RESUMO Para alcançar os objetivos de desenvolvimento e saúde sustentáveis, é fundamental aumentar a capacidade tecnológica das populações mais desfavorecidas. Com a entrada do século XXI, há tecnologias necessárias para isso. O déficit em capacidade tecnológica decorre de um gradiente tecnológico entre a produção em pequena e larga escala pela falta de incentivos à inovação e difusão em empresas e comunidades pequenas. Nestas esferas, a evolução tecnológica, que é o eixo do desenvolvimento, é um bem público que não é provido de forma eficiente pela economia de mercado. Políticas públicas de inovação e difusão tecnológicas são necessárias. Diminuir o gradiente tecnológico constitui, portanto, a base da Agenda 2030 para o Desenvolvimento Sustentável, da Agenda das Nações Unidas e da Agenda de Saúde Sustentável para as Américas 2018-2030 da Organização Pan-Americana da Saúde. Requer também o desenvolvimento dos sistemas de saúde que servem como mecanismos de redistribuição para romper com as armadilhas da pobreza. Ademais, a experiência adquirida nesses sistemas é indispensável para instituir políticas de aumento da capacidade tecnológica que diminuam a pobreza, melhorem os determinantes sociais da saúde e, assim, reduzam a dimensão da armadilha do desenvolvimento humano.

SUMMARY In order to achieve the Sustainable Development and Health Goals, it is essential to increase the technological capacity of the most disadvantaged populations. In the 21st century, the necessary technologies for this exist. The gap in technological capacity reflects the existence of a technological gradient between large- and small-scale production, due to an absence of incentives for innovation and a lack of technological dissemination in small businesses and communities. Technological change is central to development, but it is a public good that the market economy does not provide efficiently. Providing it requires the implementation of public policies aimed at technological innovation and dissemination. Reducing the technological gradient is therefore a major part of the United Nations 2030 Agenda for Sustainable Development and the Pan American Health Organization’s 2018-2030 Sustainable Health Agenda for the Americas. This also applies to the development of health systems, which function as a redistribution mechanism to break poverty traps. In addition, experiences in these systems are relevant to the implementation of policies that increase technological capacities aimed at reducing poverty, improving social determinants of health, and thereby reducing the scale of the human development trap.

RESUMEN Para lograr los objetivos de desarrollo y salud sostenibles, es esencial incrementar las capacidades tecnológicas de las poblaciones más desfavorecidas. Entrado el siglo XXI, existen las tecnologías necesarias para ello. El déficit en capacidades tecnológicas se debe a la existencia de un gradiente tecnológico entre la producción de gran y de pequeña escalas, debido a la falta de incentivos para la innovación y la difusión en empresas y comunidades pequeñas. En estos ámbitos el cambio tecnológico, punto medular del desarrollo, es un bien público que la economía de mercado no provee eficientemente. Su provisión requiere la aplicación de políticas públicas de innovación y difusión tecnológicas. La reducción del gradiente tecnológico constituye, pues, parte medular de la Agenda 2030 para el Desarrollo Sostenible, de las Naciones Unidas, y la Agenda de Salud Sostenible para las Américas 2018-2030, de la Organización Panamericana de la Salud. Esto es aplicable, así mismo, al desarrollo de los sistemas de salud, que funcionan también como mecanismos de redistribución para romper las trampas de pobreza. Asimismo, las experiencias en esos sistemas tienen relevancia para aplicar políticas de incremento de capacidades tecnológicas que disminuyan la pobreza, mejoren los determinantes sociales de la salud y, con ello, reduzcan la magnitud de la trampa de desarrollo humano.

Abstract: 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.

