Underutilization of HIV Testing Among Men with Incarceration Histories.

Annual HIV testing is recommended for individuals at high risk of infection, specifically incarcerated populations. Incarcerated men carry a higher lifetime risk of acquiring HIV than the general population, yet little is known about their HIV testing behaviors. We collected Audio Computer Assisted Self Interview data for 819 men entering a state prison in North Carolina. We assessed correlates of previous HIV testing, including stigmatizing attitudes and beliefs, and explored two outcomes: (1) ever HIV tested before current incarceration, and (2) recency of last HIV test. Eighty percent had been HIV tested before; of those, 36% reported testing within the last year. Being African American, having education beyond high school, prior incarceration, and higher HIV knowledge increased odds of ever having tested. Results of this study highlight the need to expand HIV testing and education specific to incarcerated populations. Additionally, efforts should be made to monitor and encourage repeat screening.

Supporting Community-based Healthy Eating and Active Living Efforts in Sustaining Beyond the Funding Cycle.

INTRODUCTION: Considerable research has been done to define, conceptualize, and study sustainability for public health initiatives. New research suggests evaluating sustainability through additional characteristics, like type of intervention or focus of change, may help uncover differences in approaches and resources needed for sustainability. Additionally, available research often misses perspectives from those involved on what is necessary to sustain strategies long term. METHODS: Data collected through community reports and interviews with eight Colorado communities implementing large-scale community-based healthy eating and active living initiatives were used to document strategy characteristics, barriers to sustainability, and community-based perspectives on supports needed for long-term sustainability. Characteristics of implementation were also assessed based on intervention type (program, environment, policy) and to identify similarities and differences in implementation. RESULTS: Policy and environment interventions were sustained more often compared with program interventions. Coalitions or formal committees, community-level coordination, and diverse partnerships were associated with sustainable strategies regardless of intervention type, though primary transition partners varied by intervention type. Loss of a sole champion and shifts in institutional priorities were common barriers for sustainability. Communities requested supports for creative funding and formal coordination, public and political will-building, inclusivity, and advanced evaluation methods to support long-term sustainability. CONCLUSIONS: Findings suggest that community intervention strategies can be highly sustainable, particularly for environment and policy change, and suggest strategies may require similar, yet tailored, partnerships based on intervention type. Additionally, supports requested highlight sophisticated community needs, offering important insights for how providers and funders can best support communities in long-term sustainability efforts. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.

Systematic review: effect of alcohol intake on adherence to outpatient medication regimens for chronic diseases.

OBJECTIVE: Nonadherence to medications can lead to adverse health outcomes. Alcohol consumption has been shown to be associated with nonadherence to antiretroviral medications, but this relationship has not been examined at different drinking levels or with other chronic disease medications. We conducted a narrative synthesis of the association of alcohol consumption with nonadherence to medications for four chronic diseases. METHOD: We searched MEDLINE, PsycINFO, Cochrane Library, and Web of Science for relevant studies published through 2009. To be included in this analysis, studies had to be quantitative; have a sample size of 50 or greater; and examine the effect of alcohol consumption on medication adherence for diabetes, hypertension, depression, or HIV/AIDS. Study characteristics and results were abstracted according to pre-specified criteria, and study quality was assessed. Study heterogeneity prevented a systematic synthesis. RESULTS: Sixty eligible studies addressed medication adherence for HIV in 47 (78%), diabetes in 6 (10%), hypertension in 2 (3%), both diabetes and hypertension in 1 (2%), depression in 2 (3%), and all medications in 2 (3%). Mean number of subjects was 245 (range: 57-61,511). Effect sizes for the association of alcohol use with nonadherence varied (0.76-4.76). Six of the seven highest quality studies reported significant effect sizes (p < .05), ranging from 1.43 to 3.6. Most (67%) studies reporting multivariate analyses, but only half of non-HIV medicine studies, reported significant associations. CONCLUSIONS: Most studies reported negative effects of alcohol consumption on adherence, but evidence among non-HIV studies was less consistent. These data suggest the relevance of addressing alcohol use in improving antiretroviral adherence and a need for further rigorous study in non-HIV chronic diseases.