Sergio Bautista-Arredondo

HIV prevention efforts in Mexico often overlook heterosexual-identified men who have sex with men (H-MSM), a subgroup at elevated risk for HIV. Using data from the 2021-2022 National Survey on Sexual and Gender Diversity (ENDISEG), we examined condomless sex among cisgender MSM, categorizing participants by sexual identity (heterosexual vs. gay, bisexual, or other non-heterosexual), sexual behavior (only male partners vs. both male and female), and their combinations: H-MSM, H-MSMW, GB+MSM, and GB+MSMW. Among cisgender men, 3.9% (n = 775) reported a male sexual partner in the past year, and 41% of them identified as heterosexual. Condomless sex was reported by 63.8% of MSM overall and was most common among H-MSM (74.4%). Probit regression analysis showed significantly lower probabilities of condomless sex among H-MSMW (-19.8%), GB+MSM (-14.8%), and GB+MSMW (-15.9%) compared to H-MSM. Additional risk factors included older age, lower education, and depression. These findings underscore the limitations of considering MSM as one group and reveal a sizable, high-risk subgroup that may be missed by current HIV programs. Effective prevention strategies must integrate sexual identity and behavior and be adapted to Mexico's sociocultural context. Identity-sensitive approaches, particularly for H-MSM and H-MSMW, are essential to reduce HIV transmission in this population.

Limited research has been conducted on strategies to improve the efficiency of HIV services for key populations (KPs). This study investigates ways to enhance healthcare delivery efficiency, focusing on HIV services for KPs. We explore two strategies: expanding service volume and offering multiple HIV services within a single health facility. Using data from the Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) program in Kenya and Malawi, we exploit the variation in services provided to assess correlations between different service delivery configurations and their costs. We apply log-log fixed-effects regression models to analyze relationships between the total costs of four HIV services and the volume and range of services delivered. We find that service volume increases correlate with higher total costs, albeit less than proportionally, consistent with possible economies of scale. Negative correlations between service integration and total costs suggest that integrating HIV services for KPs could lead to reduced total costs for some service combinations. These results indicate potential strategies to increase the efficiency of HIV services for KPs, which can inform strategic planning and program execution in Kenya, Malawi, and similar countries.

Objetivo. Describir la metodología y los procedimientos de análisis de la Encuesta Nacional de Salud y Nutrición Continua 2024 (Ensanut Continua 2024). Material y métodos. La Ensanut Continua 2024 es la quinta encuesta de la serie de encuestas Ensanut 2020-2024. La Ensanut Continua 2024 permitirá realizar inferencias sobre el estado de salud y nutrición de los habitantes de México en 2024; además, con esta edición se completarán los tamaños de muestra estatales para poder hacer inferencias en las 32 entidades federativas en el periodo 2021-2024. Se describen los elementos principales de la Ensanut Continua 2024: procedimientos de muestreo, estimación, medición y organización logística. Resultados. La Ensanut Continua 2024 tendrá los siguientes cuestionarios completos esperados: 10 640 hogar, 12 085 adultos, 3 589 adolescentes, 2 424 escolares y 2 346 preescolares. Además, se espera tener al menos 1 000 entrevistas de hogar completas por estado en el periodo 2021-2024. Conclusiones. La Ensanut Continua 2020-2024 obtendrá estimaciones nacionales, estatales y tendencias en el periodo 2020-2024 y podrá ser utilizada como la base para realizar estimaciones a nivel estatal con periodicidad anual en los años siguientes.

Objetivo. Estimar gasto de bolsillo médico, gasto de bolsillo no médico y costos indirectos por pérdida de ingresos laborales entre pacientes sin seguridad social que reciben atención especializada de tercer nivel en la Ciudad de México. Material y métodos. Se realizó una encuesta de salida representativa de 17 unidades de tercer nivel en la zona metropolitana de la Ciudad de México. Se emplearon modelos logísticos y de regresión lineal para explorar características asociadas con la probabilidad y magnitud del gasto médico. Resultados. De 933 individuos, 68.6% no incurrió en gastos médicos. Entre quienes reportaron gasto (31.4%), la mediana fue de 752 pesos mexicanos. La probabilidad de gasto aumentó entre residentes fuera de la Ciudad de México y aquéllos con atención mayor a un año. Para la atención actual, las medianas de gastos no médicos y costos indirectos fueron 800, 200 y 1 426 pesos mexicanos, respectivamente. Conclusiones. Este estudio detalla la carga económica de la atención especializada de tercer nivel en México entre la población sin seguridad social. Los resultados evidencian aspectos a abordar para mejorar la equidad en el acceso a la salud, incluyendo el mejoramiento de la política de gratuidad, pero que también abarcan aspectos relacionados con los gastos no médicos y la pérdida de ingresos.

We conducted a cluster-randomized hybrid effectiveness-implementation study of CyberRwanda, a digital family planning and reproductive health intervention for Rwandan adolescents. Sixty schools were randomized 1:1:1 to control or to one of two implementation models—self-service (self-guided access on tablets) or facilitated (peer-led clubs plus tablet access) with no masking. Eligible participants were aged 12–19 years, in secondary school levels 1 or 2, and willing to provide consent or assent/parental consent and contact information for follow-up. In 2021, 6,078 randomly selected adolescents were enrolled. At 24 months, 91.3% of participants were retained and included in the primary intention-to-treat analyses (control, n = 1,845; self-service, n = 1,849 and facilitated, n = 1,858). There were no adverse events related to the study. CyberRwanda did not affect the primary outcomes of modern contraceptive use (prevalence ratio (PR) = 1.04; 95% confidence interval (CI) = 0.76, 1.42), childbearing (PR = 1.33; 95% CI = 0.71, 2.50) and HIV testing (PR = 1.00; 95% CI = 0.91, 1.11) in the full sample. Significantly higher modern contraceptive use observed in the CyberRwanda facilitated arm in a prespecified analysis of sexually active participants suggests that longer-term evaluation is needed to examine effects as more of the study population becomes sexually active and has increased demand for contraception. ClinicalTrials.gov registration: NCT04198272.