Resumen: Objetivo: Mostrar la mortalidad y los años de vida saludables (Avisas) perdidos por cáncer de pulmón (CP) en México. Material y métodos: Con la herramienta de visualización del estudio de la Carga Global de la Enfermedad, se analizó mortalidad y Avisas por CP según diferentes criterios entre 1990 y 2016. Resultados: La tasa de mortalidad disminuyó de 13.9 a 9.1 por 100 000. Dicha reducción fue mayor entre hombres. Las muertes por CP crecieron de 5 478 a 8 470. La tasa de Avisas se redujo. La carga del CP se concentra en grupos de edad avanzada. Los estados del norte, con mayor nivel sociodemográfico, enfrentan mayor carga, pero presentaron mayores reducciones comparados con estados menos desarrollados. Fumar es el principal factor de riesgo para CP. Conclusiones: La carga por CP ha disminuido pero es diferencial entre estados. El CP amenaza financieramente el sistema de salud y la población, pues una fracción importante no está protegida.

Abstract: 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.

Resumen: Objetivo: Mostrar la mortalidad y los años de vida saludables (Avisas) perdidos por cáncer de pulmón (CP) en México. Material y métodos: Con la herramienta de visualización del estudio de la Carga Global de la Enfermedad, se analizó mortalidad y Avisas por CP según diferentes criterios entre 1990 y 2016. Resultados: La tasa de mortalidad disminuyó de 13.9 a 9.1 por 100 000. Dicha reducción fue mayor entre hombres. Las muertes por CP crecieron de 5 478 a 8 470. La tasa de Avisas se redujo. La carga del CP se concentra en grupos de edad avanzada. Los estados del norte, con mayor nivel sociodemográfico, enfrentan mayor carga, pero presentaron mayores reducciones comparados con estados menos desarrollados. Fumar es el principal factor de riesgo para CP. Conclusiones: La carga por CP ha disminuido pero es diferencial entre estados. El CP amenaza financieramente el sistema de salud y la población, pues una fracción importante no está protegida.

ABSTRACT This study assessed the genetic variability in open-pollinated progenies of Eucalyptus urophylla for resistance to rust (Puccinia psidii). The progeny trial was conducted on a statistical randomized block design with 20 progenies, five plants per plot, and nine replications. Analysis of variance showed high genetic variability for the studied trait, with potential for selection gains. The genetic variability of this population provides support to conduct a breeding program with superior individuals for rust resistance, allowing low costs and minimizing the yield losses on eucalyptus plantations.

RESUMO O uso de clones adaptáveis a regiões com déficit hídrico e épocas bem definidas e prolongadas de seca, como acontece no Oeste da Bahia, é uma forma de superar tal estresse. O manejo do K também interfere neste aspecto, pois regula a abertura e o fechamento dos estômatos, impedindo que a planta perca água desnecessariamente, tornando-a mais eficiente no uso da água. Logo, o objetivo deste trabalho foi avaliar o desempenho produtivo de clones de eucalipto e doses de potássio para as condições edafoclimáticas do município de Luis Eduardo Magalhães, localizado no Oeste do estado da Bahia, visando à produção energética. O delineamento experimental foi em blocos ao acaso com quatro repetições, no esquema de parcelas subdivididas. Foram testados seis clones de eucalipto (AEC-056, AEC-144, AEC-220, AEC-224, AEC-103 e AEC-1528), e quatro doses de K2O (0, 30, 60 e 120 kg ha-1). Aos dois anos de idade o clone AEC 1528 foi o que apresentou maior crescimento em altura e diâmetro enquanto o AEC 056 o menor. O clone AEC 1528 apresentou maior produtividade. Notou-se exigência diferenciada de K entre os clones de eucalipto tanto para o crescimento quanto produtividade.

ABSTRACT The use of clones adapted to regions with water deficit caused by well-defined and prolonged dry periods, as happens in the western part Bahia, is a way to overcome water stress. The adjustment of potassium (K) also influences this aspect, because it regulates the opening and closing of stomata, impeding water loss by plants and making them more efficient in water use. Therefore, the aim of this study was to evaluate the performance of eucalyptus clones grown for energy production in response to potassium levels in soil and climate conditions, in the municipality of Luis Eduardo Magalhães, located in western Bahia state. A randomized block with four replications in a split plot was used as experimental design. Six eucalyptus clones (AEC-056, CEA-144, CEA-220, CEA-224, CEA-103 and CEA-1528) and four doses of K2O (0, 30, 60 and 120 kg ha-1) were tested. At two years old, clone 1528 showed greatest productivity, with the tallest height and trunk diameter, while 056 showed the lowest performance. Different K requirements were observed among eucalyptus clones for both growth and productivity.

