***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: Clinical ly derived hypotheses regarding treatment engagement of families of low-income , HIV-positive , African American mothers are tested using univariate and multivariate logistic regression models . Predictors are baseline family relational factors ( family support , mother 's desire for involvement with family , and family hassles ) and mother 's history of substance dependence . The study examines a sub sample of 49 mothers enrolled in a clinical trial testing the efficacy of Structural Ecosystems Therapy ( SET ) . SET is a family-based intervention intended to relieve and prevent psychosocial distress associated with HIV/AIDS . Participants in the sub sample were r and omly assigned to SET and attended at least two therapy sessions . Findings reveal that family relational factors predicted family treatment engagement ( family support , p < .004 ; mother 's desire for involvement with family , p < .008 ; family hassles , p < .027 ) . Family support predicted family treatment engagement beyond the prediction provided by the other relational factors and the mother 's own treatment engagement ( p < .016 ) . History of substance dependence was neither associated with family treatment engagement nor family support . Post hoc analyses revealed that family hassles ( p < .003 ) and mother 's desire for involvement with family ( p < .018 ) were differentially related to family treatment engagement in low- versus high-support families . Implication s for clinical practice and future research are discussed Directly administered antiretroviral therapy ( DAART ) is one approach to improving adherence to among human immunodeficiency virus (HIV)-infected drug users . We evaluated the essential features of a community-based DAART intervention in a r and omized , controlled trial of DAART versus self-administered therapy .  Of the initial 72 subjects , 78 % were racial minorities , and 32 % were women . Social and medical comorbidities among subjects included homelessness ( 35 % of subjects ) , lack of interpersonal support ( 86 % ) , major depression ( 57 % ) , and alcoholism ( 36 % ) . At baseline , the median CD4 + cell count was 403 cells/mL and the median HIV-1 RNA load was 146,333 copies/mL ( log10 5.31 copies/mL ) . During the prior 6 months , 33 % of subjects had missed a medical appointment , and 47 % had visited an emergency department . Although most subjects ( 67 % ) preferred to take their own medications , 76 % would accept DAART if it were made compulsory . A methadone clinic was the DAART venue acceptable to the fewest subjects ( 36 % ) , and a mobile syringe-exchange program was acceptable to the most subjects ( 83 % ) . Adherence was higher for supervised than for unsupervised medication administration ( P<.0001 ) , a finding that supports use of daily supervision of once-daily regimens . Moreover , DAART should incorporate enhanced elements such as convenience , flexibility , confidentiality , cues and reminders , responsive pharmacy and medical services , and specialized training for staff Treatment advocacy ( TA ) programs , based in AIDS service organizations and clinics , aim to engage clients into care and support antiretroviral treatment ( ART ) adherence through client-centered counseling ; advocate for patients with providers ; and provide social service referrals . Systematic evaluations of TA are lacking . We conducted a non-r and omized evaluation examining relationships of TA participation to adherence , care engagement , social services utilization , unmet needs , patient self-advocacy , and adherence self-efficacy among 121 HIV-positive clients ( 36 in TA , 85 not in TA ; 87 % male , 34 % African American , 31 % White , 19 % Latino ) . In multivariate models , TA participants ( vs. non-TA participants ) showed higher electronically monitored [ 85.3 % vs. 70.7 % of doses taken ; b(SE ) = 13.16(5.55 ) , p < .05 ] and self-reported [ 91.1 % vs. 75.0 % ; b(SE ) = 11.60(5.65 ) , p < .05 ] adherence ; utilized more social service programs [ Ms = 5.2 vs. 3.4 ; b(SE ) = 1.97(0.48 ) , p < .0001 ] ; and had fewer unmet social-service needs [ Ms = 1.8 vs. 2.7 ; b(SE ) = -1.06(0.48 ) , p < .05 ] . Findings suggest the need for a r and omized controlled trial of TA This study investigates whether using an  HIV/AIDS symptom management manual with self-care strategies for 21 common symptoms , compared to a basic nutrition manual , had an effect on reducing symptom frequency and intensity . A 775-person , repeated measures , r and omized controlled trial was conducted over three months in 12 sites from the United States , Puerto Rico , and Africa to assess the relationship between symptom intensity with predictors