Recruitment and retention techniques for developing faith-based research partnerships, New York city, 2009-2012.

BACKGROUND: Faith-based organizations are recognized as an influential venue for behavioral health interventions. However, less is known about efficient approaches for identifying and recruiting these organizations and about the processes that enable successful partnership. COMMUNITY CONTEXT: In 2007, 66% of Latinos and 70% of blacks in New York City reported being overweight or obese. Project SCALE (Small Changes and Lasting Effects) is a 5-year randomized behavioral weight loss intervention trial aimed to help black and Latino adults lose weight by making small changes in eating behaviors and daily leisure physical activity. The study partnered with faith-based organizations. METHODS: Faith-based organizations were identified primarily through direct referrals. Recruitment consisted of screening faith-based organizations, establishing a memorandum of understanding, and intervention modification. Partnership maintenance occurred primarily via progress meetings. OUTCOMES: We identified processes that supported and impeded study recruitment and retention. Obtaining leadership support and using group orientation sessions were successful recruitment and retention processes. A balance must be found between leadership, advocacy, and causing members to feel pressured to participate in the study. INTERPRETATION: Behavioral health interventions implemented in faith-based organizations can reduce health disparities. However, researchers must determine whether faith-based organizations have the capacity to partner in intensive interventions. Focusing on the establishment of strong partnerships at the onset will help ensure that mutual objectives are achieved and sustained long-term.

Cost-effectiveness of early versus standard antiretroviral therapy in HIV-infected adults in Haiti.

BACKGROUND: In a randomized clinical trial of early versus standard antiretroviral therapy (ART) in HIV-infected adults with a CD4 cell count between 200 and 350 cells/mm³ in Haiti, early ART decreased mortality by 75%. We assessed the cost-effectiveness of early versus standard ART in this trial. METHODS AND FINDINGS: Trial data included use of ART and other medications, laboratory tests, outpatient visits, radiographic studies, procedures, and hospital services. Medication, laboratory, radiograph, labor, and overhead costs were from the study clinic, and hospital and procedure costs were from local providers. We evaluated cost per year of life saved (YLS), including patient and caregiver costs, with a median of 21 months and maximum of 36 months of follow-up, and with costs and life expectancy discounted at 3% per annum. Between 2005 and 2008, 816 participants were enrolled and followed for a median of 21 months. Mean total costs per patient during the trial were US$1,381 for early ART and US$1,033 for standard ART. After excluding research-related laboratory tests without clinical benefit, costs were US$1,158 (early ART) and US$979 (standard ART). Early ART patients had higher mean costs for ART (US$398 versus US$81) but lower costs for non-ART medications, CD4 cell counts, clinically indicated tests, and radiographs (US$275 versus US$384). The cost-effectiveness ratio after a maximum of 3 years for early versus standard ART was US$3,975/YLS (95% CI US$2,129/YLS-US$9,979/YLS) including research-related tests, and US$2,050/YLS excluding research-related tests (95% CI US$722/YLS-US$5,537/YLS). CONCLUSIONS: Initiating ART in HIV-infected adults with a CD4 cell count between 200 and 350 cells/mm³ in Haiti, consistent with World Health Organization advice, was cost-effective (US$/YLS <3 times gross domestic product per capita) after a maximum of 3 years, after excluding research-related laboratory tests. TRIAL REGISTRATION: ClinicalTrials.gov NCT00120510.

Social network characteristics associated with weight loss among black and hispanic adults.

OBJECTIVE: To examine social network member characteristics associated with weight loss. METHODS: A cross-sectional examination included egocentric network data from 245 Black and Hispanic adults with BMI ≥ 25 kg/m(2) enrolled in a small change weight loss study. The relationships between weight loss at 12 months and characteristics of helpful and harmful network members (relationship, contact frequency, living proximity, and body size) were examined. RESULTS: There were 2,571 network members identified. Mean weight loss was -4.8 (±11.3) lbs. among participants with network help and no harm with eating goals vs. +3.4 (±7.8) lbs. among participants with network harm alone. In a multivariable regression model, greater weight loss was associated with help from a child with eating goals (P = 0.0002) and coworker help with physical activity (P = 0.01). Weight gain was associated with having network members with obesity living in the home (P = 0.048) and increased network size (P = 0.002). CONCLUSIONS: There was greater weight loss among participants with support from children and coworkers. Weight gain was associated with harmful network behaviors and having network members with obesity in the home. Incorporating child and coworker support and evaluating network harm and the body size of network members should be considered in future weight loss interventions.