Abstract: Objective: To test the association between public health insurance and adequate prenatal care among female adolescents in Mexico. Materials and methods: Cross-sectional study, using the National Health and Nutrition Survey 2000, 2006, and 2012.We included 3 978 (N=4 522 296) adolescent (12-19) women who reported a live birth.We used logistic regression models to test the association of insurance and adequate (timeliness, frequency and content) prenatal care. Results: The multivariable predicted probability of timely and frequent prenatal care improved over time, from 0.60 (IC95%:0.56;0.64) in 2000 to 0.71 (IC95%:0.66;0.76) in 2012. In 2012, the probability of adequate prenatal care was 0.54 (IC95%:0.49;0.58); women with Social Security had higher probability than women with Seguro Popular and without health insurance. Conclusion: Having Social Security is associated with receipt of adequate prenatal care among adolescents in Mexico.

Resumen: Objetivo: Comprobar la asociación entre el aseguramiento público en salud y la atención prenatal adecuada en mujeres adolescentes. Material y métodos: Análisis transversal de datos de 3 978 mujeres (N=4 522 296) que reportaron embarazo en la adolescencia (12-19 años), derivados de las Encuestas Nacional de Salud 2000 y de Salud y Nutrición 2006 y 2012. Mediante modelos de regresión logística se analizó oportunidad, frecuencia y contenido de la atención prenatal. Resultados: La probabilidad de recibir atención prenatal oportuna y frecuente aumentó de 0.60 (IC95%:0.56;0.64) en 2000 a 0.71 (IC95%:0.66;0.76) en 2012. En 2012 la probabilidad de recibir atención oportuna, frecuente y con contenido básico fue 0.54 (IC95%:0.49;0.58) siendo mayor en mujeres con Seguridad Social que en aquéllas afiliadas al Seguro Popular o sin aseguramiento. Conclusión: Contar con seguridad social incrementa la probabilidad de recibir atención prenatal adecuada en adolescentes en México.

Abstract: Objective: To analyze efficiency indicators of human resources working at Mexico's Ministry of Health. Materials and methods: Three dimensions of efficiency were explored: a) labor wastage, b) distribution of human resources (HR) across levels of care, and c) productivity. Results: Health workers present significant levels of unemployment and underemployment; distribution does not meet international recommendations, and heterogeneous levels of productivity were found among states. Conclusions: Health and educational authorities should develop and implement a HR plan that takes into consideration the needs and demands of the covered population, and includes a clearly defined set of measures to regulate the future production of HR as well as their distribution among and within state health systems, and that allocates incentives to improve performance.

Resumen: Objetivo: Analizar indicadores de eficiencia de los recursos humanos (RH) de la Secretaría de Salud de México. Material y métodos: Utilizando información secundaria se exploraron tres dimensiones de eficiencia: a) desperdicio de fuerza laboral, b) distribución de RH entre niveles de atención, y c) productividad. Resultados: El grupo de trabajadores de salud analizado se caracteriza por presentar niveles importantes de desempleo y subempleo de RH, una distribución distante de las recomendaciones internacionales y niveles de producción heterogéneos entre los estados. Conclusiones: Es imperativo diseñar e implementar un plan de RH en salud alineado a las necesidades y demandas de las poblaciones cubiertas que contemple medidas regulatorias del mercado de formación de estos recursos, su distribución entre y al interior de los sistemas estatales de salud y la generación de incentivos para el desempeño.

