Transcript Slide 1

1
Assisting HIV-Infected (and other)
Patients Who May Return to Mexico
(or Central America)
Thursday, February 28, 2013
Los Angeles, CA
Disclosure Information
Helping HIV Patients Who May Return to Mexico
Tom Donohoe
Continuing Medical Education committee members
and those involved in the planning of this CME
Event have no financial relationships to disclose.
Tom Donohoe
I have no financial relationships to disclose
-and
I will not discuss off label use and/or investigational
use in my presentation
Objectives
 At the conclusion of this session,
participants will be able to:
 Review health care delivery systems in
Mexico, including those for HIV and other
services
 Facilitate culturally competent continuity of
care for HIV-infected patients returning to
Mexico and Central America
 Utilize 7 one-page bilingual HIV-referral fact
sheets for Mexico and 6 Central American
Countries
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AETC
Warmline: (800) 933 - 3413
PEPline:
(888) HIV – 4911
(888) 448 – 4911
Perinatal Hotline:
(888) 448 – 8765
http://www.aids-etc.org
http://www.AETCBorderHealth.org
Tom Donohoe
[email protected]
UCLA CHPDP HIV/AIDS Training Programs
Delivered in Mexico: 1995- 2005
Which of these US metropolitan areas
has the highest PERCENTAGE of
Spanish-speaking households?
13% 1) Miami, FL
13% 2) Los Angeles, CA
3) Santa Ana, CA
60% 4) El Paso, TX
15% 5) Las Cruces, NM
0%
The richest private citizen on the
planet is currently a man named?
24%
29%
19%
2%
26%
1)
2)
3)
4)
5)
Carlos Slim
Bill Gates
Warren Buffet
Ted Turner
Charles Delgado
The ‘US/Mexico border region’ is how
many miles above the border with
Mexico?
14% 1) 5
2)
37% 3)
23% 4)
16% 5)
9%
10
50
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I have no idea
“The Border”
I have had at least 1 patient born in
Mexico
93%
7%
1. True
2. False
I can explain how Mexican health care
systems work
17%
83%
1. True
2. False
Case
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Juan is a 23 year-old HIV-infected patient
from Mexico who calls the clinic to say he has
to return to Mexico in 2-3 days. He does not
remember all his medication names, except
“Sustiva, 2 colored pills…and Bactrim.” He
asks if he can get HIV care in Mexico and
shares he has not been there since he was a
child. He was born in Zacatecas and tells you
he thinks he may have to return there to live
with his grandparents.
Questions
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 Would you be able to connect Juan to HIV
care in Mexico?
 Why do you think Juan is returning to
Mexico?
 What other information would you need to
assist Juan? Why?
4) Most Mexicans are covered by the
largest health insurance program in
Mexico. It is paid for by the employer
and is known by the acronym______.
38%
33%
19%
2%
7%
1.
2.
3.
4.
5.
IMSS
ISSSTE
PEMEX
RED
TOTAL
7) CAPASITS are _______ HIV/STI care
clinics funded through the Secretariat of
Health and ______; referral to CAPASITS
requires an HIV diagnosis, antiretroviral
history, basic labs, clinical summary and a
referral from a general medical clinic.
0%
0%
0%
100%
0%
1.
2.
3.
4.
5.
Inpatient; CENSIDA
Inpatient; PEMEX
Outpatient; CENSIDA
Outpatient; Seguro Popular
None of the above
3) How many HIV antiretroviral
medications are currently
available in Mexico?
14%
17%
26%
12%
31%
1.
2.
3.
4.
5.
Fewer than 5
Between 5 and 10
Between 11 and 15
Between 16 and 20
More than 20
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Overview of the
Epidemiology of HIV
Infection in Mexico
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HIV and AIDS in Mexico
 Mexican population: 106,500,000
 Cumulative cases of HIV/AIDS at
the end of 2005: 182,000
HIV/AIDS Cumulative Cases
along the U.S.-Mexico Border
(as of Dec 31, 2011)
Baja Cal Norte:
Sonora:
Chihuahua:
Coahuila:
Nuevo León:
Tamaulipas:
6,863
2,748
6,457
1,783
4,367
3,737
TOTAL:
25,955
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10
Cumulative HIV by Gender
From: Update on HIV/AIDS in Mexico, Dec, 2011, General Director, National HIV/AIDS Program (Centro Nacional
para Prevención y Control del VIH/SIDA CENSIDA). http://www.salud.gob.mx/conasida
Source cited in original slide: CENSIDA based in National AIDS Cases Registry.
2) In the US, HIV prevalence is
.6%, which of the following
represents the HIV prevalence
in Mexico?
3%
33%
15%
40%
10%
1.
2.
3.
4.
5.
