***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: Optimists ( people who have positive expectations about the future ) have been shown to perform more health-promoting behaviors than pessimists . This study attempts to alter individuals ’ levels of optimism , and thereby their health behaviors , by having them write about a positive future . HIV-infected women ( N = 40 ) on combination therapies  were r and omly assigned to write about a positive future or assigned to a no-writing control group . Among participants who were low in optimism , the writing intervention led to increased optimism , a trend toward increased self-reported adherence to medications , and decreased distress from medication side effects , compared to controls who did not write . Participants who were high in optimism showed the opposite effects after writing about the future . Results suggest that a future-oriented writing intervention may be a promising technique to increase medication adherence and decrease symptom , distress in pessimistic individuals Background : We prospect ively studied the impact of an adherence counselor on the outcome of patients failing antiretroviral therapy because of nonadherence . Methods : Forty-six patients , identified as chronically nonadherent were enrolled . Individual attention was provided using the information , motivation and behavioral methodology .  HIV RNA ( viral load , in copies/mL ) , CD4 count ( in cells/mm 3 ) , and body weight before and after the adherence counselor were measured . Qualitative outcome and patient satisfaction were assessed by deidentified third-party interviews . Results : Over half completed at least 1 year ; only 8 patients were lost to follow-up . Mean CD4 counts increased significantly ( P < .05 ) for completers at 6 and 12 months . Viral loads decreased between baseline and 6 months . Most clients reported subjective benefit from working with the adherence counselor . Conclusion : Although few clients showed complete virologic suppression , the value of an adherence counselor was vali date d. Longer term adherence programs should be evaluated A r and omized 2-group medication adherence intervention is evaluated with HIV-infected adults ( N = 141 ) assessed at baseline , 3- , and 9-month follow-ups . Cognitive ( self-efficacy , behavioral intent ) , mental health ( depression , well-being ) , and substance use indicators were the outcome measures . In addition , a posttest-only analysis from 3 to 9 months evaluates intervention impact on antiretroviral adherence , measured through Medication Event Monitoring System and pill counts . Compared to the st and ard care group , the intervention group showed significant increases in adherence self-efficacy and behavioral intent at 3 and 9 months and marginal improvements in mental health . Although the st and ard care group had higher adherence at 3 months ( no baseline data were available prior to intervention ) , intervention group patients showed significant increases in adherence from 3 to 9 months . Although adherence levels achieved by intervention patients may not be sufficient for virological control , this is one of the first studies to provide promising results of longer term effectiveness of a behavioral adherence intervention The impact of an adherence enhancement program for low income HIV-infected Spanish-speaking Latinos on health literacy , patient-provider relationships , and adherence to HAART was examined . Evaluations were conducted at baseline , 6 weeks , and 6 months for participants ( n = 85 ) r and omly assigned to either the intervention group or a comparison group ; 69 ( 81 % ) remained in the study for the entire 6-month duration . The intervention group scored significantly better than the comparison group on 3 of 5 measures of HIV health literacy at 6 weeks and on 2 of 5 measures , at 6 months . While there was a weak trend for the intervention group to report an increase in self-efficacy of medication adherence management , baseline to 6 weeks , no other changes were significant . Perceptions of the quality of relationship and communications with their HIV-treating physicians improved both at 6 weeks ( p = 0.04 ) and at 6 months ( p < 0.001 ) . The comparison group showed little change baseline to 6 weeks and baseline to 6 months . While there was a trend for the pilot group to report better medication adherence , these differences were not statistically significant . Further evaluation of the impact of this adherence enhancement program is needed Child sexual abuse ( CSA ) is associated with HIV risk behaviors [ Bensley , L. , Van Eenwyk , J. , and Simmons , K. W. , 2003 . ] and more prevalent among women living