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The Connect4Care (C4C) text messaging intervention did not improve virologic suppression or retention in care for vulnerable, urban, safety-net human immunodeficiency virus (HIV) clinic patients with detectable viral loads who were poorly retained or new to clinic care at baseline. Abstract Background Text messaging is a promising strategy to support human immunodeficiency virus (HIV) care engagement, but little is known about its efficacy in urban safety-net HIV clinics. Methods We conducted a randomized controlled trial of a supportive and motivational text messaging intervention, Connect4Care (C4C), among viremic patients who had a history of poor retention or were new to the clinic. Participants were randomized (stratified by new or established HIV diagnosis status) to receive either of the following for 12 months: (1) thrice-weekly intervention messages, plus texted primary care appointment reminders and a monthly text message requesting confirmation of study participation or (2) texted reminders and monthly messages alone. Viral load was assessed at 6 and 12 months. The primary outcome was virologic suppression (<200 copies/mL) at 12 months, estimated via repeated-measures log-binomial regression, adjusted for new-diagnosis status. The secondary outcome was retention in clinic care. Results Between August 2013 and November 2015, a total of 230 participants were randomized. Virologic suppression at 12 months was similar in intervention and control participants (48.8% vs 45.8%, respectively), yielding a rate ratio of 1.07 (95% confidence interval, .82-1.39). Suppression was higher in those with newly diagnosed infection (78.3% vs 45.3%). There were no intervention effects on the secondary outcome. Exploratory analyses suggested that patients with more responses to study text messages had better outcomes, regardless of arm. Conclusions The C4C text messaging intervention did not significantly increase virologic suppression or retention in care. Response to text messages may be a useful way for providers to gauge risk for poor HIV outcomes. Clinical Trials Registration NCT01917994.

IntroductionA four-drug regimen of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is underused, in part due to prescriber inertia and low patient adherence. Although fixed-dose combination pills (‘polypills’) have improved adherence and clinical outcomes for other conditions, there are no polypills available that combine multiple classes of GDMT for HFrEF. Pharmacy-level over-encapsulation, in which several tablets are combined into one capsule, offers an opportunity to create customised HFrEF polypills with the goal of improving delivery of HFrEF therapies.Methods and analysisIn the COMBO-HF-X pilot crossover randomised clinical trial, we will enrol 30–40 patients with HFrEF in a safety-net public healthcare system in San Francisco, California. Participants will be randomised 1:1 to receive GDMT as individual tablets or as a customised, over-encapsulated HFrEF polypill. After 1 month, participants will cross over to the other formulation (individual tablets or a HFrEF polypill). Participants will attend in-person visits at 0, 4 and 8 weeks. GDMT will be initiated and titrated by study physicians as clinically indicated in accordance with HFrEF treatment guidelines. The primary outcome will be adherence to GDMT by pill count. Key feasibility outcomes will include the successful recruitment of 30–40 participants and completion of study procedures for at least 20 participants. Implementation outcomes will include the cost and time required for HFrEF polypill preparation, which will be performed by a community pharmacy partner. Exploratory clinical outcomes will include change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and Kansas City Cardiomyopathy Questionnaire. Acceptability will be assessed through a patient exit survey and semistructured exit interviews with patients, their primary care and cardiology providers, and pharmacy staff.Ethics and disseminationStudy findings will be published in peer-reviewed journals. The protocol of this study was approved by the Institutional Review Board of the University of California, San Francisco. Written informed consent for COMBO-HF-X was obtained from all participants.Trial registration number NCT06029712.

Background Few data exist on the use of text messaging as a tool to promote retention in HIV care and virologic suppression at the clinic level in the United States. We describe the protocol for a study designed to investigate whether a text messaging intervention that supports healthy behaviors, encourages consistent engagement with care, and promotes antiretroviral persistence can improve retention in care and virologic suppression among patients in an urban safety-net HIV clinic in San Francisco. Methods/Design Connect4Care (C4C) is a single-site, randomized year-long study of text message appointment reminders vs. text message appointment reminders plus thrice-weekly supportive, informational, and motivational text messages. Eligible consenting patients are allocated 1:1 to the two arms within strata defined by HIV diagnosis within the past 12 months (i.e. “newly diagnosed”) vs. earlier. Study participants must receive primary care at the San Francisco General Hospital HIV clinic, speak English, possess a cell phone and be willing to send/receive up to 25 text messages per month, a have viral load >200 copies/μL, and be either new to the clinic or have a history of poor retention. The primary efficacy outcome is virologic suppression at 12 months and the key secondary outcome, which will also be examined as a mediator of the primary outcome, is retention in HIV care, as operationalized by kept and missed primary care visits. Process outcomes include text message response rate and percent of time in study without cell phone service. Generalized estimating equation log-binomial models will be used for intent to treat, per protocol, and mediation analyses. An assessment of the cost and cost-effectiveness of the intervention is planned along with a qualitative evaluation of the intervention. Discussion Findings from this study will provide valuable information about the use of behavioral-theory based text messaging to promote retention in HIV care and virologic suppression, further elucidate the challenges of using texting technology with marginalized urban populations, and help guide the development of new mobile health strategies to improve HIV care cascade outcomes. Trial registration NCT01917994

This is the essential guide to FASD - the most common non-genetic learning disability, which is caused by alcohol consumption during pregnancy. It explains how FASD affects individuals at different stages of their lives, how you can identify it, and gives advice on how to support children, young people and adults with FASD.

