Juan Pablo Gutiérrez

To describe the socioeconomic (SE) indicator developed for the analysis of the National Health and Nutrition Survey 2012 (NHNS 2012) and its validation. The SE indicator was generated imputing deciles of income level to the households on the NHNS 2012, using demographic and socioeconomic characteristics, and based on the National Income and Expenditure Survey 2010. As a validation, distribution of different household characteristics related to SE status was described by predicted decile. The resulting SE indicator adequately describes heterogeneity on standard socioeconomic variables, as schooling years of the head of household, income, access to services, and household assets. The socioeconomic heterogeneity captured by the proposed SE indicator allows identifying variability and gaps on health outcomes and programs coverage related to socioeconomic level.

To analyze, in the context of increased health protection in Mexico, the gaps by socioeconomic status and poverty condition on effective coverage of selected preventive interventions. Data from the National Health & Nutrition Survey 2012 and 2006, using previously defined indicators of effective coverage and stratifying them by socioeconomic (SE) status and multidimensional poverty condition. For vaccination interventions, immunological equity has been maintained in Mexico. For indicators related to preventive interventions provided at the clinical setting, effective coverage is lower among those in the lowest SE quintile and among people living in multidimensional poverty. Comparing 2006 and 2012, there is no evidence on gap reduction. While health protection has significantly increased in Mexico, thus reducing SE gaps, those gaps are still important in magnitude for effective coverage of preventive interventions.

To analyze the coverage of health protection in Mexico, as well as its trends from 2000 to 2012. Descriptive analysis using household informant report about health protection in the national health surveys 2000, 2006 & 2012, profiling unprotected population in 2012, and demographic differences by scheme of health protection. From 2000 to 2012, Mexican population that reported to be without health protection decreased from 57.6 to 21.4%. This reduction is mainly due to the increase in coverage of Seguro Popular, which by 2012 is the main insurer in Mexico, covering 38.5 of the population. Unprotected population is concentrated between 15 and 30 years of age. These results present a huge increase in health protection in Mexico in the past 12 years. Nevertheless, they also highlight the complexity of reaching universal health protection in a fragmented health system.

Objective. To estimate calendar of sexual debut in Mexico and its trends using national representative household surveys. Materials and methods. Analysis of five birth cohorts extracted from four national population based household surveys in Mexico (National Health Survey 2000, National Survey on Demographic Dynamics 2009, National Youth Survey 2010, and National Health & Nutrition Survey 2012), using as outcome the proportion of individuals that reported sexual debut before the age of 16 and before the age of 20. Results. Overall, the four analyzed surveys produce consistent results, although some differences were found. While a larger proportion among younger cohorts reported sexual debut before the age of 20, that was not the case for sexual debut before 16 years. Conclusions. While data seems to reflect a relative stable age of sexual debut in Mexico, there is a recent trend to prepone sexual initiation that highlights the need to strengthen comprehensive sexual education and t...

To test acceptability and reliability of audio computer-assisted self-interviewing (ACASI) system administered at the household level to gather data on risk behaviors among adolescents in Mexico. Answers to sensitive behavior-related questions obtained using ACASI systems were compared with answers to the same questions obtained through face-to-face interviews (FFIs). Focus groups were conducted to explore ACASI acceptability among adolescents and its feasibility in obtaining better self-reported data on sensitive behaviors. ACASI was adolescents' preferred method for reporting risk behaviors, particularly sexual behavior, and did not pose greater challenges to respondents versus FFIs. Also, more risk behaviors were reported through ACASI versus FFIs. The use of ACASI systems in disadvantaged households to obtain data on adolescent risk behavior is not only feasible but may also improve data quality in the case of complex questionnaires, compared with FFIs, and should therefore be considered as an alternative survey method.

To analyze the challenges and accomplishments of the Mexican health system as it faced the HIV/AIDS epidemic over the 20 years since discovery of the virus. A review of the relevant literature was done. The topics revised were: HIV/AIDS epidemiology, the early response of the health system and civil society, prevention and risk behaviors, care and treatment, and financing and resources allocation. In Mexico a rapid initial public response surely contributed to containing any early spread of the epidemic to select populations; whether that spread will continue to be contained is an open question. Sexual risk practices remain high not only among traditional risk populations but also among youth. Even though the epidemic remains concentrated in Mexico, principally among MSM and IDU, only 13% of public HIV prevention funds are directed to key populations at especially high risk of becoming infected or infecting others. In recent years antiretroviral coverage has increased rapidly with f...

To analyze socioeconomic, health conditions and access to health services of Mexican indigenous population between 2006 and 2012. A comparative analysis was done between indigenous and non indigenous population, using the information from th National Health and Nutrition Survey (2006 and 2012). 60% of the indigenous population was allocated at the poorest socioeconomic level in 2012 despite the implementation of social programs. The Seguro Popular increased its coverage from 14 to 61.9% in indigenous population. The increase observed in coverage in no indigenous population was from 10 to 35.7%. Nevertheless, no increase was observed in the utilization of healthcare services between indigenous and non indigenous population. The access to hospital services for childbirth delivery increased from 63.8 to 76.4% in indigenous population. However there is an important difference with non indigenous population (93.9%). The increase in the coverage of the Seguro Popular in Mexico has had het...

To estimate the magnitude of diabetes in Mexico, as well as discuss alternative policies to face it appropriately. Descriptive analysis of the National Health and Nutrition Survey 2012, using reported information on previous diagnosis of diabetes from adults and adolescents. From all adults 20 years and older in Mexico, 9.17% has been diagnosed with diabetes, presenting an important geographical heterogeneity, ranging from 5.6% in the southern state of Chiapas, to 12.3% in Mexico City. Of all people with diabetes, 46.95% also have been diagnosed with hypertension, 4.47% has had a stroke, and 54.46%, reported family background of diabetes. Regarding adolescents, 0.68% has been already diagnosed with diabetes. The burden of diabetes in Mexico and the fact that is a preventable condition, calls to strengthen the health sector strategies to face it. The negative effect it has on the quality of life makes diabetes a priority for the health sector.

Compare two indirect methods for measuring adherence to antiretrovirals (ARV) for people living with HIV (PLWHA) in México. Sectional study of direct interviews with patients selected from a representative sample of PLWHA care units in México. We estimated in 2,054 patients the adherence of four days as the measurement used traditionally in México and the adherence index as a measurement that is reported more correlated with biological measurements. For the latter, use was made of all items on the questionnaire AIDS Clinical Group (ACTG) (adherence rate, monitoring the schedule and special instructions, and time since the last time you stopped taking ARV). In both cases, was considered adequate adhesion values ≥ 95%. The adherence of four days identifies 13.2% (n = 271) of patients with levels less than the recommended (8.3% of 56-94% and 4.9% of 0- 55%) according to the index, the percentage of patients with lower levels of adherence to recommended was 45.0% (n = 924) (40.5% of 56-...

The "3 by 5" goal to have 3 million people in low and middle income countries on antiretroviral therapy (ART) by the end of 2005 is ambitious. Estimates of the necessary resources are needed to facilitate resource mobilisation and rapid channelling of funds to where they are required. We estimated the financial costs needed to implement treatment protocols, by use of country-specific estimates for 34 countries that account for 90% of the need for ART in resource-poor settings. We first estimated the number of people needing ART and supporting programmes for each country. We then estimated the cost per patient for each programme by country to derive total costs. We estimate that between US5.1 billion dollars and US5.9 billion dollars will be needed by the end of 2005 to provide ART, support programmes, and cover country-level administrative and logistic costs for 3 by 5.