Participant satisfaction with group and individual components of Adolescent Impact: a secondary prevention intervention for HIV-positive youth.

Adolescent Impact, a developmentally targeted behavioral intervention aimed at decreasing risk behaviors and promoting health care adherence, was delivered to 83 HIV-infected youth, aged 13-21 years, receiving care in five urban HIV centers. Participants completed a patient satisfaction survey following the 12 part intervention consisting of seven groups and five individual sessions. A feedback questionnaire was also completed during each group session to gain more insight on participant experiences. Several indicators suggested high levels of satisfaction. First, overall attendance was relatively high. Second, participants rated their subjective experience and group content favorably. No differences in satisfaction ratings emerged between perinatally infected adolescents and those who acquired HIV through risk behaviors. However, differences emerged regarding perceived intervention utility and content-specific preferences. Findings suggest that Adolescent Impact participants were satisfied with the intervention and that a heterogeneous group of HIV-infected youth could be advantageously integrated into the same secondary prevention program.

Overview and implementation of an intervention to prevent adherence failure among HIV-infected adults initiating antiretroviral therapy: lessons learned from Project HEART.

Project HEART, an acronym for Helping Enhance Adherence to Retroviral Therapy, was a prospective, controlled study to develop, implement, and evaluate a clinic-based behavioural intervention to prevent adherence failure among HIV-infected adults beginning their first highly active antiretroviral therapy (HAART) regimen (N = 227). In this paper, we describe the conceptualisation of the Project HEART adherence intervention, characteristics of the participants, and lessons learned implementing HEART in an inner-city clinic setting. A multi-component intervention, HEART combined enhanced education, reminders, adherence feedback, social support and adherence-focused problem solving in an integrated manner to address common cognitive, motivational, and social barriers to adherence. Unique components of the intervention included use of participant-identified adherence support partners and a standardized adherence barriers assessment to develop and implement individualised adherence plans. Lessons learned regarding the feasibility of using participant-identified support partners were as follows. Few participants eligible for the study had trouble identifying a support partner. Over 90% of support partners attended at least one intervention visit. Support partners were most available and amenable to participate early in the initiation of therapy. Participants' experiences as the 'supported' partner were generally positive. Though many participants faced barriers not easily addressed by this intervention (for example, housing instability), formally integrating support partners into the intervention helped to address many other common adherence barriers. Family and friends are an under-utilised resource in HIV medication adherence. Enlisting the help of support partners is a practical and economical approach to adherence counselling.

Self-reported zidovudine adherence among pregnant women with human immunodeficiency virus infection in four US states.

OBJECTIVE: Our purpose was to identify clinical and psychosocial factors associated with rates of prenatal zidovudine use and adherence among human immunodeficiency virus-infected pregnant women. STUDY DESIGN: Two hundred sixty-four women completed 2 interviews between October 1996 and November 1998 at prenatal clinics in Miami, Florida; Brooklyn, New York; Connecticut; and North Carolina. Interviews took place after 24 weeks' gestation and then between 32 weeks and delivery. RESULTS: Prenatal zidovudine had been prescribed for 94% of the women, 37% of whom received monotherapy. Among women taking zidovudine, 20% reported incomplete adherence. In multivariate analyses having missed zidovudine doses was positively associated with prenatal illicit drug use (odds ratio, 3.49; 95% confidence interval, 1.30-9.42; P <.05) and missing prenatal vitamins (odds ratio, 2.71; 95% confidence interval, 1.30-5.67; P <.01). CONCLUSIONS: Zidovudine therapies have been successfully implemented in prenatal care settings in the United States. The success of these therapies may be limited among some patients by incomplete regimen adherence, particularly among illicit drug users.

Infant birth weight among women with or at high risk for HIV infection: the impact of clinical, behavioral, psychosocial, and demographic factors.

