The role of perceived health in retention disparity: A HIV-testing-related behavioral intervention among African American and Latinx men who have sex with men in the United States

Nathan Tran; Akihiro Nishi; Lindsay E Young; Akira Endo; William G Cumberland; Sean D Young

doi:10.1016/j.pmedr.2023.102195

The role of perceived health in retention disparity: A HIV-testing-related behavioral intervention among African American and Latinx men who have sex with men in the United States

Prev Med Rep. 2023 Mar 31:33:102195. doi: 10.1016/j.pmedr.2023.102195. eCollection 2023 Jun.

Authors

Nathan Tran¹, Akihiro Nishi¹, Lindsay E Young², Akira Endo^{3

4}, William G Cumberland⁵, Sean D Young^{6

7}

Affiliations

¹ Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA 90095, USA.
² Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA 90089, USA.
³ Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom.
⁴ School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan.
⁵ Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA 90095, USA.
⁶ Department of Emergency Medicine, University of California, Irvine, Irvine, CA 92617, USA.
⁷ Department of Informatics, University of California, Irvine, Irvine, CA 92617, USA.

Abstract

Retention in healthcare and health behavior remains a critical issue, contributing to inequitable distribution of intervention benefits. In diseases such as HIV, where half of the new infections occur among racial and sexual minorities, it is important that interventions do not enlarge pre-existing health disparities. To effectively combat this public health issue, it is crucial that we quantify the magnitude of racial/ethnic disparity in retention. Further, there is a need to identify mediating factors to this relationship to inform equitable intervention design. In the present study, we assess the racial/ethnic disparity in retention in a peer-led online behavioral intervention to increase HIV self-testing behavior and identify explanatory factors. The research used data collected from the Harnessing Online Peer Education (HOPE) HIV Study that included 899 primarily African American and Latinx men who have sex with men (MSM) in the United States. Results show that African American participants had higher lost-to-follow-up rates at 12-week follow-up compared to Latinx participants (11.1% and 5.8% respectively, Odds Ratio = 2.18, 95% confidence interval: 1.12 - 4.11, p = 0.02), which is substantially mediated by participants' self-rated health score (14.1% of the variation in the African American v.s. Latinx difference in lost-follow-up, p = 0.006). Thus, how MSM perceive their health may play an important role in their retention in HIV-related behavioral intervention programs and its racial/ethnic disparity.

Keywords: Behavioral intervention; HIV/AIDS; Mediation analysis; Racial/ethnic disparity; Retention.

Grants and funding

K01 AI166347/AI/NIAID NIH HHS/United States