Community Emergency Response Team (CERT) Training of High-Risk Teens in the Community of Watts, South Los Angeles, 2013-2014.

The Community Emergency Response Team (CERT) concept was initially developed for adult members of the community to help prepare for disasters and minimize damage when disasters occur. CERTs also served as a tool for building community capacity and self-sufficiency by supporting a diverse group of people working together in dealing with challenges affecting their communities. The novel approach to CERTs described here sought to involve high-risk youth from low-socioeconomic status communities in CERTs and first aid and cardiopulmonary resuscitation (CPR) training to help them build ties with communities, stay off the streets, and become leaders in the community. It also helped to provide different perspectives on life, while building more resilient communities better prepared to minimize damage when a disaster strikes. After the successful launch of the first high-risk teen CERT cohort in Watts (27 CERT-trained and 14 first aid/CPR-trained), the project was expanded to other community groups and organizations. Seven additional cohorts underwent CERT and first aid/CPR training in 2013 through 2014. This initiative increased CERT visibility within South Los Angeles. New partnerships were developed between governmental, nongovernmental, and community-based organizations and groups. This model can be used to expand CERT programs to other communities and organizations by involving high-risk teens or other high-risk groups in CERT training. (Disaster Med Public Health Preparedness. 2017;11:605-609).

Consistency of state statutes with the Centers for Disease Control and Prevention HIV testing recommendations for health care settings.

In September 2006, the Centers for Disease Control and Prevention (CDC) released the "Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-care Settings" to improve screening and diagnosis. The CDC now recommends that all patients in all health care settings be offered opt-out HIV screening without separate written consent and prevention counseling. State law on HIV testing is widely assumed to be a barrier to implementing the recommendations. To help policymakers and providers better understand their own legal context and to correct possible misunderstandings about statutory compatibility, a state-by-state review (including Washington, DC) of all statutes pertaining to HIV testing was performed and the consistency of these laws with the new recommendations was systematically assessed. Criteria were developed for classifying state statutory frameworks as consistent, neutral, or inconsistent with the new recommendations, and the implications for implementation of the CDC recommendations in these various legal contexts were examined. The statutory frameworks of 34 states and Washington, DC, were found to be either consistent with or neutral to the new CDC recommendations, which would enable full implementation. Statutory frameworks of 16 states were inconsistent with the new CDC recommendations, which would preclude implementation of 1 or more of the novel provisions without legislative change. In the 2 years since release of the recommendations, 9 states have passed new legislation to move from being inconsistent to consistent with the guidelines. State statutory laws are evolving toward greater compliance with the CDC recommendations. Policymakers, provider groups, consumer advocates, and other stakeholders should ensure that HIV screening practices comply with existing state law and work to amend inconsistent laws if they are interested in implementing the CDC recommendations.

The challenges of assessing fidelity to physician-driven HIV prevention interventions: lessons learned implementing Partnership for Health in a Los Angeles HIV clinic.

Documenting fidelity to HIV prevention interventions is critical to ensure consistency in intervention implementation and necessary for measuring intervention exposure and, ultimately, outcomes. Significant variation from prescribed protocols or inconsistent implementation can jeopardize the integrity of evaluation research and render outcomes uninterpretable. There is increasing support for HIV prevention models targeting seropositive individuals designed to be delivered by physicians during clinic visits. Assessing fidelity to physician-delivered interventions that occur during clinical exams present unique challenges. This paper presents findings from various data sources designed to track intervention fidelity and exposure to the Partnership for Health intervention, a physician-delivered HIV prevention intervention implemented in an urban community HIV clinic. We present findings from chart abstraction data, patient surveys and exit interviews, and provider qualitative interviews. Lessons learned and recommendations for maximizing the accuracy and validity of fidelity assessment in future evaluations of HIV prevention interventions in primary care settings are considered.

HIV/AIDS health service utilization by people who have been homeless.

People living with HIV/AIDS (PLWHA) who experience homelessness have competing priorities (e.g., food, security of property) and experience complex health-related issues (e.g., co-morbidities, transportation to clinics) that may interfere with utilizing health care services. Using data from 229 PLWHA we did not find that homelessness was related to fewer or shorter clinic visits. Patients who had ever been homeless were more likely to have a case manager (74.2%) than never homeless patients (58.8%). African American patients were less likely to have a case manager (57%) as compared to other ethnicities (66%) although this was not statistically significant.