Early receipt of and adherence to antiretroviral therapy are critical for effective treatment of HIV. But a necessary first step is engagement with and retention in HIV care. HIV+ Latinos urgently need interventions to improve their retention in HIV care, which may be affected by a number of culture-specific factors. The goal of this proposal is to culturally adapt and tailor an existing, theory-based intervention, using state-of-the-art methods designed to maximize cultural sensitivity, feasibility and acceptability to HIV+ Latinos, and to test it in a small randomized controlled trial (n=30 intervention;n=30 control). The study will be conducted among HIV+ Latinos who have scheduled at least one visit in the prior year at AltaMed, the largest provider of HIV medical services for Latinos in Los Angeles. The proposed intervention is designed to retain participants in HIV care by addressing barriers to and facilitators of HIV care salient to Latinos, using group-based as well as one-on-one, peer-based learning approaches. The proposal has three Primary Specific Aims: 1. To conduct a small formative qualitative research study to inform the adaptation and tailoring of an intervention designed to improve retention in HIV care for HIV+ Latinos;2. To utilize the qualitative input on the intervention to adapt and tailor it for HIV+ Latinos, and to conduct a small pre-test of the intervention to further improve its feasibility, acceptability, and cultural sensitivity. 3. To pilot test the intervention to refine the adapted intervention protocol, the assessment protocol, and the randomization procedures, and to evaluate the intervention's feasibility and acceptability. Secondarily, we aim to assess the preliminary effects of the intervention on retention in HIV care, self- reported adherence, and clinical outcomes, including HIV RNA viral load and health-related quality of life. In addition, we will examine correlates of retention in HIV care among variables targeted by the intervention (e.g., HIV retention knowledge, outcome expectations, and self-efficacy), and other potential mediators (e.g., perceived stigma, substance use and other psychosocial variables, and background characteristics). If the intervention is shown to be feasible, acceptable, and efficacious, then the results will be used to prepare an R-01 proposal to conduct a fully-powered, randomized intervention. Ultimately, this intervention could have substantial, widespread impact on the health care delivered to HIV+ Latinos across sites in the US where large numbers of HIV+ Latinos receive care. This proposal seeks to move beyond the traditional focus of adherence research, taking medications, to address broader cultural and social factors that affect the first necessary step in treatment adherence: retention in HIV care.
This proposal develops a culturally sensitive intervention aimed at increasing HIV+ Latinos'retention in regular HIV care. Ultimately, this intervention could have substantial, widespread impact on the health care delivered to HIV+ Latinos across sites in the US where large numbers of HIV+ Latinos receive care. This proposal seeks to move beyond the traditional focus of adherence research, taking medications, to address broader cultural and social factors that affect the first necessary step in treatment adherence: retention in HIV care.