Abstract: Objective: To test the association between public health insurance and adequate prenatal care among female adolescents in Mexico. Materials and methods: Cross-sectional study, using the National Health and Nutrition Survey 2000, 2006, and 2012.We included 3 978 (N=4 522 296) adolescent (12-19) women who reported a live birth.We used logistic regression models to test the association of insurance and adequate (timeliness, frequency and content) prenatal care. Results: The multivariable predicted probability of timely and frequent prenatal care improved over time, from 0.60 (IC95%:0.56;0.64) in 2000 to 0.71 (IC95%:0.66;0.76) in 2012. In 2012, the probability of adequate prenatal care was 0.54 (IC95%:0.49;0.58); women with Social Security had higher probability than women with Seguro Popular and without health insurance. Conclusion: Having Social Security is associated with receipt of adequate prenatal care among adolescents in Mexico.

Resumen: Objetivo: Comprobar la asociación entre el aseguramiento público en salud y la atención prenatal adecuada en mujeres adolescentes. Material y métodos: Análisis transversal de datos de 3 978 mujeres (N=4 522 296) que reportaron embarazo en la adolescencia (12-19 años), derivados de las Encuestas Nacional de Salud 2000 y de Salud y Nutrición 2006 y 2012. Mediante modelos de regresión logística se analizó oportunidad, frecuencia y contenido de la atención prenatal. Resultados: La probabilidad de recibir atención prenatal oportuna y frecuente aumentó de 0.60 (IC95%:0.56;0.64) en 2000 a 0.71 (IC95%:0.66;0.76) en 2012. En 2012 la probabilidad de recibir atención oportuna, frecuente y con contenido básico fue 0.54 (IC95%:0.49;0.58) siendo mayor en mujeres con Seguridad Social que en aquéllas afiliadas al Seguro Popular o sin aseguramiento. Conclusión: Contar con seguridad social incrementa la probabilidad de recibir atención prenatal adecuada en adolescentes en México.

Abstract: Objective: To analyze efficiency indicators of human resources working at Mexico's Ministry of Health. Materials and methods: Three dimensions of efficiency were explored: a) labor wastage, b) distribution of human resources (HR) across levels of care, and c) productivity. Results: Health workers present significant levels of unemployment and underemployment; distribution does not meet international recommendations, and heterogeneous levels of productivity were found among states. Conclusions: Health and educational authorities should develop and implement a HR plan that takes into consideration the needs and demands of the covered population, and includes a clearly defined set of measures to regulate the future production of HR as well as their distribution among and within state health systems, and that allocates incentives to improve performance.

Resumen: Objetivo: Analizar indicadores de eficiencia de los recursos humanos (RH) de la Secretaría de Salud de México. Material y métodos: Utilizando información secundaria se exploraron tres dimensiones de eficiencia: a) desperdicio de fuerza laboral, b) distribución de RH entre niveles de atención, y c) productividad. Resultados: El grupo de trabajadores de salud analizado se caracteriza por presentar niveles importantes de desempleo y subempleo de RH, una distribución distante de las recomendaciones internacionales y niveles de producción heterogéneos entre los estados. Conclusiones: Es imperativo diseñar e implementar un plan de RH en salud alineado a las necesidades y demandas de las poblaciones cubiertas que contemple medidas regulatorias del mercado de formación de estos recursos, su distribución entre y al interior de los sistemas estatales de salud y la generación de incentivos para el desempeño.

O objetivo deste estudo foi estimar os parâmetros genéticos quantitativos das progênies sob o efeito de geada, bem como determinar a interação genótipos x ambientes das progênies de Eucalyptus dunnii em dois locais de estudo. Os testes de progênies foram implantados em 2010, utilizando 20 progênies de polinização aberta de E. dunnii. Foram avaliados: altura de planta (ALT), diâmetro à altura do peito (DAP) e volume de madeira em metros cúbicos (VOL). Foram realizadas as análises estatísticas e descritivas, correlação fenotípica/genotípica por local e análise de variância conjunta, sendo estimados os parâmetros genéticos. Foram detectadas diferenças significativas (p≤0,05) entre progênies para as características silviculturais, o que sugere a possibilidade de melhoramento pela seleção. Pela análise conjunta, a interação progênies x ambientes (G x E) não apresentou diferença significativa, confirmando que as progênies superiores identificadas nos testes podem ser indicadas para ambos os locais. Os resultados de correlações genéticas e fenotípicas variaram de baixos a altos (0,23 a 1,0) para as características estudadas, sendo as correlações, em sua grande maioria, significativas (p≤0,05), em que o DAP foi altamente correlacionado com o VOL. A população, por apresentar alta variação genética e controle genético das características, permite a obtenção de ganhos com a seleção entre as progênies.

