Comparative effectiveness of a faith-based HIV intervention for African American women: importance of enhancing religious social capital.

OBJECTIVES: We assessed the effectiveness of P4 for Women, a faith-based HIV intervention. METHODS: We used a 2-arm comparative effectiveness trial involving 134 African American women aged 18 to 34 years to compare the effectiveness of the Centers for Disease Control and Prevention-defined evidence-based Sisters Informing Sisters about Topics on AIDS (SISTA) HIV intervention with P4 for Women, an adapted faith-based version of SISTA. Participants were recruited from a large black church in Atlanta, Georgia, and completed assessments at baseline and follow-up. RESULTS: Both SISTA and P4 for Women had statistically significant effects on this study's primary outcome-consistent condom use in the past 90 days-as well as other sexual behaviors. However, P4 for Women also had statistically significant effects on the number of weeks women were abstinent, on all psychosocial mediators, and most noteworthy, on all measures of religious social capital. Results were achieved by enhancing structural social capital through ministry participation, religious values and norms, linking trust and by reducing negative religious coping. High intervention attendance may indicate the feasibility of conducting faith-based HIV prevention research for African American women. CONCLUSIONS: P4 for Women enhanced abstinence and safer sex practices as well as religious social capital, and was more acceptable than SISTA. Such efforts may assist faith leaders in responding to the HIV epidemic in African American women.

Maintaining patency of tunneled hemodialysis catheters--efficacy of aspirin compared to warfarin.

OBJECTIVE: Tunneled hemodialysis catheters (caths) often fail as a result of luminal obstructive thrombus or formation of a fibrin sheath at the tip. Anecdotal and non-randomized studies have indicated that aspirin (A) and/or warfarin (W) can prolong cath patency. We examined the effect of chronic usage of either A or W on primary cath patency. MATERIAL AND METHODS: A prospective cross-sectional monitoring of cath patency was conducted over a 3-year period. Patients were grouped according to their long-term usage of either A (325 mg daily) or W. Patients on neither medication served as a control (C). The end point of the study occurred at cannulation of the patients' arteriovenous fistulae, when there was development of cath-related bacteremia or when there was inability to maintain a blood flow of 250 ml/min. RESULTS: Sixty-three patients with a mean age of 57 +/- 15 years completed the study. There were 21 patients in the A group, 11 in the W group and 31 in the C group. Cath survival was 91%, 73% and 29% at 120 days for the A, W and C groups, respectively (A vs C, p < 0.0001; W vs C, p < 0.0001; A vs W, p = NS). The mean durations of cath patency were 114 +/- 18, 111 +/- 17 and 68 +/- 37 days for the A, W and C groups, respectively (A vs C, p < 0.0001; W vs C, p < 0.0001; A vs W, p = NS). Gastrointestinal (GI) bleeding complication rates were 24%, 18% and 0% for the A, W and C groups, respectively (A vs C, p = 0.02; W vs C, p = 0.02; A vs W, p = NS). The relative risk of GI bleeding associated with aspirin was 0.71 [95% confidence interval (CI) 0.11-4.4, p = 0.7] but among elderly aspirin users it was 1.14 (CI 1.0-1.3, p = 0.008). CONCLUSION: Both aspirin and warfarin are equally effective at prolonging cath patency but their routine use for failing caths cannot be unequivocally recommended because of the increased risk of GI bleeding. Further prospective and randomized studies are called for.