The success of potent antiretroviral treatment (ART) for HIV infection is primarily determined by the level of medication adherence. We systematically review the evidence on effectiveness of interventions to enhance ART adherence in sub-Saharan Africa (SSA), where four fifths of the more than five million people receiving ART live. We identified 26 relevant publications reporting on 25 studies, conducted between 2003 and 2010, of behavioural, cognitive, biological, structural, and combination interventions. The majority (16) of the studies took place in hospital outpatient facilities in urban settings. Studies differed widely in design, sample size, length of follow-up, and outcome measurement. Despite study diversity and limitations, the evidence to date suggest that treatment supporters, directly observed therapy, cell phone short message services, diary cards and food rations and can be effective in increasing adherence in some settings in SSA. However, our synthesis of studies also shows that some interventions are unlikely to produce large or lasting effects, while other interventions are effective in some but not in other settings, emphasizing the need for more research, in particular, RCTs, to allow examination of the influence of context and particular features of intervention content on effectiveness. Important avenues for future work include intervention targeting and selection of interventions based on behavioural theories relevant to SSA.

Introduction: There has been little attention to measuring quality of prenatal care from a Black person's perspective. We examined validity and reliability of the Quality of Prenatal Care Questionnaire (QPCQ) and perceptions of the quality of prenatal care among pregnant Black women.Methods: A total of 190 women had complete data on the postpartum questionnaire containing the QPCQ within 8 weeks after birth. Internal consistency reliability was assessed using Cronbach's α. Construct validity was assessed through hypothesis testing using select questions from the Pregnancy Risk Assessment Monitoring System (PRAMS) and Pearson's r correlation. Results:The mean (SD) maternal age was 26.5 (5.5) years, and 85.3% of births were term (>37 weeks' 0 days' gestation). The total mean (SD) QPCQ score was 191.3 (27.9) points (range 46-230), and the mean (SD) item score for the subscales ranged from 3.88 (0.80) points to 4.27 (0.64). The Cronbach's α for the overall QPCQ score was .97 and ranged from .72 to .96 for the 6 subscale scores, which indicated acceptable internal consistency reliability. All but one subscale had a Cronbach's α higher than .80. The Approachability subscale had a Cronbach's α of .72. Construct validity demonstrated a moderate and significant positive correlation between the PRAMS items and the QPCQ (r = .273, P < .001).Discussion: To our knowledge, this is the first study to examine the validity and reliability of the QPCQ and perceptions of quality of prenatal care among Black women from the United States. The results indicate that participants rate the quality of their prenatal care highly and that the QPCQ is a reliable and valid measure of the quality of prenatal care. Use of a convenient and reliable instrument to measure the quality of prenatal care rather than prenatal care satisfaction or utilization may help to elucidate the factors of prenatal care that are protective specifically among Black women.

Introduction: Black women experience significant maternal mortality (3.3 times higher) compared to White women, and experience higher adverse outcomes. In the United States, cardiovascular disease is the second leading cause of maternal mortality for Black women. Hypertensive disorders of pregnancy (HDOP) falls under the cardiovascular disease spectrum. Objective: To explore differences in women diagnosed with a HDOP compared to those that do not have HDOP. Methods: A total of 226 African American women from Metro-Detroit and Columbus, Ohio enrolled in a cross-sectional study who had recently gave birth. Women enrolled in a mixed methods study on social and biological stressors to preterm birth with a completed medical record abstraction were identified as having chronic hypertension or a hypertensive disorder of pregnancy (HDOP) prior to the current pregnancy. HDOP is defined as chronic hypertension, chronic hypertension with superimposed preeclampsia, gestational hypertension, preeclampsia or eclampsia. Perinatal complications and birth outcomes were explored. Sociodemographic was derived from completed prenatal questionnaires. Chi square was used for categorical variable and T-test was used for continuous variables. Significance is defined as p ≤ 0.05. Results: The mean age was 26.8±5.9 years. Approximately 70.4% (n=159) were from Detroit, MI and 29.6% were from Columbus, OH. The mean previous live births were 1.9±1.8 (range 0-8). The average number of prenatal visits with a physician were 9.2±2.9 (range 2-19) and the total number of any prenatal visits were 16.0±6.9 (range 1-44). Average baby gestational age is 37.9±2.2 weeks (range 15-26 weeks), and weight is 2998±703.4 grams. Approximately 60 women (26.5%) were identified with a hypertensive disorder of pregnancy. Compared to women not diagnosed with a HDOP, women with a HDOP had an older mean age (28.3±6.4 vs 26.3±5.6), p=0.023; had more prenatal visits (18.2±7.6 vs 15.6±6.5) p=0.007; had babies at a younger gestational age (37.2±2.1 vs 38.2±2.1), p=0.002. Conclusion: These findings will aid in determining factors associated with HDOP in our population, and aid in determining next steps to reduce historic mortality in this group.

Background: This study evaluated the impact of the Racism in Medicine Summit on student perceptions of various topics related to racism in medicine. The Summit was organized at the Wayne State University School of Medicine (WSUSOM) to educate students, faculty and staff on how structural racism affects the residents of Detroit and the historical relationship between healthcare and vulnerable populations. The Summit aimed at providing context for what students in Detroit will encounter as physicians-in-training and the skills they will need to master while working within similar communities.  Methods: Qualtrics surveys were created and distributed via email to attendees before and after the event. Responses were obtained via Likert scale and open-text questions.  Results: A total of 342 out of 445 participants (77%) completed both the pre- and post-survey. Quantitative analysis in post-survey responses revealed more familiarity among participants regarding specific instances of racism in the history of medicine, greater extent of thinking the history of racism impacts present-day Detroit residents, greater extent of thinking that racism influences medical care and/or medical outcomes, and belief that racism is reflected in medical research, compared to pre-survey responses (p < 0.001). Participants also reported more often considering racial or societal influences when studying medicine and more knowledge of what they can do to combat racism as a student and physician (p < 0.001).  Qualitative analysis revealed seven themes among participants: the history of racism in medicine, personal reflection, racism in research, bias and microaggression, actions to take against racism, resources for anti-racist education, and racism in medical education.  Conclusions: Demonstrable changes in medical student attitude and awareness surrounding topics of racism and healthcare were achieved after the Racism in Medicine Summit. This can serve as a model for other medical schools to raise awareness about racism in medicine.