Contingency management (CM) based interventions that reinforce adherence to prescribed medications have shown promise in a variety of disadvantaged populations. Fifty-six participants with histories of illicit substance use who were prescribed antiretroviral medication but evidenced suboptimal adherence during a baseline assessment were randomly assigned to 16 weeks of weekly CM-based counseling or supportive counseling, followed by 16 additional weeks of data collection and adherence feedback to providers. The CM intervention involved review of data generated by electronic pill-bottle caps that record bottle opening (MEMS) and brief substance abuse counseling. CM participants were reinforced for MEMS-measured adherence with drawings from a bowl for prizes and bonus drawings for consecutive weeks of perfect adherence. Potential total earnings averaged $800. Mean MEMS-measured adherence to the reinforced medication increased from 61% at baseline to 76% during the 16-week treatment phase and was significantly increased relative to the supportive counseling group (p = 0.01). Furthermore, mean log-transformed viral load was significantly lower in the CM group. However, by the end of the 16-week follow-up phase, differences between groups in adherence and viral load were no longer significantly different. Proportions of positive urine toxicology tests did not differ significantly between the two groups at any phase. A brief CM-based intervention was associated with significantly higher adherence and lower viral loads. Future studies should evaluate methods to extend effects for longer term benefits.
method is presented for the synthesis of cefpodoxime proxetil (XII), a third-generation cephalosporin for oral administration. Compared to previously reported methods the new procedure affords better yields and no purification step by column chromatography is necessary. -(RODRIGUEZ, J. C.; HERNANDEZ, R.; GONZALEZ, M.; RODRIGUEZ, Z.; TOLON, B.; VELEZ, H.; VALDES, B.; LOPEZ, M. A.; FINI*, A.; Farmaco 58 (2003) 5, 363-369; Ist. Sci. Chim., Univ. Bologna, I-40127 Bologna, Italy; Eng.) -M. Bohle 36-177
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