HIV testing and HIV/AIDS treatment services in rural counties in 10 southern states: service provider perspectives.

CONTEXT: Forty percent of AIDS cases are reported in the southern United States, the region with the largest proportion of HIV/AIDS cases from rural areas. Data are limited regarding provider perspectives of the accessibility and availability of HIV testing and treatment services in southern rural counties. PURPOSE: We surveyed providers in the rural south to better understand: (1) the accessibility and availability, and (2) the facilitators and barriers of HIV testing and treatment services. METHODS: All county health departments (N = 326) serving populations of <50,000 persons, within 10 southern states, were mailed surveys. Responding health departments identified up to 3 HIV testing sites and up to 3 HIV treatment sites to which they refer clients. FINDINGS: Overall, 243 of 326 (75%) health departments, 133 of 250 (53%) HIV testing sites, and 73 of 152 (48%) HIV treatment sites responded to the surveys. The number of testing sites per county ranged from 0 to 20; the number of treatment sites ranged from 0 to 4. An average distance of 50 miles for clients to travel for HIV treatment was reported by health department respondents as a barrier. Facilitators of HIV testing were (1) integrating HIV testing into other health services; (2) using rapid HIV testing; and (3) establishing easily accessible HIV testing locations and free testing services. CONCLUSION: Providers perceive that distance from local health departments to HIV treatment sites presents a barrier to HIV care for their clients. Future studies should ascertain clients' perspectives to ensure appropriate service provisions.

A randomized trial of directly administered antiretroviral therapy and adherence case management intervention.

BACKGROUND: A randomized, controlled trial was conducted to evaluate the impact of a directly administered antiretroviral therapy program (DAART) and intensive adherence case management (IACM) intervention on virologic and immunologic response to highly active antiretroviral therapy (HAART) among patients at 3 public human immunodeficiency virus clinics in Los Angeles County, California. METHODS: Participants included 250 treatment-naive and treatment-experienced persons for whom no more than 1 prior HAART regimen had failed. Five days per week for 6 months, a community worker delivered 1 HAART dose to DAART participants and observed the participant take it. IACM participants met weekly with a case manager to overcome barriers to HAART adherence. A control group (the standard of care [SOC] group) received the usual care. RESULTS: The majority of patients were Latino (64%) or African American (24%); 57% were monolingual Spanish speakers. Seventy-five percent of the patients were male, and 64% reported an annual income of <10,000 dollars. In an intent-to-treat analysis, no statistical differences were observed in the percentage of patients with an undetectable viral load (i.e., <400 copies/mL) at 6 months between the DAART group (54%), IACM group (60%), and SOC group (54%; P>.05). An on-treatment analysis determined that there were no statistical differences in the percentage of patients with an undetectable viral load at 6 months between the DAART group (71%), IACM group (80%), and SOC group (74%; P>.05). Additionally, there were no statistical differences in 6-month changes in the CD4+ cell count or in self-reported adherence to therapy. CONCLUSIONS: Among patients with limited prior HAART experience and adherence barriers that had not been assessed before randomization, no differences were found in virologic or immunologic response for DAART or IACM, compared with SOC, at 6 months. DAART and IACM did not improve short-term outcomes when SOC included other means of adherence support that were not controlled for by the study design.

Cardiovascular risk factors in ethnic minority women aged < or =30 years.

Men and women of African and South Asian ancestry in the United States are increasingly recognized as being at greater risk for coronary heart disease (CHD) than Caucasians of European ancestry. Relatively little data on the genetic and lifestyle risk factors that predispose women to CHD in these ethnic minorities are available. We compared coronary risk factors in a volunteer sample of African-American, Asian Indian American, and Caucasian American women of college age. Life style, dietary, hemodynamic and anthropometric parameters, and laboratory data were sought from 70 subjects in each ethnic group. African-American women were found to have lower triglyceride levels and higher apolipoproten A-1, high-density lipoprotein (HDL), lipoprotein (a) (Lp(a)), fibrinogen, and fasting insulin levels. They also consumed more fat and cholesterol than their peers, had a higher percentage of body fat, body weight, and body mass indexes, and reported less physical activity than Caucasians. Asian Indian American women had higher Lp(a), HDL, and fibrinogen levels than Caucasian American women, and also reported less physical activity. Thus, young African- American and Asian Indian American women have several modifiable risk factors as well as some nontraditional lipid risk factors that warrant consideration for explaining the increased prevalence of CHD in these ethnic groups. The tendency toward peripheral insulin insensitivity and increased body fat in this age group of African-American women suggests diet and exercise may reduce the risk of subsequent CHD.