with HIV than in the general population [ Koenig , L. J. , and Clark , H. , 2004 ] . This r and omized Phase ~ I clinical trial tested the impact of a culturally congruent psychoeducational intervention design ed to reduce sexual risks  and increase  HIV medication adherence for HIV-positive women with CSA histories . An ethnically diverse sample of 147 women were r and omized to two conditions : an 11-session Enhanced Sexual Health Intervention ( ESHI ) or an attention control . Results based on “ intent to treat ’ ’ analysesof pre – post changes are reported here . Additional analyses explored whether theobserved effects might depend on “ intervention dose , ’ ’ i.e. , number of sessions attended . Women in the ESHI condition reported greater sexual risk reduction than women in the control condition . Although there were no differences between women in the ESHI and control groups on medication adherence , women in the ESHI condition who attended 8 or more sessions reported greater medication adherence at posttest than control women . The findings provide initial support for this culturally and gender-congruent psychoeducational intervention for HIV-positive women with CSA , and highlight the importance of addressing the effects of CSA on sexual risk reduction and medicationadherence in preventive interventions for women This study r and omized 90 HIV-seropositive , methadone-maintained injection drug users ( IDUs ) to an HIV Harm Reduction Program ( HHRP+ ) or to an active control that included harm reduction components recommended by the National AIDS Demonstration Research Project . The treatment phase lasted 6 months , with follow-ups at 6 and 9 months after treatment entry . Patients in both treatments showed reductions in risk behaviors . However , patients assigned to HHRP+ were less likely to use illicit opiates and were more likely to adhere to antiretroviral medications during treatment ; at follow-up , they had lower addiction severity scores and were less likely to have engaged in high risk behavior . Findings suggest that enhancing methadone maintenance with an intervention targeting HIV-seropositive IDUs increases both harm reduction and health promotion behaviors This study examined whether a self-management intervention based on feedback of adherence performance and principles of social cognitive theory improves adherence to antiretroviral dosing schedules . Forty-three individuals with HIV/AIDS who were starting or switching to a new protease inhibitor regimen were r and omly assigned to be in a medication self-management program or usual care control group . The self-management program included skills development exercises , three monthly visits for medication consultations , and monthly feedback of adherence performance using electronic monitors on medication bottles . Participants also completed a 40-item question naire that measured self-efficacy to take medications , on schedule , in a variety of situations . Logistic regression analysis indicated that individuals in the self-management group were significantly more likely to take 80 % or more of their doses each week than individuals in the control group ( n=29 , OR=7.8 , 95 % CI=2.2 - 28.1 ) . Self-management training with feedback of adherence performance is a potentially useful model for improving adherence to complex regimens in HIV/AIDS care Background . Patients cite " forgetting " as a reason for nonadherence to highly active antiretroviral therapy ( HAART ) . We measured the effect of a memory-prompting device on adherence to HAART in memory-intact and memory-impaired human immunodeficiency virus (HIV)-infected subjects . Methods . The study was a prospect i ve , r and omized , controlled trial involving 64 HIV-infected adults . The intervention was the Disease Management Assistance System ( DMAS ) device , combined with monthly adherence counseling . Control subjects received only adherence counseling . The DMAS was programmed with HAART regimen data to provide verbal reminders at dosing times .  Adherence was measured for 24 weeks using electronic drug exposure monitor ( eDEM ) caps . Results . A total of 58 subjects completed the 24-week study period ; 28 were HAART naive ( 12 DMAS users and 16 control subjects ) .  