Did universal access to ART change prescribing patterns in Mexico?
Y.N. Caro Vega1, P. Volkow2, A. Colchero Aragones1, S. Bautista-Arredondo1
1Instituto Nacional De Salud Pública, Health Economics Division, Cuernavaca, Mexico, 2Instituto Nacional de Cancerología, Distrito Federal, Mexico
Background: In Mexico, since 2001 the government provides universal access to antiretroviral (ARV) treatment. The objective of this study is to describe patterns of combinations of drugs prescribed and treatment switching before and after universal access at four facilities of two different health subsystems: the Mexican Social Security (IMSS) provided to employees from the private sector, and Public Health Care (PH) System covering individuals without social security coverage.
Methods: Information was collected from medical records of 643 patients in 4 facilities between 2001 and 2005 including treatment initiation, drugs prescribed, CD4 counts and viral load tests. Combinations of drugs were classified as toxic: drugs that increase the risk of adverse reactions; inappropriate: when two or more drugs are antagonists or used without effect on viral replication; toxic and inappropriate; recommended: suggested explicitly by national guidelines; and combination not evaluated: does not appear in guidelines. Prescription decisions were always confronted to contemporary official guidelines. Treatment changes were classified as multi therapy initiation, boosting therapy, virological failure and toxicity.
Results: In all facilities HAART prescription increased from 20% before to 2000 to 90% in 2004-2005. The percentage of recommended combinations increased with time, suggesting better access and adherence to treatment guidelines. Less than 10% of combinations evaluated were toxic, virological failure being the most common reason for treatment change. The use of viral load count to guide change increased over time from 7% before 2000 to 60% in 2004-2005.
Conclusions: Similar patterns of treatment changes and prescription of antiretroviral were observed in the four facilities, although at different speeds. Access to official guidelines and laboratory resources, as viral load test to guide ARV prescriptions increase over time. Although studies have suggested that quality of care did not improve immediately after universal coverage, this study seems to indicate that different aspects of prescription decisions improve with time.
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