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      It's Not Just the Pills: A Qualitative Meta-Synthesis of HIV Antiretroviral Adherence Research

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      Journal of the Association of Nurses in AIDS Care

      Elsevier BV

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          Most cited references 123

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          Prevention of HIV-1 infection with early antiretroviral therapy.

          Antiretroviral therapy that reduces viral replication could limit the transmission of human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. In nine countries, we enrolled 1763 couples in which one partner was HIV-1-positive and the other was HIV-1-negative; 54% of the subjects were from Africa, and 50% of infected partners were men. HIV-1-infected subjects with CD4 counts between 350 and 550 cells per cubic millimeter were randomly assigned in a 1:1 ratio to receive antiretroviral therapy either immediately (early therapy) or after a decline in the CD4 count or the onset of HIV-1-related symptoms (delayed therapy). The primary prevention end point was linked HIV-1 transmission in HIV-1-negative partners. The primary clinical end point was the earliest occurrence of pulmonary tuberculosis, severe bacterial infection, a World Health Organization stage 4 event, or death. As of February 21, 2011, a total of 39 HIV-1 transmissions were observed (incidence rate, 1.2 per 100 person-years; 95% confidence interval [CI], 0.9 to 1.7); of these, 28 were virologically linked to the infected partner (incidence rate, 0.9 per 100 person-years, 95% CI, 0.6 to 1.3). Of the 28 linked transmissions, only 1 occurred in the early-therapy group (hazard ratio, 0.04; 95% CI, 0.01 to 0.27; P<0.001). Subjects receiving early therapy had fewer treatment end points (hazard ratio, 0.59; 95% CI, 0.40 to 0.88; P=0.01). The early initiation of antiretroviral therapy reduced rates of sexual transmission of HIV-1 and clinical events, indicating both personal and public health benefits from such therapy. (Funded by the National Institute of Allergy and Infectious Diseases and others; HPTN 052 ClinicalTrials.gov number, NCT00074581.).
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            The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection.

            For individuals with human immunodeficiency virus (HIV) infection to fully benefit from potent combination antiretroviral therapy, they need to know that they are HIV infected, be engaged in regular HIV care, and receive and adhere to effective antiretroviral therapy. Test-and-treat strategies for HIV prevention posit that expanded testing and earlier treatment of HIV infection could markedly decrease ongoing HIV transmission, stemming the HIV epidemic. However, poor engagement in care for HIV-infected individuals will substantially limit the effectiveness of test-and-treat strategies. We review the spectrum of engagement in care for HIV-infected individuals in the United States and apply this information to help understand the magnitude of the challenges that poor engagement in care will pose to test-and-treat strategies for HIV prevention.
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              Renovating the Pyramid of Needs: Contemporary Extensions Built Upon Ancient Foundations.

              Maslow's pyramid of human needs, proposed in 1943, has been one of the most cognitively contagious ideas in the behavioral sciences. Anticipating later evolutionary views of human motivation and cognition, Maslow viewed human motives as based in innate and universal predispositions. We revisit the idea of a motivational hierarchy in light of theoretical developments at the interface of evolutionary biology, anthropology, and psychology. After considering motives at three different levels of analysis, we argue that the basic foundational structure of the pyramid is worth preserving, but that it should be buttressed with a few architectural extensions. By adding a contemporary design feature, connections between fundamental motives and immediate situational threats and opportunities should be highlighted. By incorporating a classical element, these connections can be strengthened by anchoring the hierarchy of human motives more firmly in the bedrock of modern evolutionary theory. We propose a renovated hierarchy of fundamental motives that serves as both an integrative framework and a generative foundation for future empirical research.
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                Author and article information

                Journal
                Journal of the Association of Nurses in AIDS Care
                Journal of the Association of Nurses in AIDS Care
                Elsevier BV
                10553290
                July 2017
                July 2017
                : 28
                : 4
                : 462-478
                Article
                10.1016/j.jana.2017.02.007
                © 2017

                https://www.elsevier.com/tdm/userlicense/1.0/

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