Objectives: To evaluate the prevalence of and factors associated with depression among HIV‐infected homeless and marginally housed men. Design: Cross‐sectional study. Participants and Setting: Homeless and marginally housed men living with HIV in San Francisco identified from the Research on Access to Care in the Homeless (REACH) Cohort. Measurements: The primary outcome was symptoms of depression, as measured by the Beck Depression Inventory (BDI). Multivariate logistic regression was used to identify associations of sociodemographic characteristics, drug and alcohol use, housing status, jail status, having a representative payee, health care utilization, and CD4 T lymphocyte counts. Results: Among 239 men, 134 (56%) respondents screened positive for depression. Variables associated with depression in multivariate analysis included white race (adjusted odds ratio [AOR]=2.2, confidence interval [CI]=1.3 to 3.9), having a representative payee (AOR=2.4, CI=1.3 to 4.2), heavy alcohol consumption (AOR=4.7, CI=1.3 to 17.1), and recently missed medical appointments (AOR=2.6, CI=1.4 to 4.8). Conclusions: Depression is a major comorbidity among the HIV‐infected urban poor. Given that missed medical appointments and alcohol use are likely indicators of depression and contributors to continued depression, alternate points of contact are necessary with many homeless individuals. Providers may consider partnering with payees to improve follow‐up with individuals who are HIV‐positive, homeless, and depressed.

Objective: To assess the reliability and validity of the Short-Form 36 (SF-36) health survey as a health status indicator among HIV-infected homeless and marginally housed (HMH) individuals. Methods: Between July 1996 and May 2000, a sample of HMH individuals completed interviews that included the SF-36. Responses to the SF-36 were analyzed for missing data, range, internal consistency, and construct validity. Results: Among 330 individuals interviewed, 83% were male, 43% were African-American, and the median age was 39 years. All internal consistency reliability coefficients exceeded 0.70, all item-scale correlations exceeded 0.40, all items were more strongly correlated with their hypothesized scale than any other scale, and all reliability coefficients exceeded inter-scale correlations for the same scale. Three of four physical health scales were significantly associated with CD4 cell count and HIV viral load. All scales were significantly associated with depression. Discussion: We found that scales were internally consistent, items correlated to an acceptable degree with their hypothesized scales, items were distinct from other scales, physical scales were associated with CD4 cell count and viral load, and all scales were associated with depression. These analyses provide evidence for the reliability and validity of the SF-36 as a measure of health status in HIV-positive HMH individuals.

Using a broad definition of the Durkheimian tradition, this book offers the first systematic attempt to explore the Durkheimians' engagement with art. It focuses on both Durkheim and his contemporaries as well as later thinkers influenced by his work. The first five chapters consider Durkheim's own exploration of art; the remaining six look at other Durkheimian thinkers, including Marcel Mauss, Henri Hubert, Maurice Halbwachs, Claude Levi-Strauss, Michel Leiris, and Georges Bataille. The contributors-scholars from a range of theoretical orientations and disciplinary perspectives-are known for having already produced significant contributions to the study of Durkheim. This book will interest not only scholars of Durkheim and his tradition but also those concerned with aesthetic theory and the sociology and history of art.

Retirement plan sponsors bear significant professional and personal risks in executing the fiduciary responsibilities required of them by their roles. Those responsibilities and risks have never been more present than in the post-Pension Protection Act environment, in which plan sponsors face heightened expectations, scrutiny, and exposure. That is why Collective Investment Trusts (CITs) are increasingly attractive to plan sponsors, particularly smaller ones, defined here as plans with $1 million to $30 million in assets. CITs can be less costly than other investment vehicles. Because CITs are not available to retail investors, there are savings related to administrative, advertising, and marketing expenses, which help keep costs down. Some CIT providers also can provide plan sponsors with solutions that invest in a full array of institutional money managers, mutual funds, ETFs, and lifestyle funds, such as target date funds. Although CITs offer many advantages, for some plan sponsors and participants they remain unfamiliar.

To address the widespread debate about the role of public assistance to the urban poor, the authors determined characteristics of individuals receiving cash assistance and explored the link between cash subsidies and risk behavior. From 1999 to 2000, a representative sample of homeless and marginally housed (HMH) adults living in San Francisco was recruited and interviewed about subsidies, shelter, jail, and drug use. Among 1,156 adults, 87% were ever homeless, 22% currently injected drugs, and 14% were HIV positive. Sixty percent of participants reported that most of their income came from subsidies [mostly subsidized (MS)]. The MS had lower odds of receiving any income from selling drugs or trading sex. Adjusting for HIV infection, the MS had higher odds of sleeping in a hotel [odds ratio (OR) = 2.39] or shelter (OR = 1.61) compared to the street. The MS had lower odds of injection drug use (OR = 0.69) and recent incarceration (OR = O.77). Among San Francisco's homeless, being MS was positively associated with having shelter and negatively associated with injection drug use and incarceration. These data suggest that government subsidies are associated with positive health behaviors among the urban poor.