**2.6 Mexico**

362 Epidemiology Insights

programs in allergy and immunology, although only few centers are able to train professionals and PID treatment, located in São Paulo (Costa-Carvalho *et al.,* 2011; Condino-Neto *et al.,* 2011).

The best laboratories for diagnosis of PID in Chile are located in Santiago, Temuco, Valparaiso and Concepcion. Initial screening tests for PID can be performed in large hospitals, although it does not receive government financial support (Goic & Armas, 2010). As in most underdeveloped countries in Latin America, the diagnosis of PID is often performed after numerous episodes of infection and treatment, and patient referral to specialist in infectious diseases, and finally to immunology center. Patients with PID, who need IVIG, are not reimbursed by the public health system for PID, burdening the costs to patients, which makes the treatment is not performed or interrupted. Chile has a three-year residency in immunology at the University of Santiago of Chile, providing training care of

Colombia has a national PID referral center located in University of Antioquia in Medellin, which has laboratory equipped to perform molecular and immunological diagnosis of PID, and other centers and programs are being developed in Bogota, Cali, Cartagena and Barranquila. Currently, 80% of cases of PID in Colombia come from Antioquia (Montoya *et al.,* 2002; Obando *et al.,* 2005) and neighboring states, which represents less than 20% of Colombia population. Most clinical laboratories in Colombia are able to perform initial PID screening, but specific tests are only available in Medellin and Bogota (Montoya *et al.,* 2002; Diaz *et al.,* 2008). In Colombia, the government Compulsory Health Plan (POS) provides basic coverage for PID and additional coverage can be obtained from private insurance companies (Gonzáles *et al.,* 1999; Cardona & Segura, 2011). Patients with PID, who need IVIG, are not refunded by POS, but IVIG treatments are covered by private insurance companies, who refunded through government's national fund FOSYGA. In this country there is Foundation for Diana Garcia de Olarte PID, which supports and develops educational programs, provides infrastructure for IVIG treatment centers and offers legal advice for patients who need IVIG (Montoya & Sorensen, 2001). The University of Antioquia in Medellin has immunology program for medical residents, and like Latin American countries, this prefer specialize in other areas, since the financial return is greater (Condino-

Honduras has two PID diagnostic centers, located in Tegucigalpa and San Pedro Sula, accessible to entire community, first laboratory support specific PID, and country have serious problems in laboratory diagnosis and access costs (Leon, 2003), availability of IVIG and cost. Only two hospitals in Tecigalpa, including National Institute of Social Security, provide treatment with IVIG. The country has no specific PID program residency, and receives training only three months on basic immunology, autoimmunity, allergy and

adult and pediatric patients (Condino-Neto *et al.,* 2011).

**2.3 Chile** 

**2.4 Colombia** 

Neto *et al.,* 2011).

**2.5 Honduras** 

immunodeficiency (Condino-Neto *et al.,* 2011).

Mexico has specialized centers diagnosis of PID in Mexico City, Monterrey and Guadalajara, and molecular diagnosis of some PID can be performed only in Mexico City. Mexico has serious access problems to laboratory tests, cost and medical education in PID (Romero-Márquez & Romero-Zepeda, 2010; Yavich *et al.,* 2010). The Access to IVIG is extended to public health system and is administered in public hospitals and clinics, but doctors do not follow specific guidelines for the administration of IVIG. The use of IVIG represents 20% of coast in obtaining drugs by National Institute of Pediatrics in Mexico City. In Mexico, there are plenty residency programs in allergy and immunology, with emphasis on allergies. Only the National Institute of Pediatrics in Mexico City has residency program with emphasis on pediatric allergy and immunology (Condino-Neto *et al.,* 2011).
