***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Purpose : To examine the performance of an instrument to assess adherence based on a visual analogue scale , compared to an instrument based on 3-day recall , using unannounced pill counts in the place of residence as the gold st and ard . Method : We prospect ively assessed adherence to antiretroviral therapy in 84 marginally housed indigent HIV-infected patients who were receiving stable antiretroviral therapy in San Francisco , California , with three adherence assessment s over no more than 4 months . Results : Mean adherence using the  visual analogue scale , 3-day recall , and unannounced pill count methods were 82.5 % , 84.2 % , and 75.9 % , respectively . The correlation between visual analogue scale and unannounced pill count was high ( r = 0.76 ) and was not statistically different from that between 3-day recall and unannounced pill count ( r = 0.71 ; p = .52 ) . Both methods were also similarly inversely correlated with HIV viral load ( r = -0.49 and -0.34 , respectively ; p = .22 for the difference in the correlations ) . The visual analogue scale correlation with unannounced pill count was stable over time and remained high in all sub population s examined . Conclusion : A visual analogue scale to assess adherence was performed as well as a more complicated 3-day recall instrument in this diverse population . Given its simplicity , the visual analogue scale adherence instrument will be useful in research and may be useful in routine patient care Objective : To assess adherence to HAART and to determine factors associated with poor adherence among HIV-1-infected patients in Abidjan , Côte d'Ivoire . Methods : A prospect i ve observational study of 614 consecutive patients attending an HIV/AIDS outpatient clinic . Adherence was measured twice at 3-month intervals by self-report of missing doses over 4 days . An adherence level of less than 95 % was defined as poor adherence . We used generalized estimating equation models for binomial distribution with repeated measures for data analysis . Results : Of the 591 subjects who completed the study , 74.3 % reported adherence levels of 95 % or greater . Six factors were independently related to poor adherence : age less than 35 years [ relative risk ( RR ) 1.45 ; 95 % confidence interval ( CI ) 1.17–1.79 ] , absence of social support ( RR 1.66 ; 95 % CI 1.24–2.24 ) , number of daily pills 10 or more ( RR 1.47 ; 95 % CI 1.14–1.91 ) , time of adherence assessment ( first versus second time assessment RR 1.36 ; 95 % CI 1.12–1.66 ) , CD4 cell count of 250 cells/μl or greater ( RR 1.43 ; 95 % CI 1.10–1.88 ) , and not being less worried about HIV infection now that treatments have improved ( RR 1.26 ; 95 % CI 1.01–1.58 ) . Drug supply interruptions in the pharmacies were reported by 10.0 % of the non-adherent patients as the reason for missing pills . Conclusion : Psychosocial factors were found to impact adherence and should be analysed in more detail by further studies . Scaling up antiretroviral therapy in sub-Saharan Africa should be preceded by reliable drug supply and distribution systems Objectives : Antiretroviral treatment ( ART ) scale-up in sub-Saharan Africa has made it possible to investigate the maintenance of adherence to HIV medications . We describe here adherence to ART and identify its correlates in the Cameroonian context . Design : Prospect i ve cohort study in 9 rural district hospitals . Methods : A mixed logistic regression model was used to identify factors associated with adherence to ART in 401 patients with data prospect ively collected on adherence . Results : Although 73 % of patients were adherent after the first month on ART , this proportion decreased to 61 % after 24 months . After adjustment for known factors of adherence to ART ( such as knowledge , motivation and side-effects ) , patients who reported willingness to start ART before initiation , those who were satisfied with information provided by their physicians , and those who implemented reminder methods for ART intake { eg , using an alarm clock , mobile phone , or watch [ odds ratio ( 95 % confidence interval ) ] = 2.45 ( 1.58 to 3.79 ) , but also the help of a relative to remind them or other methods } were more likely to be adherent to ART . Conclusions : Besides highlighting some correlates already known to have an impact on adherence to ART , our findings also underline the need to reinforce the counseling component of follow-up through innovative methods . Accordingly , training and implementation research should encourage the use of medication reminder methods , such as mobile phones , to assure adherence over time and improve long-term response to ART Background . Large-scale , government-based antiretroviral therapy ( ART ) programs in rural areas of re source -poor countries remain largely unevaluated . Methods . We conducted a retrospective review of all patients receiving ART ( n = 399 ) to assess survival and retention in care and a prospect i ve evaluation of patients on ART for at least 6 months ( n = 175 ) . We used 3-day self-report to measure  adherence . Results . The probability ( 95 % confidence interval [ CI ] ) of surviving and remaining in care was 0.76 ( 0.72 , 0.81 ) at 1 year . Men and patients with advanced disease were more likely to die or be lost to follow-up . At baseline , 149 ( 85 % ) reported 100 % adherence . Nonadherence was associated with lack of suppression of viral replication ( odds ratio [ OR ] = 4.5 ; 95 % CI : 1.8 , 11.5 ) . Missing a scheduled clinic visit and lack of disclosure of HIV status were associated with nonadherence . Conclusion . Viral suppression was high , but counseling to include HIV disclosure to family and keeping scheduled clinic appointments may improve long-term adherence and treatment outcomes We conducted a prospect i ve cohort study of 496 adults starting antiretroviral treatment ( ART )  to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality . Almost 60 % had good adherence based upon pharmacy records . Poor adherence was associated with being divorced , poorer , food insecure , and less educated . Longer travel time to clinic , concealing one 's human immunodeficiency virus ( HIV ) status , and experiencing side effects predicted poor adherence . Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence . During follow-up ( mean 275 days ) , 20 % died-usually within 90 days of starting ART . Neuropsychiatric symptoms , advanced HIV , peripheral neuropathy symptoms , food insecurity , and poverty were associated with death . Neuropsychiatric symptoms , advanced HIV , and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors . Social , economic , cognitive , and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia Background For youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome ( AIDS ) , nonadherence to antiretroviral therapy ( ART ) can lead to poor health outcomes and significantly decreased life expectancy . Objective To evaluate the feasability , acceptability , and preliminary efficacy of short message service ( SMS ) or text message reminders to improve adherence to ART for youth living with HIV/AIDS . Methods We conducted this prospect i ve pilot study using a pre – post design from 2009 to 2010 at a community-based health center providing clinical services to youth living with HIV/AIDS . Eligibility criteria included HIV-positive serostatus , age 14–29 years , use of a personal cell phone , English-speaking , and being on ART with documented poor adherence . During the 24-week study period , participants received personalized daily SMS reminders and a follow-up message 1 hour later assessing whether they took the medication , and asking participants to respond via text message with the number 1 if they took the medication and 2 if they did not . Outcome measures were feasibility , acceptability , and adherence . Self-reported adherence was determined using the visual analog scale ( VAS ) and AIDS Clinical Trial Group ( ACTG ) question naire 4-day recall . Viral load and CD4 cell count were followed as biomarkers of adherence and disease progression at 0 , 12 , and 24 weeks . Results Participants ( N = 25 ) were mean age 23 ( range 14–29 ) years , 92 % ( n = 23 ) male , 60 % ( n = 15 ) black , and 84 % ( n = 21 ) infected through unprotected sex . Mean VAS scores significantly increased at 12 and 24 weeks in comparison with baseline ( week 0 : 74.7 , week 12 : 93.3 , P < .001 ; week 24 : 93.1 , P < .001 ) . ACTG question naire 4-day recall also improved ( week 0 : 2.33 , week 12 : 3.24 , P = .002 ; week 24 : 3.19 , P = .005 ) . There was no significant difference in CD4 cell count or viral load between baseline and 12- or 24-week follow-up , although there was a trend toward improvement of these biomarkers and a small to moderate st and ardized effect size ( range of Cohen d : –0.51 to 0.22 ) . Of 25 participants , 21 ( 84 % ) were retained , and 20 of the 21 ( 95 % ) participants who completed the study found the intervention helpful to avoid missing doses . Conclusions In this pilot study , personalized , interactive , daily SMS reminders were feasible and acceptable , and they significantly improved self-reported adherence . Larger controlled studies are needed to determine the impact of this intervention on ART adherence and other related health outcomes for youth living with HIV/AIDS Background Access to programmes providing highly active antiretroviral therapy ( HAART ) is recent in Africa . In Senegal , a national initiative was launched in 1998 . The capacity of African patients to adhere to complex antiretroviral treatments ( ARV ) is largely unknown . Methods We assessed adherence and identified the main reasons for treatment interruption in a prospect i ve observational cohort of patients participating in an ARV access programme in Dakar , Senegal . Adherence was estimated each month on the basis of the patients ' stated consumption and on the proportion of the prescribed dose returned unused to the dispensing pharmacy . A total of 158 patients were studied between November 1999 and October 2001 . Results A cross-section analysis showed that the stated level of adherence was high : on average , over the study period , the patients said they had taken 91 % of each monthly dose and that they had taken the full monthly dose during two-thirds of the months studied . Adherence tended to be better among patients who were required to make little or no contribution to the cost of their treatment , through an appropriate pricing structure . Adherence was also better with efavirenz-containing regimens than with indinavir-containing regimens . Conclusion These results show that adherence to HAART can be as high in Africa as that generally observed in industrialized countries , and that the cost and type of drug regimen must be taken into account when design ing ARV access programmes for poor communities Depressive symptoms have been shown to independently affect both antiretroviral therapy ( ART ) adherence and HIV clinical outcomes in high-income countries . We examined the prospect i ve relationship between depressive symptoms and adherence , virologic failure , and suppressed immune function in people living with HIV/AIDS in Tanzania . Data from 403 study participants who were on stable ART and engaged in HIV clinical care were analyzed . We assessed crude and adjusted associations of depressive symptoms and ART adherence , both at baseline and at 12 months , using logistic regression . We used logistic generalized estimating equations to assess the association and 95 % confidence intervals ( CI ) between depressive symptoms and both virologic failure and suppressed immune function . Ten percent of participants reported moderate or severe depressive symptoms at baseline and 31 % of participants experienced virologic failure ( > 150 copies/ml ) over two years . Depressive symptoms were associated with greater odds of reported medication nonadherence at both baseline ( Odds Ratio [ OR ] per 1-unit increase = 1.18 , 95 % CI [ 1.12 , 1.24 ] ) and 12 months ( OR = 1.08 , 95 % CI [ 1.03 , 1.14 ] ) . By contrast , increases in depressive symptom score were inversely related to both virologic failure ( OR = 0.93 , 95 % CI [ 0.87 , 1.00 ] ) and immune system suppression ( OR = 0.88 , 95 % CI [ 0.79 , 0.99 ] ) , though the association between depressive symptoms and clinical outcomes was less precise than for the association with nonadherence . Findings indicate a positive association between depressive symptoms and nonadherence , and also an inverse relationship between depressive symptoms and clinical outcomes , possibly due to informative loss to follow-up Objective We determined the impact of immune 
    Output:
    
Determinants of health status had conflicting influence on adherence .
The sociodemographic , psychosocial , health status , treatment-related and intervention-related determinants are interlinked and contribute to optimal adherence .