***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: Purpose . The purpose of this study was to test the feasibility and assess outcomes of  health care adherence  based on whether participants engage in particular risky behaviors relevant to general health or living with human immunodeficiency virus ( HIV ) infection and the frequency of these adherent behaviors . Health adherent behaviors include both self-advocacy and decreased stigma as underlying key components . Design . A r and omized control trial comparing peer-led attention control support and intervention groups . Setting . Community-based women 's drop-in center in an urban , black neighborhood of Boston , Massachusetts . Subjects . Aging , low-income , black women living with HIV infection . Intervention . Peer-led , small-group , structured writing using film clips from Women 's Voices Women 's Lives as a writing prompt . Measures . Demographic and outcome data that included adherence , self-advocacy , and stigma ; collected at baseline , 6 weeks , and 6 months . Analysis . Repeated- measures analysis of variance scores were examined between groups and waves . Paired- sample t-tests were used to examine mean differences across time . Results . Sample included 110 women ( intervention , n = 56 ; comparison , n = 54 ) .  Retention was 85.5 % . Repeated- measures analysis indicated intervention group condom use ( n = 69 , F = 8.02 , df = 1 , p < .01 ) and safe sex ( n = 71 , F = 13.02 , df = 1 , p < .01 ) was higher than that of comparison group . A time effect was also found in the Silencing the Self Scale ( n = 91 , Pillai 's trace = 7.21 , df = 2 , p < .01 ) . Conclusion . This study demonstrates the feasibility of a tailored , peer-led , and culturally relevant interventions and tentative efficacy in population s affected by health disparities . Key limitations include no comparison intervention format with women who ca n't write and the need to test generalizability Abstract Multimedia technologies offer powerful tools to increase capacity of health workers to deliver st and ardized , effective , and engaging antiretroviral medication adherence counseling . Masivukeni — is an innovative multimedia-based , computer-driven , lay counselor-delivered intervention design ed to help people living with HIV in re source -limited setting s achieve optimal adherence . This pilot study examined medication adherence and key psychosocial outcomes among 55 non-adherent South African HIV+ patients , on antiretroviral therapy ( ART ) for at least 6 months , who were r and omized to receive either Masivukeni or st and ard of care ( SOC ) counseling for ART non-adherence  . At baseline , there were no significant differences between the  SOC and Masivukeni groups on any outcome variables . At post-intervention ( approximately 5–6 weeks after baseline ) , -clinic-based pill count adherence data available for 20 participants ( 10 per intervention arm ) showed a 10 % improvement for— participants and a decrease of 8 % for SOC participants . Masivukeni participants reported significantly more positive attitudes towards disclosure and medication social support , less social rejection , and better clinic – patient relationships than did SOC participants . Masivukeni shows promise to promote optimal adherence and provides preliminary evidence that multimedia , computer-based technology can help lay counselors offer better adherence counseling than st and ard approaches Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Introduction Hope is an essential dimension of successful coping in the context of illnesses such as HIV/AIDS , because positive expectations for the future alleviate emotional distress , enhance quality of life and have been linked to the capacity for behavioural change . The social environment ( e.g. family , peers ) is a regulator of hope for people living with HIV/AIDS ( PLWHA ) . In this regard , the dual aim of this article is ( 1 ) to analyze the influence of a peer adherence support ( PAS ) intervention and the family environment on the state of hope in PLWHA and ( 2 ) to investigate the interrelationship between the two determinants . Methods The Effective AIDS Treatment and Support in the Free State study is a prospect i ve r and omized controlled trial . Participants were recruited from 12 public antiretroviral treatment ( ART ) clinics across five districts in the Free State Province of South Africa . Each of these patients was assigned to one of the following groups : a control group receiving st and ard care , a group receiving additional biweekly PAS or a group receiving PAS and nutritional support . Latent cross-lagged