ABSTRACT The aim of this study was to estimate quantitative genetic parameters of progenies under frost situations and to determine the interaction of genotype x environments for Eucalyptus dunnii progenies in two different sites. The progeny trials were set up in 2010, using 20 open pollination progenies of E. dunnii. The following variables were evaluated: plant height (HGT), diameter at breast height (DBH), and wood volume (VOL) in cubic meters. Descriptive and statistical analysis were used as well as phenotypic/genotype correlation by location and joint variance analysis and the genetic parameters were estimated. Significant differences were detected (p≤ 0,05) among progenies for silvicultural characters, suggesting the possibilities for selection gain. By the joint analysis, the interaction of progenies x environments (P x E) did not show significant differences, confirming that the superior progenies identified in the tests can be used for both studied locations. The genetic and phenotypic correlations results ranged from low to high (0.23 to 1.0) values for the studied characters, and the great majority of correlations were significant (p≤ 0,05) in which the diameter at breast height was highly correlated with volume. Because of high genetic variability and genetic control of the characters, the population allows to obtain gains with selection between in the progenies.

RESUMO O reflorestamento comercial de espécies nativas brasileiras, visando à produção de madeira nobre para serraria, tem se intensificado nos últimos anos em diversas regiões do Brasil. Dentre as espécies nativas potenciais que veem sendo plantadas por empresas do setor florestal, o guanandi (Calophyllum brasiliense Cambess.) é destaque, uma espécie com ampla distribuição natural, alta adaptabilidade a diferentes condições de solo e clima, boa forma fuste e ótima qualidade madeira. O desenvolvimento de um bom programa de melhoramento genético requer prioridade para a obtenção de ganhos de produtividade e rendimento no médio e longo prazo. Nesta linha de pesquisa, o estudo das técnicas de propagação vegetativa, visando abreviar etapas no melhoramento florestal e viabilizar a produção maciça de material melhorado, tem importância fundamental no sucesso do programa de melhoramento. Com objetivo de avaliar a viabilidade da propagação vegetativa da espécie, foram realizados dois experimentos sucessivos, instalados e avaliados ao longo de dois anos, a fim de identificar os melhores tipos de estacas, doses de hormônio e manejo. Foram testados diferentes tipos de estacas, submetidas a doses crescentes de ácido indolbutírico (AIB), avaliados principalmente os dados de sobrevivência, emissão de brotos e formação de raiz. Os resultados indicaram que a espécie se mostrou viável a propagação vegetativa, obtendo índices de 85% a 90% de enraizamento de estacas provenientes de mudas, para as doses de ácido indolbutírico (AIB) nas concentrações entre 3.000 a 7.000 mg.L-1. Para as estacas de brotações da base de árvores adultas 3.000 mg.L-1 foi a melhor dose de AIB.

ABSTRACT Commercial reforestation of Brazilian native species to produce hardwood for sawmills has been recently intensified in the country. Among the potential species planted by the logging industry is guanandi (Calophyllum brasiliense Cambess) because it is widely distributed in the country, highly adapted to different soil and climate conditions, good bole form and high quality timber. The development of genetic improvement programs should prioritize gains in productivity and yields in the medium and long term. For such programs to be successful, the study of vegetative propagation techniques to abbreviate steps in forest improvement and allow its mass production is fundamental. To assess the viability of vegetative propagation of the species, two successive experiments were carried out during two years testing the best type of cutting, hormone concentration and management. Different cuttings types submitted to increasing doses of indole-butyric acid (IBA) were tested to evaluate survival, sprouting, rooting and callus formation. Results indicate that the species is viable for vegetative propagation with 85 to 90% rooting of cuttings from seedlings in the IBA concentrations of 3000 to 7000 mg.L-1. For the cuttings, sprouting from the base of adult trees 3000 mg.L-1 was the best concentration of IBA.

