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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.

Background: Obesity and insulin resistance are growing problems in HIV-positive (HIVѿ) women receiving highly active antiretroviral therapy (HAART). Objective: The objective was to determine the contribution of adipose tissue (AT) enlargement and distribution to the presence of insulin resistance in obese HIVѿ women. Design: Whole-body intermuscular AT (IMAT), visceral AT (VAT), subcutaneous AT (SAT), and SAT distribution (leg versus upper body) were measured by whole-body magnetic resonance imaging. Insulin sensitivity (S I ) was measured with an intravenous glucose tolerance test in obese HIVѿ women recruited because of their desire to lose weight (n ҃ 17) and in obese healthy controls (n ҃ 32). Results: The HIVѿ women had relatively less whole-body SAT and more VAT and IMAT than did the controls (P 0.05 for all). A significant interaction by HIV status was observed for the relation of total SAT with S I (P 0.001 for the regression's slope interactions after adjustment for age, height, and weight). However, relations of IMAT, VAT, and SAT distribution (leg SAT as a percentage of total SAT; leg SAT%) with S I did not differ significantly between groups. For both groups combined, the best model predicting a low S I included significant contributions by both high IMAT and low leg SAT%, independent of age, height, and weight, and no interaction between groups was observed (overall r 2 ҃ 0.44, P ҃ 0.0003). Conclusion: In obese HIVѿ women, high whole-body IMAT and low leg SAT% distribution are independently associated with insulin resistance.Am J Clin Nutr 2007;86:100 -6.

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AIDS-related mortality remains a leading cause of preventable death among African-Americans. We sought to determine if community health workers could improve clinical outcomes among vulnerable African-Americans living with HIV in Miami, Florida. We recruited 91 medically indigent persons with HIV viral loads ≥1,000 and/or a CD4 cell count ≤350. Patients were randomized to a community health worker (CHW) intervention or control group. Viral load and CD4 cell count data were abstracted from electronic medical records. At 12 months, the mean VL in the intervention group was log 0.9 copies/μL lower than the control group. The CD4 counts were not significantly different among the groups. Compared to the control group, patients randomized to CHWs experienced statistically significant improvements in HIV viral load. Larger multi-site studies of longer duration are needed to determine whether CHWs should be incorporated into standard treatment models for vulnerable populations living with HIV.