modelling ( Mplus ) was used to analyse the impact of  PAS  and the family environment on the level of hope in PLWHA . Results The results of the study indicate that neither  PAS  nor the family environment has a direct effect on the level of hope in PLWHA . Subsequent analysis reveals a positive significant interaction between family functioning and PAS  at the second follow-up , indicating that better family functioning increases the positive effect of PAS  on the state of hope in PLWHA . Conclusions The interplay between well-functioning families and external PAS generates higher levels of hope , which is an essential dimension in the success of lifelong treatment . This study provides additional insight into the important role played by family dynamics in HIV/AIDS care , and it underscores the need for PAS interventions that are sensitive to the context s in which they are implemented Summary Background The treatment of perinatal depression is a public-health priority because of its high prevalence and association with disability and poor infant development . We integrated a cognitive behaviour therapy-based intervention into the routine work of community-based primary health workers in rural Pakistan and assessed the effect of this intervention on  maternal depression and infant outcomes . Methods We r and omly assigned 40 Union Council clusters in rural Rawalpindi , Pakistan , in equal numbers to intervention or control . Married women ( aged 16–45 years ) in their third trimester of pregnancy with perinatal depression were eligible to participate . In the intervention group , primary health workers were trained to deliver the psychological intervention , whereas in the control group untrained health workers made an equal number of visits to the depressed mothers . The primary outcomes were infant weight and height at 6 months and 12 months , and secondary outcome was maternal depression . The interviewers were unaware of what group the participants were assigned to . Analysis was by intention to treat . The study is registered as IS RCT N65316374 . Findings The number of clusters per group was 20 , with 463 mothers in the intervention group and 440 in the control group . At 6 months , 97 ( 23 % ) of 418 and 211 ( 53 % ) of 400 mothers in the intervention and control groups , respectively , met the criteria for major depression ( adjusted odds ratio ( OR ) 0·22 , 95 % CI 0·14 to 0·36 , p<0·0001 ) . These effects were sustained at 12 months ( 111/412 [ 27 % ] vs 226/386 [ 59 % ] , adjusted OR 0·23 , 95 % CI 0·15 to 0·36 , p<0·0001 ) . The differences in weight-for-age and height-for-age Z scores for infants in the two groups were not significant at 6 months ( −0·83 vs −0·86 , p=0·7 and −2·03 vs −2·16 , p=0·3 , respectively ) or 12 months ( −0·64 vs −0·8 , p=0·3 and −1·10 vs −1·36 , p=0·07 , respectively ) . Interpretation This psychological intervention delivered by community-based primary health workers has the potential to be integrated into health systems in re source -poor setting s. Funding Wellcome Trust Background Among people living with HIV ( PLHIV ) on antiretroviral therapy ( ART ) , it is important to determine how quality of life ( QOL ) may be improved and HIV-related stigma can be lessened over time . This study assessed the effect of peer support on QOL and internal stigma during the first year after initiating ART among a cohort of PLHIV in north-eastern Vietnam . Methods A sub- sample study of a r and omised controlled trial was implemented between October 2008 and November 2010 in Quang Ninh , Vietnam . In the intervention group , participants ( n = 119 ) received adherence support from trained peer supporters who visited participants ’ houses biweekly during the first two months , thereafter weekly . In the control group , participants ( n = 109 )  were treated according to st and ard guidelines , including adherence counselling , monthly health check and drug refills . Basic demographics were measured at baseline . QOL and internal stigma were measured using a Vietnamese version of the WHOQOL-HIVBREF and Internal AIDS-related Stigma Scale instruments at baseline and 12 months . T-tests were used to detect the differences between mean values , multilevel linear regressions to determine factors influencing QOL . Results Overall , QOL improved significantly in the intervention group compared to the control group . Among participants initiating ART at clinical stages 3 and 4 , education at high school level or above and having experiences of a family member dying from HIV were also associated with higher reported QOL . Among participants at clinical stage 1 and 2 , there was no