CAM Practices and Treatment Adherence Among Key Subpopulations of HIV+ Latinos Receiving Care in the San Diego-Tijuana Border Region: A Latent Class Analysis.

Charles Marks,María Luisa Zúñiga

doi:10.3389/fpubh.2019.00179

Abstract

Latinos living in the United States-Mexico border region bear a disproportionate HIV/AIDS burden compared to individuals living in the interior of both nations and face a constellation of barriers that determine their ability to access and adhere to HIV care. Use of complementary and alternative medicine (CAM) may be associated with suboptimal treatment adherence. Sociodemographic factors, health practices, and social determinants of health unique to the border region may further contribute to health disparities that undermine care engagement and continuity. Improved understanding of HIV-positive Latino subgroups and their risk profiles can lead to more effective, targeted clinical and public health interventions. We undertook this study to identify and characterize distinct classes of HIV-positive Latinos in the San Diego-Tijuana border region, differentiated by HIV and border-related factors, utilizing latent class analysis. We investigated relationships between class membership and CAM utilization and self-reported antiretroviral therapy (ART) adherence. Five distinct classes were identified with unique demographic, HIV risk, and border mobility profiles. CAM was recently used by nearly half of each class, though there were significant differences in the proportion of CAM use by class ranging from 44.4 to 90.9%. As well, all classes were currently receiving ART at similarly high rates and ART adherence outcomes were not significantly different based on class. Findings highlight the significant use of CAM by all HIV-positive Latinos in the border region and imply the need for a research framework which appropriately acknowledges the heterogeneous nature of this population, such as intersectionality. Further research is recommended into understanding how patients integrate CAM into HIV treatment and the risks and benefits of incorporating CAM into HIV treatment.

Highlights

In order to meet the United Nations goal of identifying, treating, and achieving viral suppression in 90% of all people living with HIV/AIDS (PLWHA) globally [1], it is necessary to understand the specific barriers and challenges faced by subpopulations that are disproportionately impacted by HIV
While this research is only reflective of classes of individuals who have made contact with HIV-related services, the results provide a foundation for investigating and understanding the context of Latino PLWHA living in the border region who are not in contact with HIV care services
This study establishes the heterogeneity of Latino PLWHA living in the border region and the widespread utilization of complementary and alternative medicine (CAM) across the population

Summary

Introduction

In order to meet the United Nations goal of identifying, treating, and achieving viral suppression in 90% of all people living with HIV/AIDS (PLWHA) globally [1], it is necessary to understand the specific barriers and challenges faced by subpopulations that are disproportionately impacted by HIV. For Latinos in the United States (US) and Mexico, especially those residing in the shared border region, efforts to improve HIV-related health outcomes will require further attention to the unique needs of Latino subpopulations, especially those factors that place this vulnerable group at higher risk for falling out of care [2]. It is well-documented that US Latino immigrants face unique challenges to remain engaged in care throughout the continuum of HIV care [3,4,5,6]. Improved understanding of border patient profiles can inform clinical and health system efforts to promote care continuity and improved health outcomes

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