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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. - PowerPoint PPT Presentation
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Assisting HIV-Infected (and other) Patients Who May Return to Mexico (or Central America)
Thursday, February 28, 2013Los Angeles, CA
1
Disclosure InformationHelping 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
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
Objectives 4
AETCWarmline: (800) 933 -
3413 PEPline: (888) HIV –
4911 (888) 448 – 4911 Perinatal Hotline:
(888) 448 – 8765
http://www.aids-etc.orghttp://www.AETCBorderHealth.org
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?
15%60%0%13%13% 1) Miami, FL
2) Los Angeles, CA3) Santa Ana, CA4) El Paso, TX5) Las Cruces, NM
The richest private citizen on the planet is currently a man named?
26%
2%
19%
29%
24% 1) Carlos Slim2) Bill Gates3) Warren Buffet4) Ted Turner5) Charles Delgado
The ‘US/Mexico border region’ is how many miles above the border with Mexico?
16%23%37%9%14% 1) 5
2) 103) 504) 625) I have no idea
“The Border”
I have had at least 1 patient born in Mexico
7%93% 1. True
2. False
I can explain how Mexican health care systems work
83%17% 1. True
2. False
Case 5Juan 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 6 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______.
7%
2%
19%
33%
38% 1. IMSS2. ISSSTE3. PEMEX4. RED5. 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%
100%
0%
0%
0% 1. Inpatient; CENSIDA2. Inpatient; PEMEX3. Outpatient; CENSIDA4. Outpatient; Seguro Popular5. None of the above
3) How many HIV antiretroviral medications are currently available in Mexico?
31%
12%
26%
17%
14% 1. Fewer than 52. Between 5 and 103. Between 11 and 154. Between 16 and 205. More than 20
Overview of the Epidemiology of HIV
Infection in Mexico
7
HIV and AIDS in Mexico
Mexican population: 106,500,000
Cumulative cases of HIV/AIDS at the end of 2005: 182,000
8
HIV/AIDS Cumulative Cases 9 along the U.S.-Mexico Border
(as of Dec 31, 2011)
Baja Cal Norte: 6,863Sonora: 2,748Chihuahua: 6,457 Coahuila: 1,783 Nuevo León: 4,367Tamaulipas: 3,737
TOTAL: 25,955
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.
Cumulative HIV by Gender10
2) In the US, HIV prevalence is .6%, which of the following represents the HIV prevalence in Mexico?
10%40%
15%33%
3% 1. .1%2. .3%3. .6%4. 1.8%5. 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
Mexico’s Adult HIV Prevalence 11 in Regional Context
Mexico 0.3% United States 0.6% El Salvador 0.7% Guatemala 1.1% Honduras 1.8% Belize 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: “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).
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%
15
HIV in the U.S.-Mexico Border Region
17
U.S.-Mexico Border 18
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 Characteristics19
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
U.S. Border Characteristics20
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
Immigration
University of Oklahoma Center for Applied Research, 2005. HIV AIDS Along the US Mexico Border
21
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
Mexican Immigration22
Who Is UMBAST?
U.S.-MexicoBorderAETCSteering Team
Promote high-quality, culturally sensitive education & capacity building programs
Provide focused collaboration through joint planning, resource sharing, & evaluation
23
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
24
Regional AETCs
L
25
Mexican Health Care Delivery Systems
26
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
27
U.S. HIV Health Care Funding Private insurance Public insurance Ryan White HIV/AIDS Treatment
Modernization Act Clinical trials Compassionate release
28
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
29
Health Care Funding SourcesIMSS
Servicios MédicosPrivados
DIF
ServiciosMédicos
MunicipalesServicios Médicos Estatales
SecretaríaDe
Marina
SDN
PEMEX
Hospitales Universitarios
Cruz Roja Mexicana
ISSSTE
Health Services
Secretaría deSaludSSA
IMSS
Servicios MédicosPrivados
DIF
ServiciosMédicos
MunicipalesServicios Médicos Estatales
SecretaríaDe
Marina
SDN
PEMEX
Hospitales Universitarios
Cruz Roja Mexicana
ISSSTE
Health Services
Secretaría deSaludSSA
IMSS
Servicios MédicosPrivados
DIF
ServiciosMédicos
MunicipalesServicios Médicos Estatales Secretaría
de Marina
SDN
PEMEX
Hospitales Universitarios
Cruz Roja Mexicana
ISSSTE
Health Services
Secretaría de Salud
SSA
Health Servicesin Mexico
L
30
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)
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)
31
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
32
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
0
5,000
10,000
15,000
20,000
25,000
30,000
1997 1998 1999 2000 2001 2002 2003 2004
Social Security SEGURO POPULAR Uncovered
Source: CENSIDA based in National AIDS Cases Registry.
28,600
33
SSACENSIDA
Seguro Popular
SME
Health Services
IMSS
DIF SMSDN
Hospitals & Universities
CRM
ISSSTE
SMPSMM
ONG
PEMEX
HIV Health Care Funding Sources34
Major HIV Care Sources 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
35
CAPASITS Centro Ambulatorio de Prevención y Atención en SIDA y Infecciones de Transmisión Sexual
OutpatientCenter forPrevention andCare forAIDS and Sexually TransmittedInfections
36
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 Locations37
CAPASITS Border Locations Tijuana (San Diego, CA) Mexicali (El Centro, CA) Nogales (Nogales, AZ) Cd. Juarez (El Paso, TX) Piedras Negros (Eagle Pass,
TX) Nvo Laredo (Laredo, TX) Reynosa (McAllen, TX) Matamoros (Brownsville, TX)
38
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
Ciudad Victoria Nayarit La Paz
Veracruz ZacatecasMexicali
39
Referral to CAPASITS Referral from a general medical
clinic HIV diagnosis Antiretroviral history Basic labs Clinical summary
40
CAPASITS Services General medical
care HIV care ART treatment Laboratory
testing Specialist
referrals Dental care
Behavioral health services
Social work services Adherence
counseling STD screening Outreach
42
ARVs in Mexico:full chart available at
http://aidsetc.org/pdf/p02-et/et-03-00/mexicodrugs.pdfAntiretrovirals
Available in the United States
Antirretrovirales Disponibles en México
Generic Brand Name Genérico Nombre Comercial
Nucleoside/Nucleotide Analogues (NRTIs)
Inhibidores de la Trascriptasa Reversa Análogos a Nucleósidos (ITRAN)
Abacavir Ziagen Abacavir ZiagenavirDidanosine Videx Didanosina VidexEmtricitabin
e Emtriva Emtricitabina Emtriva
Lamivudine Epivir Lamivudina 3TCStavudine Zerit Estavudina* Zerit
43
46
UMBAST Fact sheet: Mexico 47
48
↑
50
CAPASITS link 51
Search “Mexico border AIDS”
T
57
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______.
7%
2%
19%
33%
38% 1. IMSS2. ISSSTE3. PEMEX4. RED5. 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%
100%
0%
0%
0% 1. Inpatient; CENSIDA2. Inpatient; PEMEX3. Outpatient; CENSIDA4. Outpatient; Seguro Popular5. None of the above
Comments, Questions and Answers
Post Test, Evaluation and Needs Assessment
60