Access to diagnostic testing for invasive fungal diseases and other opportunistic infections in Mexican health care centers caring for patients living with HIV.

Abstract

Background: The burden of opportunistic infections (OIs) remains high among people living with HIV (PLWH) in Mexico, despite improvements in mortality worldwide.

Objective: Reporting the current access to diagnostics of OIs in Mexican Health Care Centers offering health-care services to PLWH.

Methods: An online questionnaire was sent to public health care facilities providing HIV care in Mexico. We evaluated capacities to 1) identify individuals with advanced-HIV, and 2) local and/or on-site access to: point-of-care assays, imaging studies, histological analysis, and microbiology tests useful to diagnose a wide variety of OIs.

Results: In 2022, 46 centers answered the questionnaire, from 23/32 (71.8%) states of the country; 29 (63%) were primary care facilities, 5 (11%) general hospitals and 12 (26%) tertiary care hospitals, providing health services to 67,000 PLWH. These centers received 1,135 new patients/month, 48% with advance disease. Less than 50% could determine CD4 + T cell count (39%, N = 18), toxoplasma serology (41%, N = 19) and HIV viral load (41%, N = 19). Twenty-five centers could diagnose cryptococcosis and tuberculosis (54%). Meanwhile, 11 centers (24%) had access to aspergillosis or Histoplasma tests. Seven centers (11%) had access to coccidioidomycosis tests, five centers to any Pneumocystis diagnosis. In primary care centers, Mycobacterium tuberculosis complex GeneXPert was accessible in 41%, cryptococcal antigen by latex agglutination was available in one facility (3%), Indian ink in 9 centers (31%). No primary health center had access to lateral flow test for Cryptococcus or Histoplasma antigens.

Conclusions: In Mexico, most public HIV-dedicated health care centers lack on-site capacity to diagnose opportunistic infections, specifically fungal infections. Rapid tests and point-of-care tests are frequently unavailable, which is more pronounced in primary care centres. Considering that IFDs still contribute significantly to mortality among PLWH, better access to diagnostic tools in all levels of HIV-care is urgent.