significant effect of peer support , whereas having children was associated with an increased QOL . Viral hepatitis was associated with a decreased QOL in both groups . Lower perceived stigma correlated significantly but weakly with improved QOL , however , there was no significant relation to peer support . Conclusion The peer support intervention  improved QOL after 12 months among ART patients presenting at clinical stages 3 and 4 at baseline , but it had no impact on QOL among ART patients enrolled at clinical stages 1 and 2 . The intervention did not have an effect on Internal AIDS-related stigma . To improve QOL for PLHIV on ART , measures to support adherence should be context ualized in accordance with individual clinical and social needs OBJECTIVE To evaluate the effectiveness of a culturally adapted , primary care – based nurse – community health worker ( CHW ) team intervention to support diabetes self-management on diabetes control and other biologic measures . RESEARCH DESIGN AND METHODS Two hundred sixty-eight Samoan participants with type 2 diabetes were recruited from a community health center in American Samoa and were r and omly assigned by village clusters to the nurse-CHW team intervention or to a wait-list control group that received usual care . RESULTS Participants had a mean age of 55 years , 62 % were female , mean years of education were 12.5 years , 41 % were employed , and mean HbA1c was 9.8 % at baseline . At 12 months , mean HbA1c was significantly lower among CHW participants , compared with usual care , after adjusting for confounders ( b = −0.53 ; SE = 0.21 ; P = 0.03 ) . The odds of making a clinical ly significant improvement in HbA1c of at least 0.5 % in the CHW group was twice the odds in the usual care group after controlling for confounders ( P = 0.05 ) . There were no significant differences in blood pressure , weight , or waist circumference at 12 months between groups . CONCLUSIONS A culturally adapted nurse-CHW team intervention was able to significantly improve diabetes control in the U.S. Territory of American Samoa . This represents an important translation of an evidence -based model to a high-risk population and a re source -poor setting In the current context of human re source shortages in South Africa , various community support interventions are being implemented to provide long-term psychosocial care to persons living with HIV/AIDS ( PLWHA ) . However , it is important to analyze the unintended social side effects of such interventions in regards to the stigma felt by PLWHA , which might threaten the successful management of life-long treatment . Latent cross-lagged modeling was used to analyze longitudinal data on 294 PLWHA from a r and omized controlled trial ( 1 ) to determine whether peer adherence support ( PAS ) and treatment buddying influence the stigma experienced by PLWHA ; and ( 2 ) to analyze the interrelationships between each support form and stigma . Results indicate that having a treatment buddy decreases felt stigma scores , while receiving PAS increases levels of felt stigma at the second follow up . However , the PAS intervention was also found to have a positive influence on having a treatment buddy at this time . Furthermore , a treatment buddy mitigates the stigmatizing effect of PAS  , result ing in a small negative indirect effect on stigma . The study indicates the importance of looking beyond the intended effects of an intervention , with the goal of minimizing any adverse consequences that might threaten the successful long-term management of HIV/AIDS and maximizing the opportunities created by such support OBJECTIVE To evaluate the acceptability , practicality , and short-term efficacy of a health education program to improve disease self-management in patients with symptomatic HIV/AIDS . DESIGN R and omized controlled trial , baseline and 3-month follow-up question naire assessment s. SETTING San Francisco Bay communities . PARTICIPANTS Seventy-one men with symptomatic HIV or AIDS were r and omly assigned to a seven-session group educational intervention ( N=34 ) or a usual-care control group ( N=37 ) . INTERVENTION Interactive health education groups were used to teach wide-ranging disease self-management skills and information : symptom assessment and management , medication use , physical exercise , relaxation , doctor-patient communication , and nutrition . Each group was led by two trained peer-leaders ( one of whom was HIV-positive ) recruited from the community . MAIN OUTCOME MEASURES The primary outcome 
    Output:
    
Evidence partially supported the use of CHWs in promoting psychosocial outcomes in PLWH .