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Did Universal Access to ARVT in Mexico Impact Suboptimal Antiretroviral Prescriptions?

DOI: 10.1155/2013/170417

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Abstract:

Background. Universal access to antiretroviral therapy (ARVT) started in Mexico in 2001; no evaluation of the features of ARVT prescriptions over time has been conducted. The aim of the study is to document trends in the quality of ARVT-prescription before and after universal access. Methods. We describe ARVT prescriptions before and after 2001 in three health facilities from the following subsystems: the Mexican Social Security (IMSS), the Ministry of Health (SSA), and National Institutes of Health (INS). Combinations of drugs and reasons for change were classified according to current Mexican guidelines and state-of-the-art therapy. Comparisons were made using tests. Results. Before 2001, 29% of patients starting ARVT received HAART; after 2001 it increased to 90%. The proportion of adequate prescriptions decreased within the two periods of study in all facilities ( value < 0.01). The INS and SSA were more likely to be prescribed adequately ( value < 0.01) compared to IMSS. The distribution of reasons for change was not significantly different during this time for all facilities ( value > 0.05). Conclusions. Universal ARVT access in Mexico was associated with changes in ARVT-prescription patterns over time. Health providers’ performance improved, but not homogeneously. Training of personnel and guidelines updating is essential to improve prescription. 1. Introduction The use of highly active antiretroviral therapy (HAART) has shown a dramatic impact in terms of decreasing morbidity and mortality among HIV/AIDS patients [1]. However, the large-scale implementation of antiretroviral therapy (ARVT), a term used to describe any type of antiretroviral drug regimen, has faced enormous barriers worldwide, particularly in middle and lower income countries. These obstacles are not solely related to the high cost of antiretrovirals but also to other factors related to the health systems and access to drugs. Some of these barriers have been as follows: a low level of expertise of the prescribing health professionals, little investment in training of healthcare workers, and limited laboratory capacity for viral load (VL) and CD4 monitoring [2]. Other more complex factors, such as poor adherence to treatment, antiretroviral drug toxicities, emergence of viral resistance, and social factors that include incarceration, drug abuse, and unmet basic human needs caused by extreme poverty, have also been mentioned as barriers to optimal treatment effectiveness [3, 4]. In Mexico between 1997 and 2001, ARVT was only provided to subjects that were affiliated with the

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