Late Diagnosis Due to Missed Opportunities and Inadequate Screening Strategies in HIV Infected Mexican Women

Abstract

Late diagnosis of HIV remains a public health issue in Mexico. Most national programs target high-risk groups, not including women. More data on factors associated with late diagnosis and access to care in women are needed. In 2012-2013, Mexican women recently diagnosed with HIV were interviewed. Socio-cultural background, household-dynamics and clinical data were collected. Of 301 women, 49 % had <200 CD4 cells/mm, 8 % were illiterate, 31 % had only primary school. Physical/sexual violence was reported by 47/30 %; 75 % acquired HIV from their stable partners. Prenatal HIV screening was not offered in 61 %; 40 % attended consultation for HIV-related symptoms without being tested for HIV. Seeking medical care ≥3 times before diagnosis was associated with baseline CD4 <200 cells/mm (adjusted OR 3.74, 95 % CI 1.88-7.45, p < 0.001). There were missed opportunities during prenatal screening and when symptomatic women seeked medical care. Primary care needs to be improved and new strategies implemented for early diagnosis in women.

Sociodemographic differences among HIV-positive and HIV-negative recently pregnant women in Mexico City

“…That prevalence, when using national surveys and census as a comparator, seemed higher than the prevalence reported in the general population of women. [13] There are no published studies comparing HIV-positive with HIV-negative women in Mexico. One study compared gender differences between HIV-positive men and women in Mexico City and found that in general, women had less years of schooling than men, lower average monthly salaries, and they were more likely to have been infected by a stable partner than men.…”

“…Besides the fact that HPV infection and other STD are clearly described as risk factors associated with acquiring HIV, many studies have also described STD clinics as an opportunity to improve prevention and early diagnosis, since these clinics are the main contacts with medical services in young women. [13,25] It has been reported that women tend to have more medical contacts than men, through family planning and screening for cervical and breast cancer. This should be an opportunity to extend HIV test offer and improve HIV detection in women.…”

“…This questionnaire was adapted from a validated questionnaire used in a previous study for Mexican HIV-positive women. [13] To avoid observer bias, all questions were formatted as multiple-choice questions, with objective answers that did not depend on the interviewer's perception.…”

“…Although some studies describe Mexican women with HIV as highly vulnerable, [8,12,13] so far no studies have compared them to women without HIV. The aim of this study was to compare the sociodemographic characteristics of HIV-positive and HIV-negative women with a recent pregnancy, and evaluate the circumstances of HIV diagnosis for positive women.…”

Machine learning-selected variables associated with CD4 T cell recovery under antiretroviral therapy in very advanced HIV infection

“…It is thus likely that a person with HIV initiating ARV at a late phase of infection will recover CD4 T cells deficiently. This is aggravated by the high rate of late diagnosis in different countries and regions [7][8][9][10].…”