <1%


private insurance



Private


Government

States

Government

IMSS ISSSTE

PEMEX SEDENA

MARINA


family

Ministry of Health



Private insurance


Sector

Funds

Buyers

Users

Households Employer

Mexico City

providers

Condesa Specialized Clinics (CSC)

National Institutes

(INCMNSZ and INER)


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



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



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

https://www.gob.mx/salud/documentos/

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

https://coronavirus.gob.mx/datos/

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

impact of covid19 pandemic on hiv care in mexico city · • andrea gonzález • eduardo...

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