No abstract

IMPORTANCE Community health worker (CHW) intervention is a promising approach to address type 2 diabetes among Latinos. However, evidence from randomized clinical studies is limited.OBJECTIVE To compare a CHW intervention with enhanced usual care. DESIGN, SETTING, AND PARTICIPANTSThis 52-week, single-blind, randomized clinical trial included 300 Latino adults aged 18 to 65 years who were treated in 2 public hospital outpatient clinics in Miami-

Objectives Highly active antiretroviral therapy (HAART) has transformed HIV infection into a manageable chronic illness, yet AIDS mortality among ethnic minorities persists in the USA. HAART nonadherence is associated with increased HIV viral load, low CD4 cell count and racial disparities in HIV outcomes. While there is no universal consensus on how to improve medical adherence in HIV‐positive populations, the community health worker (CHW) model is emerging as an effective strategy to overcome barriers to HAART adherence. Although utilized in international settings, there is little evidence regarding the effects of CHWs on HIV outcomes in the USA. Methods We performed a comprehensive search from May 2010 to November 2010 to identify studies carried out in the USA that utilized CHWs to improve HAART adherence and measured HIV viral loads and CD4 cell counts to assess intervention effects. Sixteen studies met the inclusion criteria and were reviewed for this article. All studies reported clinical HIV outcomes. Results Interventions that lasted at least 24 weeks, provided frequent contact with participants, and focused on medication management were associated with improved HAART adherence, as indicated by reduced HIV viral load and increased CD4 cell count. Conclusions Compared with current standards of care, CHW programmes may offer a practical and cost‐effective alternative to improve HAART adherence, which may lead to reduced HIV viral load and increased CD4 cell counts among HIV‐positive populations in the USA.

Background Haitian Immigrant women, the largest growing Black ethnic group in Miami, experience the highest rates of cervical cancer and account for one of the largest populations diagnosed with HIV/AIDS in South Florida. Using community-based participatory research methods, we conducted a pilot study to examine HPV/cervical cancer knowledge and identify intervention preferences among HIV positive Haitian women. Methods Community health workers (CHWs) conducted three focus groups with 21 HIV-positive Haitian women. All sessions were conducted in Haitian Kreyol, digitally recorded, and later interpreted and transcribed into English. The first focus group assessed HPV/Cervical Cancer Knowledge; the second session explored HPV/Cervical Cancer considerations specific to HIV positive women, and the third focus group discussed HPV/Cervical Cancer screening and intervention preferences. Data analysis was guided by a grounded theory approach. Findings Our sample had limited HPV/Cervical Cancer knowledge. Misconceptions about screening, transmission, and treatment were common. Participants felt stigma by providers negatively impacted the care they received and stigma by the community diminished social support. Strong support for culturally-tailored interventions to improve HPV/Cervical Cancer knowledge was expressed. Although no participants had previously participated in research, all were willing to participate in future trials. Conclusions There is critical need for culturally relevant interventions to improve HPV/Cervical Cancer knowledge among HIV-positive Haitian women.

BackgroundType 2 diabetes mellitus disproportionately affects the Latino community. Latinos with diabetes are also less likely to have adequate control of cardiovascular risk factors such as cholesterol and blood pressure. Community health workers (CHWs) are increasingly being used to address various health disparity conditions, including diabetes. However, evidence of their effectiveness from randomized controlled trials is limited.MethodsThe Miami Health Heart Initiative is a randomized controlled trial of 300 Latino patients with diabetes. Patients with hemoglobin A1c (HbA1c) ≥8.0% were recruited from Miami-Dade’s public hospital system. At baseline, all patients underwent phlebotomy, physical examination, and a structured 90-minute research interview. They were then randomized to either usual care or a CHW intervention called Cariño. For participants in the Cariño arm of the study, CHW services included assistance with nonmedical social services, health education, and patient navigation in which the CHWs serve as a bridge between patients and the health care system. These services were delivered through home visits, phone calls, and group visits. At 12 months, all subjects had a follow-up examination. The primary outcomes at 1 year are changes in systolic blood pressure, low-density lipoprotein, and HbA1c. Secondary outcomes include medication adherence, medication intensification, diabetes self-efficacy, physical activity, and self-reported fruit and vegetable intake.DiscussionThe Miami Healthy Heart Initiative is one of the first rigorously conducted randomized controlled trials to provide evidence on the impact of CHWs on diabetes intermediate outcomes among Latinos. If the data support our primary hypotheses, the study would lend added support to ongoing efforts to incorporate CHWs as part of our national efforts to reduce and ultimately eliminate health disparities.