Background: The provision of food supplementation to food insecure patients initiating antiretroviral therapy may improve adherence to medications. Methods: A home-based adherence support program at 8 government clinics assessed patients for food insecurity. 4 clinics provided food supplementation and 4 acted as controls. The analysis compared adherence (assessed by medication possession ratio [MPR]), CD4, and weight gain outcomes among food insecure patients enrolled at the food clinics to those of controls. Results: Between May 1, 2004 and March 31, 2005, 636 food insecure adults were enrolled. Food supplementation was associated with better adherence to therapy. 258 of 366 (70%) of patients in the food group achieved an MPR of 95% or greater versus 79 of 166 (48%) among controls (relative risk, RR=1.5; 95%CI:1.2-1.8). This finding was unchanged after adjustment for sex, age, baseline CD4 count, baseline WHO stage, and baseline hemoglobin. We did not observe a significant effect of food supplementation on weight gain or CD4 cell response. Conclusions: This analysis suggests that providing food to food insecure patients initiating ART is feasible and may improve adherence to medication. A large randomized study of the clinical benefits of food supplementation to ART patients is urgently needed to inform international policy.

The established infrastructure of an HIV treatment program was successfully used to build capacity for cervical screening in a low-resource setting. By using task-shifting and evidence-based, low-cost approaches, population-based cervical screening in a rural African clinical network was found to feasible; however, loss to follow-up and poor pathology infrastructure remain important obstacles.

We sought to examine racial/ethnic differences in deliveries by caesarean section (CS) over time, particularly among women at low risk for this procedure. To do so, we conducted a retrospective cohort study at the University of California, San Francisco, a tertiary care academic centre. Births occurring between 1980 and 2001 were included in the analyses. Women with multiple gestations, fetuses in other than the cephalic presentation or with other known contraindications to vaginal birth were excluded. A total of 28 493 African American, Asian, Latina and White women were studied. Risk-adjusted models were created to explore differences in CS risk by race/ethnicity. We also performed analyses of subgroups of women at relatively low risk of CS, and explored changes in observed disparities over time. The overall CS rate was 15.8%. The absolute rate was highest among Latinas (16.7%) and lowest among Asians (14.7%). After adjustment for known risk factors, African American women had a 1.48 times greater odds of having a CS than did White women [95% confidence interval (CI) 1.31, 1.68], and Latina women had a 1.19 times greater odds [95% CI 1.05, 1.34]. Stepwise adjustment for confounders showed that this variation is not entirely explained by known risk factors. These differences exist even for women at low risk of CS, and have persisted over time. We conclude that racial and ethnic disparities in CS delivery exist, even among women presumed to be at lower risk of CS; rates have not improved with time. Disparities in risk-adjusted CS should be considered as a quality metric for obstetric care, whether at the national, state, hospital or provider level.

Background Black and Latina women in the United States are known to undergo cesarean delivery at a higher rate than other women. We sought to explore the role of medical indications for cesarean delivery as a potential explanation for these differences. Methods A retrospective cohort study was conducted of 11,034 primiparas delivering at term at the University of California, San Francisco, between 1990 and 2008. We used multivariable analyses to evaluate racial and ethnic differences in risks of, and indications for, cesarean delivery. Results The overall rate of cesarean delivery in our cohort was 21.9 percent. Black and Latina women were at significantly higher odds of undergoing cesarean delivery than white women (adjusted odds ratio (AOR) 1.54; 95% CI: 1.30, 1.83, and 1.21; 95% CI: 1.03, 1.43, respectively). Black women were at significantly higher odds of undergoing cesarean delivery for nonreassuring fetal heart tracings than white women (AOR: 2.19; 95% CI: 1.55, 3.09), and black women (AOR: 1.55; 95% CI: 1.21, 1.98), Latina women (AOR: 1.48; 95% CI: 1.19, 1.85), and Asian women (AOR: 1.47; 95% CI: 1.22, 1.85) were at significantly higher odds of undergoing cesarean delivery for failure to progress. Black, Latina, and Asian women were at significantly lower odds of undergoing cesarean delivery for malpresentation than white women (AORs: 0.56; 95% CI: 0.34, 0.89, 0.66, 95% CI: 0.44, 0.98, and 0.55, 95% CI: 0.40, 0.76, respectively). Conclusions Racial and ethnic differences exist in specific indications for cesarean delivery among primiparas. Clarifying the possible reasons for increased cesareans for nonreassuring fetal heart tracing in black women, in particular, may help to decrease excess cesarean deliveries in this racial and ethnic group. (BIRTH 39:2 June 2012)