***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: We evaluated the efficacy of LifeWindows , a theory-based , computer-administered antiretroviral ( ARV ) therapy adherence support intervention , delivered to HIV + patients at routine clinical care visits . 594 HIV + adults receiving HIV care at five clinics were r and omized to intervention or control arms . Intervention vs. control impact in the intent-to-treat sample ( including participants whose ARVs had been entirely discontinued , who infrequently attended care , or infrequently used LifeWindows ) did not reach significance . Intervention impact in the On Protocol sample ( 328 intervention and control arm participants whose ARVs were not discontinued , who attended care and were exposed to LifeWindows regularly ) was significant . On Protocol intervention vs. control participants achieved significantly higher levels of perfect 3-day ACTG-assessed adherence over time , with sensitivity analyses maintaining this effect down to 70 % adherence . This study supports the utility of LifeWindows and illustrates that patients on ARVs who persist in care at clinical care sites can benefit from adherence promotion software . ResumenEvaluamos la eficacia de LifeWindows , una intervención de apoyo para la adherencia a la terapia antirretroviral ( TAR ) basada en teoría y con administración informatizada para pacientes con VIH + en sus visitas clínicas rutinarias . 594 adultos de cinco clínicas con VIH + y bajo tratamiento fueron aleatoriamente asignados a un grupo de intervención o de control . No se alcanzó significación estadística al comparar ambos grupos bajo la estrategia de ‘ intención de tratar ’ ( incluyendo los participantes cuyos TAR se habían interrumpido por completo , habían asistido a la clínica en pocas ocasiones , o usaron LifeWindows con poca frecuencia ) . Sin embargo , la intervención obtuvo un impacto significativo cu and o se evaluó con la muestra bajo Protocol o ( un total de 328 participantes cuyos TAR no fueron interrumpidos , asistieron a sus visitas clínicas y se expusieron a LifeWindows regularmente ) . Los participantes bajo Protocol o de intervención obtuvieron niveles más altos de adherencia que el grupo control en tres días de Estudios de Grupos Clinicos con SIDA ( EGCS ) con repetidas evaluaciones y manteniendo como mínimo un 70 % de la adherencia . Este estudio apoya la utilidad de LifeWindows e indica que los pacientes con TAR que asisten a las visitas clínicas , pueden beneficiarse de este software de promoción de la adherencia Background : There is a lack of effective behavioral interventions for HIV-positive injection drug users ( IDUs ) . We sought to evaluate the efficacy of an intervention to reduce sexual and injection transmission risk behaviors and to increase utilization of medical care and adherence to HIV medications among this population . Methods : HIV-positive IDUs ( n = 966 ) recruited in 4 US cities were r and omly assigned to a 10-session peer mentoring intervention or to an 8-session video discussion intervention ( control condition ) . Participants completed audio computer-assisted self-interviews and had their blood drawn to measure CD4 cell count and viral load at baseline and at 3-month ( no blood ) , 6-month , and 12-month follow-ups . Results : Overall retention rates for r and omized participants were 87 % , 83 % , and 85 % at 3 , 6 , and 12 months , respectively . Participants in both conditions reported significant reductions from baseline in injection and sexual transmission risk behaviors , but there were no significant differences between conditions . Participants in both conditions reported no change in medical care and adherence , and there were no significant differences between conditions . Conclusions : Both interventions led to decreases in risk behaviors but no changes in medical outcomes . The characteristics of the trial that may have contributed to these results are examined , and directions for future research are identified Purpose The purpose of this study was to examine whether integrating depression treatment into care for type 2 diabetes mellitus among older African Americans improved medication adherence , glycemic control , and depression outcomes . Methods Older African Americans prescribed pharmacotherapy for type 2 diabetes mellitus and depression from physicians at a large primary care practice in west Philadelphia were r and omly assigned to an integrated care intervention or usual care .  Adherence was assessed at baseline , 2 , 4 , and 6 weeks using the  Medication Event Monitoring System to assess adherence . Outcomes assessed at baseline and 12 weeks included st and ard laboratory tests to measure glycemic control and the Center for Epidemiologic Studies Depression Scale ( CES-D ) to assess depression . Results In all , 58 participants aged 50 to 80 years participated . The proportion of participants who had 80 % or greater adherence to an oral hypoglycemic ( intervention 62.1 % vs usual care 24.1 % ) and an antidepressant ( intervention 62.1 % vs usual care 10.3 % ) was greater in the intervention group in comparison with the usual care group at 6 weeks . Participants in the integrated care intervention had lower levels of glycosylated hemoglobin ( intervention 6.7 % vs usual