***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Consistent use of antiretroviral therapy ( ART ) during pregnancy and breastfeeding reduces the likelihood of mother-to-child HIV transmission . All pregnant and breastfeeding women living with HIV in Zimbabwe are offered ART with same-day initiation regardless of CD4 count ( Option B+ ) . We investigated patterns of clinic attendance and adherence to ART among HIV-infected pregnant women in Zimbabwe . Methods : The Evidence for Elimination cluster-r and omized trial evaluating point-of-care CD4 testing included 1150 HIV-infected ART-naive women attending antenatal care between January 2014 and June 2015 . Thirty-two primary care facilities were r and omized between 2 arms . In this secondary analysis of Evidence for Elimination data collected from routine clinic records , we classified women by number of pills dispensed , and estimated adherence from the ratio of pills to days since ART initiation ( Medication Possession Ratio , adherent if ≥95 % ) or the period when they stopped receiving medication . Results : Two-thirds ( 67.7 % ) were still receiving medication 1 year after initiation ; less than half of the cohort ( 39.1 % ) were adherent . Younger women , newly diagnosed with HIV , and /or first presenting to antenatal care in their third trimester were more likely to drop from care or be nonadherent 360 days after ART initiation . Conclusion : Adherence to ART is suboptimal particularly among young , newly diagnosed , and /or late presenting patients . Interventions that target these groups , as well as provide additional support to all women who are newly diagnosed , may improve Option B+ ART care . More information is needed about the barriers to ART care among late presenters and teenagers Abstract Engaging both partners of a pregnant couple can enhance prevention of mother‐to‐child transmission of HIV and promote family health . We developed and piloted an intervention to promote couple collaboration in health during pregnancy and postpartum in southwestern Kenya . We utilized formative data and stakeholder input to inform development of a home‐based couples intervention . Next , we r and omized pregnant women to intervention ( n = 64 ) or st and ard care ( n = 63 ) arms , subsequently contacting their male partners for enrollment . In the intervention arm , lay health workers conducted couple home visits , including health education , couple relationship and communication skills , and offers of couple HIV testing and counseling ( CHTC ) services . Follow‐up question naires were conducted 3 months postpartum ( n = 114 women , 86 men ) . Baseline characteristics and health behaviors were examined by study arm using t‐tests , chi‐square tests , and regression analyses . Of the 127 women r and omized , 96 of their partners participated in the study . Of 52 enrolled couples in the intervention arm , 94 % completed at least one couple home visit . Over 93 % of participants receiving couple home visits were satisfied and no adverse social consequences were reported . At follow‐up , intervention couples had a 2.78 relative risk of having participated in CHTC during the study period compared with st and ard care couples ( 95 % confidence interval : 1.63‐4.75 ) , and significant associations were observed in other key perinatal health behaviors . This pilot study revealed that a home‐based couples intervention  for pregnant women and male partners  is acceptable , feasible , and has the potential to enhance CHTC and perinatal health behaviors , leading to improved health outcomes Background Disclosure of HIV positive status to sexual partners is promoted by HIV prevention programs including those targeting the prevention of mother-to-child transmission . Among other benefits , disclosure may enhance spousal support and reduce stigma , violence and discrimination . HIV status disclosure and associated outcomes were assessed among a cohort of women , newly initiating lifelong antiretroviral therapy in Ug and a between October 2013 and May 2014 . Methods This was a mixed method study , drawing data from a prospect i ve cohort study of 507 HIV positive pregnant women on lifelong antiretroviral therapy  , who were followed for four months to determine disclosure and its outcomes . Women were recruited from three facilities for the cohort study ; in addition , fifty-seven women were recruited to participate in qualitative interviews from six facilities . Factors associated with spousal support and negative outcomes were determined using r and om-effects logistic regression in two separate models , with prevalence ratio as measure of association . In-depth interviews were used to document experiences with disclosure of HIV status . Results Overall HIV status disclosure to at least one person was high [ ( 375/507 ) , 83.7 % ] . Nearly three-quarters [ ( 285/389 ) , 73.3 % ] , had disclosed to their spouse by the fourth month of follow up post-enrolment . Among married women , spousal support was high at