Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV but requires sustained adherence. Conditional economic incentives (CEIs) can improve medication-taking behaviors, yet preferences for programs that employ CEIs to increase PrEP use among male sex workers (MSWs) have not been investigated. We conducted a discrete choice experiment in Mexico City to elicit stated preferences for a CEI-based PrEP adherence program among MSWs. Respondents expressed their preferences for different program characteristics: incentive amount; incentive format; incentive type; and adherence-verification method. We used a random utility logit model to estimate the relative importance of each attribute and estimated willingness-to-pay (WTP). MSWs preferred a higher, fixed incentive, with PrEP adherence measured via hair sampling. MSWs were willing to forego up to 21% of their potential maximum CEI amount to ensure receipt of a fixed payment. MSWs are highly willing to accept a CEI-based intervention for PrEP adherence, if offered along with fixed payments.

The purpose of this study is to analyze the alignment of supply and demand for antenatal care (ANC) in Mexico based on the definition of access provided by Donabedian: the “degree of adjustment” between resources and needs. Alignment was studied in the teenage and adult population of Mexico that lacked conventional social security between 2008 and 2015, a period of expanding financial resources for health and public health insurance coverage. Spatial econometric methods were used to analyze data from the Ministry of Health on the supply and demand for ANC in 2,314 municipalities (94% of all municipalities in Mexico). During this period, the relative weight of ANC demand among adolescents increased 37% while the production of antenatal consultations for adolescent and adult women remained unchanged. Bivariate spatial analyses of correlation between supply and demand for ANC services yielded a minimal spatial correlation, or lack of territorial correspondence, between supply and demand among women in both age groups. Spatial econometric analysis confirmed a non-significant association between supply and demand for ANC services. Our findings suggest the existence of misalignment between supply and demand for these services. This requires a reassessment of the management and delivery of ANC services at the local level in order to increase effective coverage and improve the overall performance of the health system.

Objective. In 2021, Mexico launched the HEARTS program to improve the prevention and control of cardiovascular disease (CVD) risk factors in 20 primary care facilities in the states of Chiapas and Yucatán. This study projects the annual cost of program implementation and discusses budgetary implications for scaling up the program. Methods. We obtained district-level data on treatment protocols, medication costs, and other resources required to prevent and treat CVD. We used the HEARTS Costing Tool to estimate total and per-patient costs. A “partial implementation” scenario calculated the costs of implementing HEARTS if existing pharmacological treatment protocols are left in place. The second scenario, “full implementation,” examined costs if programs use HEARTS pharmacological protocol. Results. Respectively in the partial and full implementation scenarios, total annual costs to implement and operate HEARTS were $260 023 ($32.1 per patient/year) and $255 046 ($31.5 per patient/year) in Chiapas, and $1 000 059 ($41.3 per patient/year) and $1 013 835 ($43.3 per patient/year) in Yucatán. In Chiapas, adopting HEARTS standardized treatment protocols resulted in a 9.7 % reduction in annual medication expenditures relative to maintaining status-quo treatment approaches. In Yucatán, adoption was $12 875 more expensive, in part because HEARTS hypertension treatment regimens were more intensive than status quo regimens. Conclusion. HEARTS in the Americas offers a standardized strategy to treating and controlling CVD risk factors. In Mexico, approaches that may lead to improved program affordability include adoption of the recommended HEARTS treatment protocols with preferred medications and task shifting of services from physicians to nurses and other providers.

Summary Objective To analyze the formation of spatial clusters of technical efficiency (TE) in the production of outpatient maternal health services in México for the period 2008 to 2015. Methods We performed a longitudinal analysis of administrative and structural data related to the 243 Mexican health jurisdictions. We use window data envelopment analysis and spatial and econometric techniques. Structural correlates of each TE cluster obtained were identified estimating a pooled multinomial logit model. Results We observed an increase in the overall TE, accompanied by a reduction in its standard deviation. Furthermore, we identified positive TE spatial dependence both globally and locally. Multiple regression analysis showed that the maximum‐performance TE cluster was composed of health jurisdictions located in the North of México and characterized by social marginalization, a reduced indigenous population, and a low demand for maternal health services. Conclusions The identification of TE clusters can provide elements to induce decision makers to innovative in ways of allocating resources and manage their utilization. In México as other low‐ and middle‐income countries, it is key to develop targeting strategies to implement specific health services innovations putting to the population to be served at the front of the strategy. This implies testing new modalities to strengthen primary health services, the empowerment of community participation, the training and allocation of health personnel that could respond adequately to population's demand, and the active involvement of competent state and local authorities in the assessment of the results of these innovations.

Objective. To show lung cancer (LC) mortality and disability-adjusted life years (DALYs) in Mexico. Materials and methods. With the visualization tools at the Global Burden of Disease Study website, we analyzed LC mortality and disability-adjusted life years (DALYs) by state, sex, sociodemographic index (SDI), age, and risk factors between 1990 and 2016. Results. Mortality rate decreased from 13.9 to 9.1 per 100 000 between 1990 and 2016. This reduction is greater among men. However, deaths by LC rose from 5 478 to 8 470. DALYs rate also decreased. Northern states with higher SDI face a larger burden from LC but exhibited greater reductions compared with southern, less developed states. The burden of LC is concentrated among older population. Smoking is the main risk factor for LC. Conclusions. The burden by LC has decreased but is differential between states. LC threatens financially both the health system and individuals, since an important fraction of the population is not protected.