Objetivo. Estimar las prevalencias de uso de las pruebas del Papanicolaou (Pap) y del virus del papiloma humano (VPH) antes y después del inicio de la pandemia por SARS-CoV-2. Material y métodos. Se analizó el uso de las pruebas de tamizaje Pap y/o VPH en mujeres de 25 a 64 años (población objetivo) utilizando datos de Encuestas Nacionales de Salud y Nutrición 2018 y 2021-2023. Resultados. El uso de Pap disminuyó de 34.6% en 2018 a 24.9% en 2021, recuperándose hasta alcanzar 31.5% en 2023. De forma similar, el uso del VPH disminuyó de 12.7% en 2018 a 11% en 2021, y se incrementó a 16.0% en 2023. Se observó un mayor uso de las pruebas de detección del cáncer cervical a mayor nivel socioeconómico y urbanización. Conclusiones. Es preciso actualizar las directrices normativas y revisar los lineamientos para facilitar el tamizaje y el seguimiento del cáncer cervical en México.

Objetivo. Analizar la inseguridad del agua (IAg), frecuencia del suministro de agua (FSA) e inseguridad alimentaria (IA) en hogares mexicanos, abordando sus determinantes sociales y aportar recomendaciones para las políticas públicas. Material y métodos. Se analizó la información de 28 500 hogares de la Encuesta Nacional de Salud y Nutrición (Ensanut Continua 2020-2023). Se aplicaron escalas de experiencias validadas como HWISE y ELCSA, para medir la IAg e IA, así como un indicador sobre FSA, de acuerdo con algunos determinantes. Resultados. 16% de los hogares mexicanos experimentan IAg y 22% padecen IA moderada y severa. Sólo 34.7% recibe agua las 24 horas todos los días. Los determinantes de los hogares más afectados por la IAg, IA y en FSA son las peores condiciones de bienestar, ser indígena y cuando la IA e IAg se encuentran juntas en los hogares. Conclusiones. Es imprescindible acelerar la aplicación y mejorar la cobertura de acciones que impacten positivamente en el acceso y disponibilidad de agua y alimentos de las personas vulnerables.

This study aimed to evaluate the interest in event-driven PrEP (ED-PrEP) among men who have sex with men (MSM) using daily PrEP in Mexico's PrEP demonstration project between 2019 and 2020. We compared participants interested or not in ED-PrEP during their first-month visit and identified associated factors. Of 1,021 MSM attending their first-month visit, 7% had previous knowledge of ED-PrEP, but 40% were interested in ED-PrEP. However, over 50% perceived the scheme as less protective than daily PrEP. Having doubts about ED-PrEP's level of protection was related to less interest in the scheme (aOR = 0.11; CI = 0.07-0.18), just like reporting perceived barriers such as having frequent sex (aOR = 0.06; CI = 0.03-0.14), unplanned sex (aOR = 0.17; CI = 0.11-0.27), forgetting the medicine (aOR = 0.06; CI = 0.03-0.12), or difficulty carrying the medicine (aOR = 0.13; CI = 0.07-0.25). Finally, reporting not taking PrEP for >20 days in the last month (aOR = 0.05; CI = 0.01-0.27) diminished interest in ED-PrEP. In conclusion, few MSM daily PrEP users knew about ED-PrEP yet many were interested in it, suggesting the importance of awareness campaigns regarding ED-PrEP's effectiveness. The lack of interest in ED-PrEP among participants with poor adherence to daily PrEP indicates that they might prefer long-acting PrEP or HIV prevention strategies without medication.

PURPOSE: Cost containment and efficiency in the provision of health care are primary concerns for health systems that aim to provide affordable, high-quality care. Between 2005 and 2015, Seguro Poplar's Fund against Catastrophic Expenditures (FPGC) funded ALL treatment in Mexico. Before January 1, 2011, FPGC reimbursed a fixed amount per patient according to risk. In 2011, the per capita reimbursement method changed to fee for service. We used this natural experiment to estimate the impact of the reimbursement policy change on average expenditure and quality of care for ALL treatment in Mexico. METHODS: We used nationwide reimbursement data from the Seguro Poplar's FPGC from 2005 to 2015. We created a patient cohort to assess 3-year survival and estimate the average reimbursement before and after the fee-for-service policy. We examined survival and expenditure impacts, controlling for patients' and providers' characteristics, including sex, risk (standard and high), the volume of patients served, type of institution (federally funded v other), and level of care. To quantify the impact, we used a regression discontinuity approach. RESULTS: The average reimbursement for standard-risk patients in the 3-year survival cohort was $16,512 US dollars (USD; 95% CI, 16,042 to 17,032) before 2011 and $10,205 USD (95% CI, 4,659 to 12,541) under the fee-for-service reimbursement scheme after 2011. The average annual reimbursement per patient decreased by 136% among high-risk patients. The reduction was also significant for the standard-risk cohort, although the magnitude was substantially smaller (34%). CONCLUSION: As Mexico's government is currently restructuring the health system, our study provides evidence of the efficiency and effectiveness of the funding mechanism in the Mexican context. It also serves as a proof of concept for using administrative data to evaluate economic performance and quality of care of publicly funded health programs.