ClinicalThought – Impact of COVID-19 on HIV care – Clinical rationales – COVID-19 and HIV in Mexico – HIV

Various factors have affected HIV treatment and care in Mexico during the COVID-19 pandemic; some factors are linked to patients, others to healthcare institutions and systems, and still others to healthcare personnel, including physicians, nurses and social services. Next, I will share my experience with each of these factors.

Factors linked to patients
Many patients chose not to attend the clinic for fear of catching COVID-19, which led to the suspension of their antiretroviral (ARV) treatment. Patients do not want to go to the laboratory for their tests (for example, viral loads and CD4 + cell counts) for fear of exposure to SARS-CoV-2 and, for this reason, we are now seeing patients who have not had a follow-up of laboratory for more than a year.

Many patients lost their jobs and, as a consequence, also lost their employer-funded health insurance (eg, IMSS or ISSSTE). So they had to transfer to other health coverage plans, such as the one offered by the Ministry of Health (INSABI), or to private health insurance. During the transition to a different health coverage system, some patients lost follow-up care and others did not even get other insurance.

Institutional factors
From March to August 2020, many HIV clinics in Mexico suspended all in-person outpatient consultations and chose to provide appointments by phone or video call only as recommended by the Ministry of Health guidelines. Although the evaluation of viral loads and CD4 + cell counts in virally controlled patients was discontinued, the initiation of treatments or the evaluation of people without viral control continued. In August, the Ministry of Health recommended resuming the evaluations of viral loads and CD4 + cell counts in all people with HIV, scheduling appointments to avoid crowds, and continuing to take into account the local conditions of the pandemic.

Most clinics only continued to fill pharmacy forms (refills) for one month of ART. Some clinics provided pharmacy forms to patients and this allowed them to go to the outpatient department every 3 months instead of every month, but patients had to keep going to the pharmacy every month to get their medications. Due to the shortage of many medicines, many patients were forced to change their ARV treatment for what the pharmacy offered when they went to the clinic. In general, the health infrastructure has been saturated and the availability of hospital beds for patients with a disease other than COVID-19 has been very limited.

Health personnel
While many clinics had sufficient staff and social services to contact patients, the presidential decree required vulnerable staff (including pregnant and lactating women, people at risk of developing serious illnesses, people with a disease or drug treatment that suppresses the immune system, people with chronic non-communicable diseases, people with disabilities, and adults over 65 years of age) ) stayed at home, and healthcare personnel at risk of COVID-19 received a 6-month or longer license. This caused a sudden decrease in staff at most institutions and made communication with patients who had lost follow-up even more difficult. Sadly, some of our experienced healthcare providers passed away from COVID-19 and the new healthcare staff have very little experience treating HIV.

As the pandemic continues, we are learning how to address each of these factors. However, it remains to be seen what the long-term consequences will be for HIV patients in Mexico.

Your opinion
Have these factors affected your ability to provide adequate care for HIV patients during the COVID-19 pandemic? Answer the survey question and share your opinion in the discussion section.

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