Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy.

OBJECTIVE: Compare the efficacy of a multicomponent social support intervention to standard-of-care counseling on medication adherence among HIV-infected patients initiating antiretroviral therapy. DESIGN: Randomized controlled trial. Generalized estimating equations tested for differences in the percentage of participants achieving 90% adherence. MAIN OUTCOME MEASURES: Pill-taking, electronically monitored over 6 consecutive months; plasma viral load (VL), assessed at 3 and 6 months following initiation of therapy. RESULTS: Of 226 participants who were randomized and began the trial, 87 (38%) were lost to the study by 6 months. The proportion of adherent participants declined steadily over time, with no time by group interaction. Sustained adherence was associated with increased odds of achieving an undetectable VL (OR=1.78; 95% CI=1.01, 3.13). In intention-to-treat analyses, a larger proportion of the intervention group than the control group was adherent (40.15% vs. 27.59%, p=.02) and achieved an undetectable VL p=.04). However, the majority of participants who remained on study experienced some reduction in VL (>or=1-log drop or undetectable), regardless of experimental condition. CONCLUSION: The multicomponent social support intervention significantly improved medication adherence over standard-of-care counseling; evidence for improved virologic outcomes was inconsistent. Early discontinuation of care and treatment may be a greater threat to the health of HIV patients than imperfect medication-taking.     

The Concept of Voluntary Motor Control in the Recent Neuroscientific Literature

Synthese - The concept of voluntary motor control(VMC) frequently appears in the neuroscientific literature, specifically in the context of cortically-mediated, intentional motor actions. For...     

When the happy victimizer says sorry: Children's understanding of apology and emotion

Previous research suggests that children gradually understand the mitigating effects of apology on damage to a transgressor's reputation. However, little is known about young children's insights into the central emotional implications of apology. In two studies, children ages 4–9 heard stories about moral transgressions in which the wrongdoers either did or did not apologize. In Study 1, children in the no‐apology condition showed the classic pattern of ‘happy victimizer’ attributions by expecting the wrongdoer to feel good about gains won via transgression. By contrast, in the apology condition, children attributed negative feelings to the transgressor and improved feelings to the victim. In Study 2, these effects were found even when the explicit emotion marker ‘sorry’ was removed from the apology exchange. Thus, young children understand some important emotional functions of apology.