.1%
.3%
.6%
1.8%
2.4%
Mexico’s Adult HIV Prevalence 11
in Regional Context






Mexico
United States
El Salvador
Guatemala
Honduras
Belize
0.3%
0.6%
0.7%
1.1%
1.8%
2.4%
From: Update on HIV/AIDS in Mexico, June, 2007, Dr. Jorge Saavedra, General Director, National HIV/AIDS
Program (Centro Nacional para Prevención y Control del VIH/SIDA CENSIDA).
http://www.salud.gob.mx/conasida
Source cited in original slide: UNAIDS. 2004 Report on the global AIDS epidemic, Geneva, 2004
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Stigma and Discrimination
 “I will not live in the same house
with a person…
…of a different race” = 40%
…of a different religion” = 44%
…with HIV/AIDS” = 57%
…who is homosexual” = 66%
From: Update on HIV/AIDS in Mexico, June, 2007, Dr. Jorge Saavedra, General Director, National HIV/AIDS Program
(Centro Nacional para Prevención y Control del VIH/SIDA CENSIDA). http://www.salud.gob.mx/conasida
Source cited in original slide: “Encuesta Nacional de Cultura Política y Prácticas ciudadanas 2001”. Revista Cambio,
17 de Agosto del 2002. (National Survey of Culture, Politics and Citizen Practices, 2001, Change Magazine, August
17, 2002).
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HIV in the U.S.-Mexico
Border Region
U.S.-Mexico Border
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U.S. Border Characteristics
 3 of the 10 poorest counties in the U.S.
 21 counties designated as economically
distressed areas
 Unemployment rate 250-300% higher than
U.S. average
 432,000 people live in 1,200 colonias in
TX & NM; unincorporated, semi-rural
communities, often with unsafe water
supplies and substandard housing
United States Mexico Border Health Commission, 2008 http://www.borderhealth.org/border_region.php
U.S. Border Characteristics
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 Higher incidence of infectious diseases
compared with U.S. average
 If made a state, border region would rank:
 Last in access to health care
 2nd in death rates due to hepatitis
 3rd in deaths related to diabetes
 Last in per capita income
 1st in number of school children living
in poverty
 1st in number of uninsured children
Immigration
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 43 points of entry on U.S. border
 Nearly 195M passenger vehicle crossings
& 49M pedestrian crossings/year
at 25 ports of entry
 Numbers do not include undocumented
crossings
 Not all people who enter from the
U.S.-Mexico border are Mexican,
numbers include people from further south
University of Oklahoma Center for Applied Research, 2005. HIV AIDS Along the US Mexico Border
Mexican Immigration
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 People of Mexican origin make up
29.5% of all immigrants in the U.S.
 In 2005, 11 million Mexican
immigrants were living in the U.S.
• 66% located in the 4 border states
• 70% are 18-44 years of age
• 59% have no health coverage
• 55% are undocumented
Conasida 2008: Manual para la prevención del VIH/SIDA en migrantes Mexicanos a Estados Unidos. www.salud.gob/conasida
Who Is UMBAST?
 U.S. Mexico
 Border
 AETC
 Steering
 Team
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 Promote high-quality,
culturally sensitive
education & capacity
building programs
 Provide focused
collaboration through
joint planning,
resource sharing, &
evaluation
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Who Is UMBAST?
 UMBAST includes members from 3
AETCs that serve border region:
• Mountain Plains AETC (New Mexico)
• Pacific AETC (Arizona & California)
• Texas/Oklahoma AETC (Texas)
 In collaboration with AETC National
Resource & Evaluation Centers, HRSA
representatives, & others with an interest
in HIV and the border
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Regional AETCs
L
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Mexican Health Care
Delivery Systems
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US Health Care (1968 through 2014)
 Guaranteed only for military, prison, and
special programs for poor or elderly
 Most obtain coverage through an
employer, but employers are not required
to provide coverage
 Employees often must share plan costs
  30 million without coverage often use ER
or pay-for-service clinics
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U.S. HIV Health Care Funding
 Private insurance
 Public insurance
 Ryan White HIV/AIDS Treatment
Modernization Act
 Clinical trials
 Compassionate release
Mexico: Health as a
Constitutional Right
 Mexican Constitution establishes the right
of health care for all Mexican citizens
 Secretary of Health, appointed by the
President, oversees Secretaria de Salud
 Secretaria de Salud charged with health
surveillance, reporting, prevention, and
management
 Constitution protects migrant populations,
indigenous populations, children, youth,
women, and agricultural laborers
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30
de
Secretaría
Health CareSecretaría
Funding
Sources
IMSS
deSalud
Salud
SSA
ISSSTE
Servicios
Médicos
Privados
DIF
Cruz Roja
Mexicana
Health
Health
Health
Services
Services
Services
Hospitales
Universitarios
in Mexico
Servicios
Servicios
Médicos
Médicos
Municipales
Municipales
Servicios
Servicios
Médicos
Médicos
Estatales
Estatales
PEMEX
PEMEX
Secretaría
Secretaría
De
deMarina
Marina
SDN
SDN
L
HIV Care: A Priority
CONASIDA:
Policy-setting body
 Consejo Nacional
para la Prevención y
Control del SIDA
(National Council for
the Prevention and
Control of HIV/AIDS)
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CENSIDA:
Funding, care,
prevention, &
education
 Centro Nacional para
la Prevención y el
Control del VIH/SIDA
(National Center for
the Prevention and
Control of HIV/AIDS)
Seguro Popular
 2001: Secretaria de Salud instituted
Seguro Popular insurance program to
provide health care coverage to
uninsured/underserved populations
 2005: 5.1 million families covered by
Seguro Popular
 2007: Seguro Popular becomes law
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Seguro Popular
> 250 medical interventions covered
 Diabetes……….YES
(# 78. “Diagnosis and pharmacological treatment
of diabetes mellitus 2 (blood sugar)”
 TB Treatment…YES
 Family Planning Services…YES
 STI Treatment (CAPASITS)
 HIV Treatment (CAPASITS)
 Hepatitis C Treatment…NO
http://www.seguropopular.org
Antiretroviral Coverage
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28,600
30,000
25,000
20,000
15,000
10,000
5,000
0
1997
1998
1999
Social Security
2000
2001
2002
2003
SEGURO POPULAR
Source: CENSIDA based in National AIDS Cases Registry.