for differences in initial symptom status and change over time . A mixed model growth analysis showed a significantly greater decline in symptom frequency and intensity for the group using the symptom management manual ( intervention ) compared to those using the nutrition manual ( control ) ( t=2.36 , P=0.018 ) . The models identified three significant predictors for increased initial symptom intensities and in intensity change over time : ( 1 ) protease inhibitor-based therapy ( increased mean intensity by 28 % ) ; ( 2 ) having comorbid illness ( nearly twice the mean intensity ) ; and ( 3 ) being Hispanic receiving care in the United States ( increased the mean intensity by 2.5 times ) . In addition , the symptom manual showed a significantly higher helpfulness rating and was used more often compared to the nutrition manual . The reduction in symptom intensity scores provides evidence of the need for palliation of symptoms in individuals with HIV/AIDS , as well as symptoms and treatment side effects associated with other illnesses . The information from this study may help health care providers become more aware of self-management strategies that are useful to persons with HIV/AIDS and help them to assist patients in making informed choices General self-efficacy ( GSE ) , the expectation that one is able to perform a behavior successfully , may differentiate those who are able to successfully utilize self-care symptom management strategies ( SCSMS ) . This sub analysis ( n=569 ) of an international 12 site longitudinal r and omized controlled trial ( RCT ) ( n=775 ) , investigated GSE as an important factor determining symptom burden , SCSMS , engagement with the provider , and medication adherence over time , and identified differences in those with high and low GSE ratings concerning these variables . Parametric and nonparametric repeated- measures tests were employed to assess GSE and the perceived effectiveness of SCSMS for anxiety , depression , diarrhea , fatigue , nausea , and neuropathy . Symptom burden , engagement with the provider , and antiretroviral adherence were analyzed with regard to GSE . Our data indicated that there were differences in the perceived symptom burden over time of HIV infected individuals by GSE . Those individuals with higher GSE had fewer symptoms and these symptoms were perceived to be less intense than those experienced by the low GSE group . There were few meaningful differences in the SCSMS used by those with high versus low GSE other than the use of illicit substances in the low GSE group . The low GSE group was also significantly ( p= < 0.001 ) less engaged with their healthcare providers . Given the difference in substance use by perceived GSE , and the importance of engagement with the healthcare provider , more attention to the resolution of the concerns of those with low GSE by healthcare providers is warranted Here , we describe our patient-centered medical home ( PCMH ) quality improvement retention project conducted by a Health Re sources and Services Administration ( HRSA ) Ryan White-funded Primary Care HIV clinic . The single urban academic clinic serving 2,776 active HIV positive patients identified 25.8 % ( 716/2,776 ) patients who had not been retained in care within the prior six months during two separate six-month interval analyses . Multiple modalities including a retention specialist , a secure clinic phone message line , algorithms , flyers , brochures , data base , and staff education were built to facilitate re-engagement . The project located 87.7 % ( 628/716 ) patients who had not been retained . The retention specialist was directly responsible for the return of 16.2 % ( 116/716 ) patients . Results from the project demonstrated that a formalized approach is a necessary component to effective retention efforts . We believe that this work will provide a strategic framework for the development of r and omized control trials to formally evaluate an HIV retention intervention The purpose of this study was to contribute to the limited literature on newly diagnosed persons living with HIV/AIDS ( PLWHA ) by describing their retention in HIV primary care and changes in barriers to care over 12 months of follow-up subsequent to enrolling in outreach interventions . Medical chart review and interview data were collected from 104 newly diagnosed PLWHA at baseline , 6-month , and 12-month follow-up . Almost all newly diagnosed PLWHA ( 92 % ) had an HIV  care appointment in the 6 months post-enrollment . Newly diagnosed persons were more likely to have undetectable viral loads at 6 and 12-month follow-up compared to baseline with 45 % undetectable by 12 months . Adequate retention in care ( at least one appointment in