BACKGROUND: Unannounced pill counts conducted in patients' homes is a valid objective method for monitoring medication adherence that is unfortunately costly and often impractical. Conducting unannounced pill counts by telephone may be a viable alternative for objectively assessing medication adherence. PURPOSE:To test an unannounced pill count assessment of adherence conducted by telephone. METHODS: HIV-positive men and women (N=77) inAtlanta GA completed an unannounced telephonebased pill count immediately followed by a pill count conducted in an unannounced home visit. RESULTS:A high degree of concordance was observed between phone and home-based number of pills counted (Intraclass correlation, ICC= .997, 95% CI .995-.998, P<.001) and percent of pills taken (ICC= .990, 95% CI .986-.992, P<.001). Concordance between adherence above/below 90% and phone/home counts was 95%, Kappa coefficient = .995. Concordance between pill counts was not influenced by participant education or health literacy and was maintained when the data were censored to remove higher levels of adherence. Analyses of discordant pill counts found the most common source of error resulted from overcounted doses in pillboxes on the telephone.CONCLUSIONS: Unannounced phone-based pill counts offer an economically and logistically feasible objective method for monitoring medication adherence.

HIV/AIDS is concentrated among the inner-city poor and poverty may directly interfere with HIV treatment. This study examined food insufficiency in relation to HIV-related health and treatment. A sample of 344 men and women living with HIV/ AIDS in Atlanta, Georgia completed measures of food security, health, and HIV disease progression and treatment. HIV treatment adherence was monitored using unannounced pill counts. Results showed that half of people living with HIV/AIDS in this study lacked sufficient food, and food insufficiency was associated with multiple indicators of poor health, including higher HIV viral loads, lower CD4 cell counts, and poorer treatment adherence. Adjusted analyses showed that food insufficiency predicted HIV treatment non-adherence over and above years of education, employment status, income, housing, depression, social support, and non-alcohol substance use. Hunger and food insecurity are prevalent among people living with HIV/AIDS, and food insufficiency is closely related to multiple HIV-related health indicators, particularly medication adherence. Interventions that provide consistent and sustained meals to people living with HIV/AIDS are urgently needed.

Background-Although demonstrated valid for monitoring medication adherence, unannounced pill counts conducted in patients' homes are costly and logistically challenging. Telephone-based unannounced pill counts offer a promising adaptation that resolves most of the limitations of homebased pill counting.

Background People with lower health literacy are vulnerable to health problems. Studies that have examined the association between literacy and medication adherence have relied on self-reported adherence, which is subject to memory errors, perhaps even more so in people with poor literacy. Purpose To examine the association between health literacy and objectively assessed HIV treatment adherence. Methods Men and women (N = 145) receiving antiretroviral therapies completed a test of health literacy and measures of common adherence markers. Medication adherence was monitored by unannounced pill counts. Results Median adherence was 71%; Participants with lower health literacy also demonstrated poorer adherence compared to individuals with higher literacy. Hierarchical regression showed literacy predicted adherence over and above all other factors. Sensitivity tests showed the same results for 80% and 90% adherence. Conclusions The association between literacy and adherence appears robust and was confirmed using an objective measure of medication adherence.

Objective-The purpose of the current study was to assess whether or not men who have sex with men who limit their unprotected anal sexual partners to those who are of the same HIV status (serosort) differ in their risk for HIV transmission than MSM who do not serosort.Methods-Cross-sectional surveys administered at a large gay pride festival (80% response rate) were collected from MSM. Univariate and multivariate logistic regressions were used to identify predictors of serosorting.Results-Participants were self-identified as HIV negative MSM (N=628), about one third of whom engaged in serosorting (n=229). Men who serosort were more likely to believe that serosorting offered protection against HIV transmission, perceived themselves as being at no relatively higher risk for HIV transmission, and had more unprotected anal intercourse partners. Over half the sample reported their frequency of HIV testing as yearly or less frequently; this finding did not differ between serosorters and non-serosorters.Conclusions-Men who identify as HIV negative and serosort are no more likely to know their HIV status than men who do not serosort and are at higher risk for exposure to HIV. Interventions targeting MSM must address the limitations of serosorting.Human Immunodeficiency Virus (HIV) is the most destructive pandemic in history, with nearly 40 million people worldwide living with HIV 1 . In the US it is estimated that one million people are infected with HIV and there are over 40,000 new HIV infections in the US each year, the majority of which occur among men who have sex with men 2 . To reduce the likelihood of HIV transmission, many individuals seek out their own strategies of prevention. One such method is serosorting; the practice of limiting sexual partners to those who have the same HIV serostatus. Several studies have found that serosorting is commonly used among men who have sex with men 3-6 . For many HIV infected and uninfected persons, serosorting is believed to reduce concerns about HIV/AIDS and make condom use less necessary. Additionally, for various reasons, people tend to dislike using condoms [7][8][9] and practice behaviors they believe are protective, such as serosorting, to avoid condom use. Public health policy is also embracing serosorting as a viable alternative to condom use. 10 As a result, partner HIV serostatus is often a determining factor in sexual risk decision making. 11,12 Multiple caveats to serosorting do exist. For uninfected persons, the effectiveness of serosorting relies on complete and open HIV status disclosure among monogamous men. Unfortunately, fear of rejection, physical threat, alcohol or drug related impairment, and the lag between HIV tests can all affect the accuracy of knowing a sexual partner's HIV status. Moreover, HIV testing is not universal among men who have sex with men (MSM). 13 16 In light of these circumstances, serosorting may be limited for preventing HIV transmission.Beliefs about the protective benefits of serosorting are inextricably linked to risk per...