Methods to improve recruitment to randomised controlled trials : Cochrane systematic review and meta-analysis

Peer reviewedPublisher PD

1 A Perspective on Metacomputing

The goal of a metacomputing system is to increase job throughput by using all available resources in a grid, while transparently providing for resource heterogeneity, network heterogeneity, and a security model for the multiple administrative domains that correspond to the autonomous sites comprising the underlying grid. The initial vision of metacomputing was to harness idle cycles of a local network, and grew to encompass those in geographically distinct government laboratories. Such systems were not without problems: each cluster had different hardware, resulting in non-portable and non-scalable software and preventing the realization of infinitely-scalable computing. In recent years several new systems have been developed with a focus on developing working systems that provide a comprehensive set of resources. We examine a representative subset of these systems in this paper, as well as some of the conceptual problems stemming from the inhomogeneities in a metacomputer

Housing and Reentry: A Mixed-Method Evaluation of a Low-Cost Community-Based Intervention for Increasing Access to Housing Post-Incarceration

Background: Housing assistance programs for the formerly incarcerated typically provide housing vouchers that cannot be used to pay court fees, fines, or debts. We evaluated whether flexible spending and case-management assistance would facilitate housing placement for individuals with criminal records. Method: A community foundation provided funds to four housing programs in Oregon that removed financial barriers to housing for individuals with criminal records. A subset of these individuals was interviewed for qualitative program assessment. Results: A total of $243,401 was spent serving 113 individuals, 99 of whom were housed. Successfully housed individuals tended to be younger than those not housed by the end of the program period (median age 38 vs. 43, respectively, p = 0.0556) and had higher median monthly incomes ($900 vs. $169, respectively, p = 0.0462). Providing at least$1,000 in assistance per person was associated with quicker placement vs. providing less than $1,000 (p = 0.012). Median move-in time for those with$1,000 or more in funding was 1 month vs. 3 months for those with less than $1,000 (p = 0.0112). Participants reported satisfaction with case-management and housing assistance, which they felt helped them avoid recidivism. Conclusion: Providing flexible financial assistance for housing and case management can facilitate successful, efficient housing and help individuals with criminal records achieve stability after reentry. Keywords: incarceration, rehousing, reentry, recidivism, case management, flexible funding, community program

Effects of Lifetime History of Use of Problematic Alcohol on HIV Medication Adherence

BACKGROUND: The effects of previous alcohol abuse on antiretroviral therapy (ART) adherence have been less studied. MATERIALS AND METHODOLOGY: Participants were randomized to a 3-month group intervention or an individual-enhanced standard-of-care condition and assessed over 6 months. Individual assessment at baseline, 3, and 6 months was done; interviews included lifetime history of problematic alcohol use. RESULTS: A total of 80 HIV-positive individuals on ART were recruited. In all, 35% of participants reported a history of problematic alcohol use, 37% had a detectable viral load, 55% were nonadherent, and 24% reporting skipping medication in the previous 3 months. There was no association between a history of problematic use and an adherence at any time point, that is, at baseline (t = −.7, P = .47), midpoint (t = −.39, P = .69), and 6-month follow-up (t = −1.2, P = .23). CONCLUSION: Results suggest that a history of problematic alcohol use may not impact ART adherence

A Group Intervention for HIV/STI Risk Reduction among Indian Couples

Background: HIV in India is transmitted primarily by heterosexual contact. The present study sought to test the feasibility of a group HIV/STI risk re­duction intervention among heterosexual couples in India. Methods: Focus groups and key informant interviews were used in 2008 to cul­turally tailor the intervention. Thirty sexually active and HIV/STI negative cou­ples were enrolled and assessed regarding risk behavior and sexual barrier accept­ability. Gender-concordant group sessions used cognitive behavioral strategies for HIV/STI prevention. Results: At baseline, male condom use was low (36%); no participants re­ported use of female condoms or vaginal gels. HIV knowledge was low; women had more HIV knowledge and more positive attitudes towards con­dom use than men. Post-intervention, willingness to use all barrier products (t = 10.0, P< .001) and intentions to avoid risk behavior increased ( t = 5.62, P< .001). Conclusion: This study illustrates the feasibility of utilizing a group interven­tion to enhance HIV/STI risk reduction among Indian couples

Enhancing HIV Medication Adherence in India

BACKGROUND: This pilot study evaluated an intervention designed to enhance adherence among those new to antiretroviral therapy. METHODS: Participants (n = 80) were recruited from a hospital clinic in Chandigarh, India, and randomized to a 3-month group intervention or individual enhanced standard of care followed by crossover of condition and assessed over 6 months. Adherence was measured by prescription refill, pill count, and self-report. RESULTS: At baseline, 56% of group condition (immediate intervention) and 54% of individual condition (delayed intervention) participants were nonadherent by pill count and 23% of group and 26% of individual condition participants self-reported skipping medication at least once over the last 3 months. From the postintervention to long-term follow-up, adherence in the group condition (immediate intervention) improved in comparison with adherence in the individual condition (delayed intervention; χ(2) = 5.67, P = .02). CONCLUSIONS: Results support the use of interventions early in treatment to provide information and social support to establish long-term healthy adherence behaviors

Neuropsychological test performance among healthy persons in northern India: development of normative data

Accurate identification of neurocognitive impairment associated with HIV infection (and other CNS-involved conditions) is dependent upon utilization of appropriate normative neuropsychological test performance data from healthy individuals with a similar background, culture, and characteristics of the target individual or group to be tested. In India, regional differences in language, culture, and availability of resources can significantly affect performance on neuropsychological testing. This study developed age- and education-adjusted normative data for commonly used neuropsychological test scores for use in northern India

Reducing sexual risk behavior among high risk couples in Northern India

PURPOSE: This study sought to assess the feasibility of conducting a group, culturally tailored behavioral intervention and its impact on sexual barrier use, self efficacy, knowledge, conflict resolution and coping among high risk heterosexual couples in Northern India. METHOD: This pilot study was conducted at the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India from February 2008 to January 2009. Thirty sexually active high risk couples were drawn from a convenience sample of PGIMER patients attending infectious disease and family planning clinics. Couples participated in one month of 3 weekly gender concordant behavioral intervention groups and were individually administered assessments pre- and post-intervention. The intervention was tailored to the Northern Indian context, and addressed sexual barrier use, HIV/STI transmission and cognitive behavioral skill building focusing on sexual negotiation and communication. RESULTS: Participants were a mean age of 32 (men) and 29 (women) years, and the majority had at least 10 years of education. At baseline, the majority reported inconsistent condom use (<100% of the time) (64% of women, 59% of men). Post-intervention, nearly all participants reported consistent use (100% of the time) (100% of men, 97% of women). Participants also reported decreased verbal aggression, increased self efficacy and increased HIV-related knowledge, and women increased their use of positive coping tactics. CONCLUSIONS: Results highlight the potential to successfully utilize a group intervention to discuss sensitive issues such as sexual risk behavior among both men and women. Strategies to improve condom use and communication without increasing intimate partner violence in high risk couples may be an important adjunct to preventing the development of a generalized epidemic in India