Alcohol Use and HIV Prevention Among Personnel in the Belize Defence Force.

To evaluate the effect of a peer-based risk reduction project on alcohol use and sexual behavior within Belize Defence Force personnel. We used a quasi-experimental, mixed quantitative and qualitative methods design to evaluate project outcomes. Two serial cross-sectional surveys were conducted [baseline (n = 126) and 6-month follow-up (n = 128)] using computer assisted self-interview. Semistructured interviews were collected from 12 peer counselors 3 months after the beginning of the project. The proportion of respondents screening positive for alcohol dependence decreased significantly from 80 % at preintervention to 66 % at postintervention (p = 0.045), and the percentage of respondents reporting that they normally drink alcohol before work decreased from 11 to 3 % (p = 0.013). Alcohol abuse and dependency scores correlated positively with the overall number of sexual partners in both male and female respondents. There was a slight decrease in the percentage of female respondents' reporting inconsistent condom use for vaginal sex (baseline 100 %, follow-up 83 %, p = 0.088), but there was no appreciable change reported in condom use among male respondents. Qualitative findings suggest that techniques to reduce the quantity of alcohol consumed were a salient focus of peer counselors, and administrative barriers can readily mitigate implementation of such interventions. In this evaluation of a risk reduction program with the BDF, we found evidence of a reduction in types of alcohol use from baseline to follow-up. Alcohol-related risk reductions carry implications for reducing sexual risk behavior in military personnel. Future research with stronger experimental design strategies may better elucidate how substance use reduction is linked with sexual risk reduction in military personnel.

Contraceptive continuation in Hispanic women.

OBJECTIVE: The purpose of this study was to examine the effect of Hispanic ethnicity on the continuation and satisfaction of reversible contraceptive methods. STUDY DESIGN: We analyzed 12 months of data that were collected from 7913 participants in the Contraceptive CHOICE Project. Kaplan-Meier survival curves were used to estimate continuation, and Cox proportional hazard models were used to estimate the risk of discontinuation. RESULTS: Hispanic women were more likely to choose a long-acting reversible contraceptive (LARC) method compared with non-Hispanic black and non-Hispanic white women (80%, 73%, and 75%, respectively; P < .05). The 12-month continuation rates were higher for LARC methods than combined hormonal methods for all race/ethnicity (Hispanic women, 87% vs 40%; non-Hispanic black women, 85% vs 46%; non-Hispanic white women, 87% vs 56%). There was no statistical difference in discontinuation of LARC methods at 12 months. Eighty percent of LARC users reported high satisfaction levels at 12 months, regardless of race/ethnicity. CONCLUSION: Hispanic women in the Contraceptive CHOICE Project experienced high continuation and satisfaction for LARC methods, similar to women of other ethnicities.

North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.

BACKGROUND: The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits.  OBJECTIVES: To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.  METHODS: We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability.  RESULTS: Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists.  CONCLUSIONS: Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.