each 6-month window ) was significantly associated with reductions in substance use and improvements in insurance coverage . Improvements in mental health status and the elimination of stigma as a barrier were not associated with retention , but those who reported stigma as a barrier at baseline and continued to report stigma at 6 months had less than adequate retention . These results suggest the need for early and intensive outreach interventions for newly diagnosed persons . Future directions include testing outreach interventions in a r and omized clinical trial , and evaluating programs that integrate early HIV identification and intensive outreach to enroll and retain persons newly infected with HIV in care Background Human immunodeficiency virus ( HIV ) infection has become a serious health problem for low-income African American women in their childbearing years . Interventions that help them cope with feelings about having HIV and increase their underst and ing of HIV as a chronic disease in which self-care practice s , regular health visits , and medications can improve the quality of life can lead to better health outcomes . Objective This study aim ed to determine the efficacy of an HIV self-care symptom management intervention for emotional distress and perceptions of health among low-income African American mothers with HIV . Method Women caregivers of young children were r and omly assigned to self-care symptom management intervention or usual care . The intervention , based on a conceptual model related to HIV in African American women , involved six home visits by registered nurses . A baseline pretest and two posttests were conducted with the mothers in both groups . Emotional distress was assessed as depressive symptoms , affective state , stigma , and worry about HIV . Health , self-reported by the mothers , included the number of infections and aspects of health-related quality of life ( i.e. , perception of health , physical function , energy , health distress , and role function ) . Results Regarding emotional distress , the mothers in the experimental group reported fewer feelings of stigma than the mothers in the control group . Outcome assessment s of health indicated that the mothers in the experimental group reported higher physical function scores than the control mothers . Within group analysis over time showed a reduction in negative affective state ( depression/dejection and tension/anxiety ) and stigma as well as infections in the intervention group mothers , whereas a decline in physical and role function was found in the control group . Conclusions The HIV symptom management intervention has potential as a case management or clinical intervention model for use by public health nurses visiting the home or by advanced practice nurses who see HIV-infected women in primary care or specialty clinics Objective : The Antiretroviral Treatment Access Study ( ARTAS ) assessed a case management intervention to improve linkage to care for persons recently receiving an HIV diagnosis . Methods : Participants were recently diagnosed HIV-infected persons in Atlanta , Baltimore , Los Angeles and Miami . They were r and omized to either st and ard of care ( SOC ) passive referral or case management ( CM ) for linkage to nearby HIV clinics . The SOC arm received information about HIV and local care re sources ; the CM intervention arm included up to five contacts with a case manager over a 90-day period . The outcome measure was self-reported attendance at an HIV care clinic at least twice over a 12-month period . Results : A higher proportion of the 136 case-managed participants than the 137 SOC participants visited an HIV clinician at least once within 6 months [ 78 versus 60 % ; adjusted relative risk ( RRadj ) , 1.36 ; P = 0.0005 ) and at least twice within 12 months ( 64 versus 49 % ; RRadj , 1.41 ; P = 0.006 ) . Individuals older than 40 years , Hispanic participants , individuals enrolled within 6 months of an HIV-seropositive test result and participants without recent crack cocaine use were all significantly more likely to have made two visits to an HIV care provider . We estimate the cost of such case management to be US$ 600–1200 per client . Conclusion : A brief intervention by a case manager was associated with a significantly higher rate of successful linkage to HIV care . Brief case management is an affordable and effective re source that can be offered to HIV-infected clients soon after their HIV diagnosis 
    Output:
    
Results highlight interventions that can be replicated by social workers -- such as the use of ancillary support services , the  use of adherence manuals , and theory-based interventions --to  engage this population in care .