Mean adherence scores did not differ significantly between DMAS users ( 80 % ) and control subjects ( 65 % ) . Post hoc analysis of 31 memory-impaired subjects ( 14 DMAS users and 17 control subjects ) revealed significantly higher adherence rates among DMAS users ( 77 % ) , compared with control subjects ( 57 % ) ( P=.001 ) . However , analysis of memory-intact subjects showed that adherence was not significantly improved for DMAS users ( 83 % ) , compared with control subjects ( 77 % ) ( P=.25 ) . At week twelve , 38 % of the DMAS users and 14 % of the control subjects had an undetectable plasma HIV RNA load ( P=.014 ) , and at week 24 , the plasma HIV RNA load was undetectable for 34 % of the DMAS users and 38 % of the control subjects ( P=.49 ) . CD4(+ ) cell counts did not differ between the study arms . Virological and immunological responses were not related to DMAS use in memory-impaired subjects . Conclusion . The DMAS prompting device improved adherence for memory-impaired subjects but not for memory-intact subjects BACKGROUND Directly administered antiretroviral therapy ( DAART ) in methadone clinics has the potential to improve treatment outcomes for human immunodeficiency virus (HIV)-infected injection drug users ( IDUs ) . METHODS DAART was provided at 3 urban methadone clinics . Eighty-two participants who were initiating or reinitiating highly active antiretroviral therapy ( HAART ) received supervised doses of therapy at the clinic on the mornings on which they received methadone . Treatment outcomes in the DAART group were compared with outcomes in 3 groups of concurrent comparison patients , who were drawn from the Johns Hopkins HIV Cohort . The concurrent comparison patients were taking HAART on a self-administered basis . The 3 groups of concurrent comparison patients were as follows : patients with a history of IDU who were receiving methadone at the time HAART was used ( the IDU-methadone group ; 75 patients ) , patients with a history of IDU who were not receiving methadone at the time that HAART was used ( the IDU-nonmethadone group ; 244 patients ) , and patients with no history of IDU ( the non-IDU group ; 490 patients ) . RESULTS At 12 months , 56 % of DAART participants achieved an HIV type 1 RNA level < 400 copies/mL , compared with 32 % of participants in the IDU-methadone group ( P=.009 ) , 33 % of those in the IDU-nonmethadone group ( P=.001 ) , and 44 % of those in the non-IDU group ( P=.077 ) . The DAART group experienced a median increase in the CD4 cell count of 74 cells/mm3 , compared with 21 cells/mm3 in the IDU-methadone group ( P=.04 ) , 33 cells/mm3 in the IDU-nonmethadone group ( P=.09 ) , and 84 cells/mm3 in the non-IDU group ( P=.98 ) . After adjustment for other covariates in a logistic regression model , DAART participants were significantly more likely to achieve viral suppression than were patients in each of the 3 comparison groups . CONCLUSIONS These results suggest that methadone clinic-based DAART has the potential to provide substantial clinical benefit for HIV-infected IDUs A 24-week open-label clinical trial was conducted in 195 HIV-infected adults commonly underrepresented in research ( 35 % female , 71 % African American , 21 % Hispanic , and 20 % injection drug users [ IDUs ] ) to evaluate the effect of an HIV educational program on efficacy and adherence with a simple , compact , twice-daily triple nucleoside regimen containing a lamivudine ( 150 mg)/zidovudine ( 300 mg ) combination ( COM ) tablet plus abacavir ( ABC ) , 300 mg . At baseline , the patients ' median plasma HIV-1 RNA level was 4.18 log10 copies/mL and the median CD4 + cell count was 379 cells/mm3 . Patients were r and omized 1:1 to 4 modules of the Tools for Health and Empowerment HIV education intervention plus routine counseling ( EI + RC ; n = 96 ) or to routine counseling alone ( RC ; n = 99 ) . No differences between the EI + RC and RC treatment arms were observed with respect to the proportion of patients achieving plasma HIV-1 RNA levels < 40 copies/mL ( 60 % [ 33/55 ] vs. 55 % [ 38/69 ] ; P = 0.529 ) or < 400 copies/mL ( 80 % [ 44/55 ] vs. 80 % [ 55/69 ] ; P = 0.689 ) at week 24 ( intent-to-treat observed analysis ) , increase in median CD4 cell count above baseline at week 24 ( 78.3 vs. 104.8 cells/mm3 
    Output:
    
We discerned congruence between the prominence of substance abuse as a factor identified in the descriptive studies as a barrier to adherence and its prominence as the problem most addressed in those reports of intervention studies that specified the problems targeted for intervention .
We also discerned congruence between the prominence of family and provider support as factors identified in the descriptive studies as facilitators of adherence and the presence of social support as an intervention component and outcome variable .
Less discernible in the reports of intervention studies was specific attention to other factors prominent in the descriptive studies , which may be due to the complex nature of the problem , individualistic and rationalist slant of interventions , or simply the ways interventions were presented .