The purpose of these analyses was to provide a prospective examination of the impact of HIV on birth weight using clinical, behavioral, psychosocial, and demographic correlates. HIV-positive (n = 319) and HIV-negative (n = 220) pregnant women matched for HIV risk factors (i.e., drug use and sexual risk behaviors) were interviewed during the 3rd trimester of pregnancy and 6 weeks postpartum. Medical chart reviews were also conducted for the HIV-seropositive pregnant women to verify pregnancy-related and birth outcome data. In a logistic regression analysis, model chi2(9, N = 518) = 124.8, p < .001, controlling for parity and gestational age, women who were HIV seropositive were 2.6 times more likely to have an infant with low birth weight. In addition, Black women and those who did not live with their partners were more than 2 times as likely to have infants with low birth weight, and those who smoked were 3.2 times more likely to have infants with low birth weight. Knowing that women with HIV, those who are Black, and those not living with a partner are at highest risk for adverse birth outcomes can help those in prenatal clinics and HIV specialty clinics to target resources and develop prevention interventions. This is particularly important for women with HIV because birth weight is associated with risk of HIV transmission from mother to child.

Women, violence, and HIV: a critical evaluation with implications for HIV services.

OBJECTIVE: Violence is highly prevalent among women with HIV. Determining whether HIV is causally related to violence, and whether risk for violence is increased by certain HIV prevention practices, has been difficult. METHODS: We review recent literature concerning (1) violence and HIV serostatus, including the risk for violence associated with disclosure of a positive serostatus, and (2) violence associated with requests that male sex partners use condoms. RESULTS: Studies suggest that women with or at risk for HIV come from populations that are also at risk for violence. Violence is not statistically increased among HIV-infected women compared to demographically and behaviorally similar uninfected women. However, for a small proportion of women, violence may occur around disclosure or in response to condom negotiation. CONCLUSIONS: Integrating violence screening and referral into HIV services could help many women obtain the assistance they need while minimizing the risk for violence that may be associated with partner notification or condom requests.

Pubertal development and school transition. Joint influences on depressive symptoms in middle and late adolescents.

The impact of simultaneous changes in biological and social context on the mental health of adolescents was examined by testing the hypothesis that normative developmental transitions can be associated with increased dysphoria if they occur in close temporal proximity. Girls experiencing physical changes associated with middle or later stage pubertal development during the initial high school or college year were predicted to experience more dysphoria than those experiencing these changes during non-transitional times, with negative pubertal attitudes exacerbating the relation. Pubertal status and dysphoria of high school and college students were assessed. Among females experiencing pubertal changes, dysphoria was indeed highest for the 15 and 19 year olds, and lower for the 16, 17, and 18 year olds with females viewing menstrual onset as negative experienced depressive symptoms of moderate clinical severity. This pattern did not emerge for males, or females not experiencing pubertal changes. In contrast, the hypothesis was not supported when transition time was operationalized using grade level. Implications for psychopathology risk are discussed.

Intrabony neurilemmoma: diagnosis and management.

The authors present a case of a mandibular neurilemmoma discovered on routine radiographic examination of an asymptomatic young woman. The lesion was surgically removed and there was no radiographic evidence of recurrence. A review of the literature is presented and the differential diagnosis, prognosis and treatment of this benign neurogenic tumor are discussed.

Self-image of emotionally disturbed adolescents.

This study examined the ways in which normal, depressed, and conduct-disordered adolescents differ with regard to self-image. Normal and psychiatrically hospitalized adolescents completed the Offer Self Image Questionnaire for Adolescents (OSIQ). Patients were grouped on the basis of their DSM-III diagnoses, and their OSIQ scores were compared. Major depressive disorder, particularly the first episode, was associated with poor self-evaluation in multiple areas, while conduct disorder was associated with almost no specific self-image deficits. For younger (12- to 15-year-old) adolescents, a repeated episode of depression was associated with a poorer self-image than was a diagnosis of dysthymic disorder or atypical depression, but a better self-image than a single episode of depression, suggesting that at this age, repeated episodes are met with internal adaptation rather than continued self-devaluation. Adolescents who received a diagnosis of both conduct disorder and major depression reported an overall level of self-image disturbance between those with either of these disorders alone, suggesting that acting-out behaviors may attenuate the self-devaluing experience of depression. Results are discussed in terms of current issues in adolescent development and developmental psychopathology.