care 7.9 % ) and fewer depressive symptoms ( CES-D mean scores : intervention 9.6 vs usual care 16.6 ) compared with participants in the usual care group at 12 weeks . Conclusion A pilot r and omized controlled trial integrating type 2 diabetes mellitus treatment and depression was successful in improving outcomes among older African Americans . Integrated interventions may be more feasible and effective in real-world practice s with competing dem and s for limited re sources Background Hypertension is more prevalent and clinical ly severe among African – Americans than whites . Several health behaviors influence blood pressure ( BP ) control , but effective , accessible , culturally sensitive interventions that target multiple behaviors are lacking . Purpose We evaluated a culturally adapted , automated telephone system to help hypertensive , urban African – American adults improve their adherence to their antihypertensive medication regimen and to evidence -based guidelines for dietary behavior and physical activity . Methods We r and omized 337 hypertensive primary care patients to an 8-month automated , multi-behavior intervention or to an education-only control . Medication adherence , diet , physical activity , and BP  were assessed at baseline and every 4 months for 1 year . Data were analyzed using longitudinal modeling . Results The intervention was associated with improvements in a measure of overall diet quality ( + 3.5 points , p < 0.03 ) and in energy expenditure ( + 80 kcal/day , p < 0.03 ) . A decrease in systolic BP between groups was not statistically significant ( −2.3 mmHg , p = 0.25 ) . Conclusions Given their convenience , scalability , and ability to deliver tailored messages , automated telecommunications systems can promote self-management of diet and energy balance in urban African – Americans 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 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 Background Up to 50 % of patients do not take medications as prescribed . Interventions to improve adherence are needed , with an underst and ing of which patients benefit most . Objective To test the effect of two low-literacy interventions on medication adherence . Design R and omized controlled trial , 2 × 2 factorial design . Participants Adults with coronary heart disease in an inner-city primary care clinic . Interventions For 1 year , patients received usual care , refill reminder postcards , illustrated daily medication schedules , or both interventions .Main Measures The primary outcome was cardiovascular medication refill adherence , assessed by the cumulative medication gap ( CMG ) . Patients with CMG < 0.20 were considered adherent . We assessed the effect of the interventions overall and , post-hoc , in subgroups of interest . Key Results Most of the 435 participants were elderly ( mean age = 63.7 years ) , African-American ( 91 % ) , and read below the 9th- grade level ( 78 % ) . Among the 420 subjects ( 97 % ) for whom CMG could be calculated , 138 ( 32.9 % ) had CMG < 0.20 during follow-up and were considered adherent . Overall , adherence did not differ significantly across treatments : 31.2 % in usual care , 28.3 % with mailed refill reminders , 34.2 % with illustrated medication schedules , and 36.9 % with both interventions . In post-hoc analyses , illustrated medication schedules led to significantly greater odds of adherence among patients who at baseline had more than eight medications ( OR = 2.2 ; 95 % CI , 1.21 to 4.04 ) or low self-efficacy for managing medications ( OR = 2.15 ; 95 % CI , 1.11 to 4.16 ) ; a trend was present among patients who reported non-adherence at baseline ( OR = 1.89 ; 95 % CI , 0.99 to 3.60 ) . Conclusions The interventions did not improve adherence overall . Illustrated medication schedules may improve adherence among patients with low self-efficacy , polypharmacy , or baseline non-adherence , though this requires confirmation 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 BACKGROUND To improve medication adherence in cardiac patients , in partnership with a safety-net provider , this research team developed and evaluated a low-literacy medication education tool . METHODS Using principles of community-based participatory research , the team developed a prototype of a low-literacy hospital discharge medication education tool , customizable for each patient , featuring instruction-specific icons and pictures of pills . In 2007 , a r and omized controlled clinical trial was performed , testing the tool 's effect on posthospitalization self-reported medication adherence and knowledge , 2 weeks postdischarge in English- and Spanish-speaking safety-net in patients . To vali date the self-report measure , 4 weeks postdischarge , investigators collected self-reports of the number of pills remaining for each medication in a sub sample of participants . Nurses rated tool acceptability . RESULTS Among the 166/210 eligible participants ( 79 % ) completing the Week-2 interview , self-reported medication adherence was 70 % ( 9 
    Output:
    
Primary studies infrequently reported strategies to enhance cultural relevance .
Exploratory moderator analyses found no evidence that associated cultural relevance strategies with better medication adherence outcomes .