Former GloCal Fellow Studies Improving Retention in HIV Care with Emerging Global Leader Award

October 6, 2020

Former GloCal fellow Luis Menacho has received a prestigious Emerging Global Leader Award from the National Institutes of Health’s Fogarty International Center. Also known as the K43, the award provides support to research scientists from low- and middle-income countries to help them advance their career and research goals.

“This will enable me to achieve my goal of becoming a leading global health researcher at Universidad Peruana Cayetano Heredia, actively collaborating with top international institutions and fostering health policies with rigorous evidence,” Menacho said.

With research and mentoring support from the award, Menacho is studying whether a program of targeted two-way text messaging can help Peruvian HIV-positive men who have sex with men stay in medical care. The project will use a health text-messaging platform called WelTel that has been used successfully in the United States, Canada, and Africa to improve HIV patients’ adherence to antiretroviral therapy. Menacho’s measure of success is whether retention in care, meaning whether HIV-positive people stay in health care, improves over a year.

Keeping HIV-positive people in care is challenging partly because the process is long, Menacho said. People must come for regular appointments, go to the HIV center to pick up prescriptions, and have laboratory tests routinely performed. For optimum care, the process must continue for the patient’s life.

An additional challenge is the stigma men who have sex with men face in Peru, as they do in other parts of Latin American, he said.

But reaching Menacho’s target population is important. While just 0.4% of the general population in Peru is HIV positive, 12.2% of men who have sex with men are, according to Menacho. Retention in care in Peru is around 55% during the first year for people living with HIV who are receiving treatment. This leads to numerous public health problems. With an unsuppressed viral load, patients are more likely to infect others. They are also more likely to become sick themselves or to die.

Menacho will test whether targeted text messaging can make a difference. The first aim of Menacho’s project is to get information about the population to help tailor the intervention. That includes collecting information about barriers to care, such as why people have been getting lost to care during and after the COVID-19 pandemic.

“We are aware that there are new gaps for getting to the health centers, for instance, due to lack of transportation, due to social and economic crisis,” he said.

Menacho has trained health care providers in communication skills to make sure they don’t treat people based on stereotypes or with bias.

“We train them to avoid using stigmatizing words or a stigmatizing approach,” he said.

In the next phase, the project will deliver two-way text messages through the WelTel platform. The 208 men recruited will be in two groups: one that receives targeted text messages and follow-up, and one that receives the typical standard of care in Peru.

Providers in the study will use two types of text messages with the men who receive them. Some are pre-tailored messages that have been used and validated before, like reminders for appointments with physicians or for laboratory tests. In addition, depending on the needs of each client, Menacho plans to use messages to provide information and support. The topics for these are based on work previously published by Menacho and his colleagues that found HIV-positive people are interested in specific topics outside of HIV, including how to eat healthily, how to work out, and how to cope with mental health issues like anxiety and depression.

“We’re planning to approach each client depending on what needs they have,” he said.

He will then study whether the messages improve retention in HIV care six months to a year after the second phase starts. If the messages are successful, he hopes to scale up the intervention in settings across Peru and for other diseases.

Menacho is currently a public health physician and epidemiologist at the Instituto de Medicina Tropical Alexander von Humboldt, which is part of Cayetano Heredia University in Lima, Peru. The institute works closely with and is within the Cayetano Heredia hospital. In addition to his project for the award, Menacho has been working with his peers at the institute to develop informational videos on COVID-19. These are made available to the public on YouTube and include videos on prevention of transmission of the virus from asymptomatic cases and how to care for high-risk populations, how easily the virus can be disseminated, and motivational messaging on why it’s important to stay at home, he said.

Menacho was a GloCal fellow from 2013 to 2014 and describes the professional network the fellowship provided him with as “amazing not only for mentors, but also for collaborators, peers and friends.” Menacho applied for the K43 award three times, but it wasn’t until a strong team of mentors and collaborators, including Elsa González, Ann Duerr, Richard Lester, Joseph Zunt, Eduardo Gotuzzo, Magaly Blas, Patty Garcia, Larissa Otero and Kimberly Bale, Deputy Director of the GloCal Health Fellowship, helped Menacho with his most recent attempt that he was successful.

“I'm very thankful for their support,” he said.