2004
Uncovered
HIV Health Care Funding Sources
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SSA
CENSIDA
Seguro Popular
IMSS
ISSSTE
PEMEX
Health
Services
ONG
CRM
Hospitals &
Universities
SME
SDN
SMM
SMP
DIF
SM
Major HIV Care Sources
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 Most public employees: ISSSTE
(Instituto de Seguridad y Servicios Sociales
de los Trabajadores del Estado)
 Insured private sector employees: IMSS
(Instituto Mexicano del Seguro Social)
 Uninsured/Migrant: SSA/CENSIDA
(Secretaria de Salud/Centro Nacional para la
Prevención y el Control del VIH/SIDA)
• Referred to CAPASITS Clinics
• Insured under Seguro Popular
CAPASITS








Centro
Ambulatorio de
Prevención y
Atención en
SIDA y
Infecciones de
Transmisión
Sexual
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Outpatient
Center for
Prevention and
Care for
AIDS and
Sexually
Transmitted
Infections
CAPASITS Locations
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From: National Center for Prevention and Control of HIV/AIDS, Operative Investigation Administration, Mexico
Secretariat of Health,
(Centro Nacional para la Prevención y el Control del VIH/SIDA Dirección de Investigación Operativa, Secretaría de
Salud). http://www.salud.gob.mx
CAPASITS Border Locations 38








Tijuana
Mexicali
Nogales
Cd. Juarez
Piedras Negros
Nvo Laredo
Reynosa
Matamoros
(San Diego, CA)
(El Centro, CA)
(Nogales, AZ)
(El Paso, TX)
(Eagle Pass, TX)
(Laredo, TX)
(McAllen, TX)
(Brownsville, TX)
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CAPASITS
Ciudad Victoria
Mexicali
Nayarit
Veracruz
La Paz
Zacatecas
From: National Center for Prevention and Control of HIV/AIDS, Operative Investigation Administration, Mexico
Secretariat of Health,
(Centro Nacional para la Prevención y el Control del VIH/SIDA Dirección de Investigación Operativa, Secretaría de
Salud). http://www.salud.gob.mx
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Referral to CAPASITS
 Referral from a general medical
clinic
 HIV diagnosis
 Antiretroviral history
 Basic labs
 Clinical summary
CAPASITS Services
 General medical
care
 HIV care
 ART treatment
 Laboratory
testing
 Specialist
referrals
 Dental care
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 Behavioral health
services
 Social work
services
 Adherence
counseling
 STD screening
 Outreach
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ARVs in Mexico:full chart available at
http://aidsetc.org/pdf/p02-et/et-03-00/mexicodrugs.pdf
Antiretrovirals Available in
the United States
Generic
Brand Name
Nucleoside/Nucleotide
Analogues (NRTIs)
Antirretrovirales Disponibles
en México
Genérico
Nombre Comercial
Inhibidores de la Trascriptasa
Reversa Análogos a Nucleósidos
(ITRAN)
Abacavir
Ziagenavir
Abacavir
Ziagen
Didanosine
Videx
Didanosina
Videx
Emtricitabine
Emtriva
Emtricitabina
Emtriva
Lamivudine
Epivir
Lamivudina
3TC
Stavudine
Zerit
Estavudina*
Zerit
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UMBAST Fact sheet: Mexico
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↑
CAPASITS link
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Search “Mexico border AIDS”
T
4) Most Mexicans are covered by the
largest health insurance program in
Mexico. It is paid for by the employer
and is known by the acronym______.
38%
33%
19%
2%
7%
1.
2.
3.
4.
5.
IMSS
ISSSTE
PEMEX
RED
TOTAL
7) CAPASITS are _______ HIV/STI care
clinics funded through the Secretariat of
Health and ______; referral to CAPASITS
requires an HIV diagnosis, antiretroviral
history, basic labs, clinical summary and a
referral from a general medical clinic.
0%
0%
0%
100%
0%
1.
2.
3.
4.
5.
Inpatient; CENSIDA
Inpatient; PEMEX
Outpatient; CENSIDA
Outpatient; Seguro Popular
None of the above
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Comments, Questions and
Answers
Post Test, Evaluation
and Needs Assessment