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

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 χ (2) 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 (P value < 0.01). The INS and SSA were more likely to be prescribed adequately (P value < 0.01) compared to IMSS. The distribution of reasons for change was not significantly different during this time for all facilities (P 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.

Figure 1

Comparison between patients who were included and patients who were not included.

Figure 2

Type of drugs used by subsystem and year of introduction. Note. Every drug was used beginning at the year marked in the figure during the period of study, with the following exceptions in the INS: DELAV was used between 1998 and 1999, HU was used between 1999 and 2000, and DDC was used between 1992 and 1998. The “x” indicates the year the FDA approved the drug, except for AZT which was approved in 1987 [15].

Figure 3

Distribution of patients by health subsystem and the type of initial ARVT. *Percentages were calculated with respect to the number of patients initiating therapy by period in each facility. IMSS information was available from 1993, SSA from 1999, and INS from 1990. The number over each bar is the total number of patients by category.