Latinos with HIV are less likely to receive or be retained in care. COPH professor examines how to combat the problem.

USF College of Public Health (COPH) associate professor Dr. Miguel Reina Ortiz has received a $299,000 grant from the National Institutes of Health’s Center for AIDS Research (NIH CFAR) ADeLANTE Mentored Research Program. The grant, “EnRICHing Latinos living with HIV by optimizing retention in care: a culturally responsive incentive-based intervention that leverages loss aversion and fixed financial incentives,” will extend for two years.

“Latinos are the only ethnic/racial group for which new HIV diagnoses increased consistently between 2010 and 2016,” Reina Ortiz said, “and the trend continues. Compared to whites, Latinos experience lower rates of HIV diagnosis, receipt of, and retention in care, as well as lower viral suppression rates. Altogether, these represent urgent HIV-related health disparities that disproportionately affect Latinos, and which lead to higher numbers of new diagnoses that could be prevented with proper interventions.”

Reina Ortiz, who is an alumnus of the college, plans to focus his intervention strategies on behavioral economic principles. Behavioral economics, he says, is a field that provides insights into human decision-making processes.

“Behavioral economics principles try to address decision-making biases, such as the preference for immediate vs. delayed rewards,” Reina Ortiz explained. “In the case of health decision-making, modifying behaviors that have a long-term reward may be less attractive. Therefore, different alterations of the choice architecture may be designed to motivate people to engage in the desired behavior—that is, to create an immediate, as opposed to delayed, reward. Behavioral economic principles have successfully been used to address smoking or to improve HIV testing. Because of this previous effectiveness (combined with an appropriate and responsive cultural adaptation), the research we propose is expected to be successful in optimizing retention in HIV care.”

The nature and amount of the incentives will be decided during the cultural adaptation process, Reina Ortiz says. 

According to Reina Ortiz, there are many reasons why Latinos experience HIV-related health disparities, including things like lack of access to health care services or health insurance, not having services that are culturally appropriate, as well as immigration concerns that may lead someone to avoid seeking services.

“We need to urgently address retention in care in HIV among Latinos,” Reina Ortiz noted. “This is not just because Latinos suffer a disproportionate burden of HIV in the U.S., but because retention in care has the potential to be of great benefit to the individual (less possibility of hospitalizations and death and higher chances of achieving viral suppression) and to the community (reduced transmission linked to the lower viral loads achieved with retention in care). If this pilot study is successful,” he added, “we could seek further research support to continue to investigate the effect of the proposed strategy on optimizing retention in HIV care among Latinos and to generate evidence that may influence programmatic designs aimed at optimizing retention in HIV care among Latinos.”

Story by Donna Campisano, USF College of Public Health