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Clear prospective associations exist between grip strength and multiple indices of health and well-being, including frailty, morbidity, and mortality. The usual explanation is that low grip strength arises from loss of muscle function, indicative of a more general decline in physical health.1 However, the relationship that also exists between grip strength and preservation of cognitive capacity2, 3—when cognitive and muscle function are not linked,4 suggests that this account is incomplete. Beyond middle age, individual variations in grip strength may predominantly be a marker of brain health, rather than physical status.5 Application of grip force demands sophisticated neuromuscular coordination and control. Advances in brain imaging make clear that neural degeneration is an orderly and sequential process6 affecting networks that mediate functionally related processes such as cognition and motor control.7 From this perspective, the proximate cause of the relationship between grip strength and cognitive decline is weakening of the functional integrity of brain networks. The distal cause is the dysregulation of multiple physiological systems, which ultimately also becomes manifested in the associations of grip strength (and cognitive function) with frailty, morbidity, and mortality.

HIV continues to be an important public health issue. Voluntary community-based HIV testing (VCBT) helps to reduce the undiagnosed population of HIV-positive individuals, enabling early diagnosis and treatment. Monitoring is essential to determine whether at-risk groups are being effectively reached. Our aim was to pilot and then introduce sustained monitoring of VCBT in Ireland, through collaboration between statutory and non-statutory organisations. The study was initiated by the Health Protection Surveillance Centre in 2018. Steps included forming a multisectoral steering group and developing a minimum standardised dataset. De-identified case-based data were requested for VCBT carried out from 1 January 2017 onwards; this paper includes data for 2018. Six organisations participated; all four NGOs involved in VCBT, one medical charity, and the Health Service Executive National Social Inclusion Office. Methods were rapid point-of-care testing (POCT) (54%) or laboratory based (46%). Total HIV test reactivity was 1.7% (1.5% excluding persons later identified as previously diagnosed HIV positive). All POCT data were case based; the test reactivity rate was 0.8% and was higher in bar/club settings (1.2%). Most (74%) laboratory testing data were in aggregate format; the test positivity rate in one asylum centre was 5.0%. Ongoing challenges include testing among persons later identified as previously diagnosed HIV positive, monitoring case-based testing in asylum settings, and suboptimal data on confirmatory testing and linkage to care. Sustained national monitoring in community settings will help inform HIV testing guidelines and will enable assessment of the impact of local and regional community HIV testing strategies.

In 2012, immigrants constitute 63 % of new cases of heterosexually transmitted HIV among individuals born outside Ireland. Current strategies to encourage testing can be ineffective if immigrants perceive them as culturally insensitive. We obtained qualitative data to explore challenges to voluntary HIV-testing for immigrants in Ireland. Content analysis was undertaken to identify and describe pertinent themes. Widespread beliefs that HIV is primarily a disease of African immigrants were identified as challenges that constrain access to testing and care. The organization and location of testing services, attitude of health workers, and beliefs regarding mandatory HIV-testing for immigrants seeking access to welfare benefits were also identified. Immigrants in Ireland encounter a variety of structural, cultural and personal constraints to HIV testing. Opportunities exist in the Irish Health system to increase testing among immigrants through greater acknowledgement of cultural sensitivities of immigrant groups.