Objective. To document the association between supply-side determinants and AIDS mortality in Mexico between 2008 and 2013. Materials and methods. We analyzed the SALVAR database (system for antiretroviral management, logistics and surveillance) as well as data collected through a nationally representative survey in health facilities. We used multivariate logit regression models to estimate the association between supply-side characteristics, namely management, training and experience of health care providers, and AIDS mortality, distinguishing early and non-early mortality and controlling for clinical indicators of the patients. Results. Clinic status of the patients (initial CD4 and viral load) explain 44.4% of the variability of early mortality across clinics and 13.8% of the variability in non-early mortality. Supply-side characteristics increase explanatory power of the models by 16% in the case of early mortality, and 96% in the case of non-early mortality. Conclusions. Aspects of management and implementation of services contribute significantly to explain AIDS mortality in Mexico. Improving these aspects of the national program, can similarly improve its results.

Objetivo. Documentar la asociación entre factores de la oferta de servicios de atención de VIH sobre la mortalidad por sida en México en el periodo 2008-2013. Material y métodos. Se analizaron datos del sistema de administración, logística y vigilancia de antirretrovirales (SALVAR) y de una encuesta aplicada en unidades de atención. Se utilizaron modelos de regresión logit multivariados para estimar la asociación entre características de la oferta de servicios -en particular, de la gerencia de servicios y de la capacitación y experiencia de los prestadores- y la mortalidad por sida, distinguiendo entre mortalidad temprana y no temprana, y controlando por características clínicas de los pacientes. Resultados. Las características clínicas de los pacientes (CD4 inicial y carga viral) explican 44.4% de la variabilidad en la mortalidad temprana entre clínicas y 13.8% de la variabilidad de mortalidad no temprana. Las características de la oferta aumentan 16% del poder explicativo en el caso de la mortalidad temprana y 96% en el de la mortalidad no temprana. Conclusiones. Los aspectos de gerencia e implementación de los servicios de atención de VIH contribuyen significativamente a explicar la mortalidad por sida en México. Mejorar estos aspectos del programa nacional puede mejorar sus resultados.

Objective. To describe the distribution of AIDS-related mortality according to the time of occurrence since entry to the System for the Administration, Logistics and Surveillance of Antiretrovirals (SALVAR, in Spanish), among users of Ministry of Health facilities in Mexico. Materials and methods. Descriptive analysis of AIDS mortality and the related clinical and demographic profile of 41847 patients registered in SALVAR. Results. 3195 patients (8.1%) died within the study period, 59% of these deaths occurred within six months after treatment initiation. Among those patients, 87.3% were diagnosed late, given their CD4 levels (CD4cel<200 cel/ml³). Conclusion. Our results underscore the need to strengthen programs aimed to increase opportune HIV diagnosis and linkage to care, as a key component of universal access policy to antiretroviral treatment in Mexico.

Objetivo. Describir la distribución de la mortalidad por sida (2008-2012) en usuarios de unidades de atención de la Secretaría de Salud de México, en el Sistema de Administración, Logística y Vigilancia de Antirretrovirales (SALVAR). Material y métodos. Análisis descriptivo del tipo de mortalidad y el perfil clínico y sociodemográfico relacionado, de 41847 pacientes registrados en el SALVAR. Resultados. Se identificaron 3195 (8.1%) pacientes que fallecieron en el periodo de estudio, de los cuales 59% murió durante los primeros seis meses de seguimiento en el sistema. De éstos, 87.3% fue diagnosticado de manera tardía de acuerdo con su nivel de CD4 inicial (CD4<200 cel/ml³). Conclusión. Los hallazgos resaltan la importancia de fortalecer los programas de detección oportuna y la vinculación efectiva al tratamiento de las personas VIH positivas, como un componente fundamental de la política de acceso universal a tratamiento antirretroviral en México.

