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.     

A measurement model of women's behavioral risk taking.

The current study was designed to gain a better understanding of the nature of the relationship between substance use and sexual risk taking within a community sample of women (N = 1,004). Using confirmatory factor analysis, the authors examined the factor structure of sexual risk behaviors and substance use to determine whether they are best conceptualized as domains underlying a single, higher order, risk-taking propensity. A 2 higher order factor model (sexual risk behavior and substance use) provided the best fit to the data, suggesting that these 2 general risk domains are correlated but independent factors. Sensation seeking had large general direct effects on the 2 risk domains and large indirect effects on the 4 first-order factors and the individual indicators. Negative affect had smaller, yet still significant, effects. Impulsivity and anxiety were unrelated to sexual health risk domains.     

Prevention of nonadherence to nonsteroidal anti-inflammatory medications for newly diagnosed patients with juvenile rheumatoid arthritis.

Adherence to medications for chronic pediatric diseases decreases overtime. This randomized controlled trial evaluated a clinic-based, nurse-administered educational and behavioral intervention to prevent the anticipated drop in adherence to nonsteroidal medications among newly diagnosed patients with juvenile rheumatoid arthritis. Thirty-four participants completed the study (mean age = 8.44 years, SD = 3.96), including 19 in the experimental group and 15 in the standard-treatment (education) control group. There were significant group and Group x Time effects for adherence (assessed with an electronic monitor over a 13-month period) favoring the experimental group. In contrast, the groups did not differ significantly in disease activity or functional limitations. Factors that may have prevented detection of differences in these health parameters are dicussed.     

The Rate and Characteristics of Suicide Attempters in the Native Hawaiian Adolescent Population

Native Hawaiian high school students, N = 1779, were surveyed for symptoms of psycho-pathology and suicide attempts in the previous 6 months. Seventy-seven (4.3%) of the students reported making a suicide attempt. There were no significant differences in prevalence rates for males and females. Depression, anxiety, aggression, substance abuse symptoms, and low family support, but not peer support, were significantly correlated with suicide attempts. On logistic regression, depression, substance abuse, and family support independently predicted attempts. The lack of gender difference may indicate a cultural characteristic of the Hawaiian population that differentiates it from mainstream American populations but likens it to the Native American population.