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CISIDAT Consorcio de Investigación en VIHISIDA y Tuberculosis A.C.
Infectious Diseases Consultant
Departamento de Infectologia
Hospital de Especialidades CMN Siglo XXI. Instituto Mexicano del Seguro Social
Ciudad de Mexico, Mexico
Dra Leticia M. Pérez Saleme has disclosed that she has received consulting fees from Gilead Sciences and Merck, and fees for non-CME/CE services from BD, Gilead Sciences, Janssen, Sandoz, and Siegfried.
Numerous factors have affected HIV treatment and care in México during the COVID-19 pandemic—some regarding patients, some healthcare institutions and systems, and others related to health personnel, including doctors, nurses, and social services. Below I address my experience with each of these factors.
Many patients opted not to present to the clinic because of fear of contracting COVID-19, resulting in suspension of their ARV treatment. Patients are afraid to present to the lab for their tests (eg, viral loads and CD4+ cell counts) due to fear of SARS-CoV-2 exposure, so we are now seeing patients who have not had lab follow-up for over a year.
Many patients lost their jobs, and with that also lost their employer-based health insurance (eg, IMSS or ISSSTE). These patients then had to transfer to other health coverage plans, such as that provided by the Ministry of Health (INSABI), or to private health insurance. During transition to a different health coverage system, some patients were lost to follow-up care, while other patients never transferred to another insurance at all.
From March through August 2020, many HIV clinics in México stopped all in-person outpatient consultations, switching to telephone or video call appointments only as recommended in the guidelines from the Secretary of Health. While evaluation of viral loads and CD4+ cell counts in virologically controlled patients was suspended, treatment initiation or assessment of persons without virologic control continued. In August, the Secretary of Health recommended resuming viral load and CD4+ cell count assessments in all persons with HIV, scheduling of appointments to avoid crowding, and that local pandemic conditions continue to be considered.
Most clinics continued to only dispense pharmacy forms (receta resurtible) for one month of ART. Some clinics provided pharmacy forms to patients that allowed them to present to the outpatient department every 3 months instead of every month, but patients still had to go to the pharmacy every month for their medications. There were many drug shortages, so many patients had to change their ARV treatment to what was available at the pharmacy at the time they presented to the clinic. Overall, the health infrastructure has been overwhelmed, so the availability of hospital beds for patients sick with something other than COVID-19 has been very limited.
While some clinics had enough personnel and social services to be able to contact patients, the presidential decree required vulnerable personnel—including pregnant and nursing women, people at risk of developing serious illness, people with a disease or pharmacological treatment that suppresses their immune system, persons with chronic noncommunicable diseases, persons with disabilities, and adults over 65 years of age—to stay at home, and health personnel who were at risk for severe COVID-19 were given work leave for 6 months or longer. This resulted in sudden staff shortages at most institutions, making it even more difficult to connect with patients who were lost to follow-up. Unfortunately, some of our experienced healthcare providers died of COVID-19, and the newly hired health personnel have little experience with HIV treatment.
As the pandemic continues, we are learning how to address each of these factors. However, the long-term consequences for patients with HIV in México remain to be seen.
Have these factors affected your ability to provide patients with HIV proper care during the COVID-19 pandemic? Please answer the polling question and share your thoughts in the discussion section.