Objective. To describe the distribution of AIDS-related mortality according to the time of occurrence since entry to the System for the Administration, Logistics and Surveillance of Antiretrovirals (SALVAR, in Spanish), among users of Ministry of Health facilities in Mexico. Materials and methods. Descriptive analysis of AIDS mortality and the related clinical and demographic profile of 41847 patients registered in SALVAR. Results. 3195 patients (8.1%) died within the study period, 59% of these deaths occurred within six months after treatment initiation. Among those patients, 87.3% were diagnosed late, given their CD4 levels (CD4cel<200 cel/ml³). Conclusion. Our results underscore the need to strengthen programs aimed to increase opportune HIV diagnosis and linkage to care, as a key component of universal access policy to antiretroviral treatment in Mexico.

Objetivo. Describir la distribución de la mortalidad por sida (2008-2012) en usuarios de unidades de atención de la Secretaría de Salud de México, en el Sistema de Administración, Logística y Vigilancia de Antirretrovirales (SALVAR). Material y métodos. Análisis descriptivo del tipo de mortalidad y el perfil clínico y sociodemográfico relacionado, de 41847 pacientes registrados en el SALVAR. Resultados. Se identificaron 3195 (8.1%) pacientes que fallecieron en el periodo de estudio, de los cuales 59% murió durante los primeros seis meses de seguimiento en el sistema. De éstos, 87.3% fue diagnosticado de manera tardía de acuerdo con su nivel de CD4 inicial (CD4<200 cel/ml³). Conclusión. Los hallazgos resaltan la importancia de fortalecer los programas de detección oportuna y la vinculación efectiva al tratamiento de las personas VIH positivas, como un componente fundamental de la política de acceso universal a tratamiento antirretroviral en México.

Objective. To document the association between supply-side determinants and AIDS mortality in Mexico between 2008 and 2013. Materials and methods. We analyzed the SALVAR database (system for antiretroviral management, logistics and surveillance) as well as data collected through a nationally representative survey in health facilities. We used multivariate logit regression models to estimate the association between supply-side characteristics, namely management, training and experience of health care providers, and AIDS mortality, distinguishing early and non-early mortality and controlling for clinical indicators of the patients. Results. Clinic status of the patients (initial CD4 and viral load) explain 44.4% of the variability of early mortality across clinics and 13.8% of the variability in non-early mortality. Supply-side characteristics increase explanatory power of the models by 16% in the case of early mortality, and 96% in the case of non-early mortality. Conclusions. Aspects of management and implementation of services contribute significantly to explain AIDS mortality in Mexico. Improving these aspects of the national program, can similarly improve its results.

Objetivo. Documentar la asociación entre factores de la oferta de servicios de atención de VIH sobre la mortalidad por sida en México en el periodo 2008-2013. Material y métodos. Se analizaron datos del sistema de administración, logística y vigilancia de antirretrovirales (SALVAR) y de una encuesta aplicada en unidades de atención. Se utilizaron modelos de regresión logit multivariados para estimar la asociación entre características de la oferta de servicios -en particular, de la gerencia de servicios y de la capacitación y experiencia de los prestadores- y la mortalidad por sida, distinguiendo entre mortalidad temprana y no temprana, y controlando por características clínicas de los pacientes. Resultados. Las características clínicas de los pacientes (CD4 inicial y carga viral) explican 44.4% de la variabilidad en la mortalidad temprana entre clínicas y 13.8% de la variabilidad de mortalidad no temprana. Las características de la oferta aumentan 16% del poder explicativo en el caso de la mortalidad temprana y 96% en el de la mortalidad no temprana. Conclusiones. Los aspectos de gerencia e implementación de los servicios de atención de VIH contribuyen significativamente a explicar la mortalidad por sida en México. Mejorar estos aspectos del programa nacional puede mejorar sus resultados.