the first 330/407 ( 81.1 % ) and second follow-up 320/389 ( 82.2 % ) . The majority of women who reported spousal support for either antenatal care or HIV-related care services had disclosed their HIV status to their spouses ( adj . PR = 1.17 ; 95 % CI : 1.02–1.34 ) . However , no significant differences were observed in the proportion of self-reported negative outcomes by HIV status disclosure ( adj . PR = 0.89 ; 95 % CI : 0.56–1.42 ) . Qualitative findings highlighted stigma and fear of negative outcomes as the major barriers to disclosure . Conclusion HIV status disclosure to partners by pregnant women on lifelong antiretroviral therapy was associated with increased spousal support , but was impeded by fear of adverse outcomes such as stigma , discrimination and violence . Interventions to reduce negative outcomes could enhance HIV status disclosure Objectives : The US National HIV/AIDS Strategy identifies retention in care as an important quality performance measure . There is no gold st and ard to measure retention in care . This study is the first to compare different measures of retention , using a large geographically diverse sample . Design : A prospect i ve cohort of 17 425 HIV-infected adults enrolled in care at 12 US HIV clinics between 2001 and 2008 . Methods : We compared three measures of retention for each patient : proportion of time not spent in a gap of more than 6 months between successive outpatient visits ; proportion of 91-day quarters in which at least one visit occurred ; proportion of years in which two or more visits separated by at least 90 days occurred . Associations among measures and effects of sociodemographic and clinical characteristics were examined . Results : The three measures of  retention  were moderately to strongly correlated . Averaging across patients , 71 % of time in care was not spent in a gap more than 6 months ; 73 % of all quarters had at least one visit ; and 75 % of all years had at least two visits separated by at least 90 days . For all measures ,  retention  was significantly higher for women , whites , older individuals , men who had sex with men (MSM)-related HIV transmission , and initial CD4 cell counts 50 cell/&mgr;l or less . Conclusions : This is one of the first studies to provide a national estimate of retention in HIV care in the US , which ranged from 71 to 75 % using any of the accepted retention measures . Future studies should assess how well different measures predict clinical outcomes and establish acceptable target levels for retention & NA ; As lifelong antiretroviral therapy ( ART ) for pregnant women is implemented , it is important to underst and the attitudes and norms affecting women 's postpartum ART adherence . This is a qualitative cross‐sectional study of HIV‐positive postpartum women ( n = 112 ) enrolled in a 2‐year observational prospect i ve cohort in Rw and a. Informed by the Theory of Reasoned Action ( TRA ) , we conducted in‐depth interviews with women whose children were 0–6 , 7–12 , 13–18 , or 21–24 months of age to describe factors contributing to adherence and changes over time . Positive ART attitudes reported by women included mothers ’ health promotion , prevention of infant HIV infection , higher CD4 count , and improved physical appearance . Negative attitudes were few , but included side effects and the lifelong nature of treatment . Learning from people living with HIV ( PLHIV ) was identified as a norm facilitating adherence ; ART adherence was inhibited by fear of disclosure or stigmatization in communities and clinics . Poor adherence behaviors were common immediately after HIV diagnosis , not necessarily during prevention of mother‐to‐child transmission ( PMTCT ) . Women with older children , most of whom stopped breastfeeding by 13–18 months , reported more barriers and missed doses than women with younger children . The TRA was useful in identifying the collective influence of attitudes , norms , and intentions on behavior . Findings suggest that HIV‐positive women are vulnerable to poor adherence following HIV diagnosis and around the time of breastfeeding cessation . Lifelong treatment adherence can be supported through PLHIV exemplifying long‐term ART use , fewer and less stigmatizing clinic visits , and counseling messages highlighting the benefits of drugs on appearance and illness prevention and incorporating biological feedback OBJECTIVE To assess linkage and retention in care along the PMTCT cascade in HIV-positive pregnant and breastfeeding women initiating Option B+ in Cameroon . METHODS We prospect ively determined uptake of HIV testing and counselling ( HTC ) , uptake of ART and retention in care after Option B+ initiation between October 2013 and December 2014 in pregnant and breastfeeding women from five sites within the Kumba Health District .  Retention in care was assessed over at least 12 months follow-up and estimated by Kaplan-Meier analysis . During follow-up , tracing outcomes and reasons for discontinuing treatment were documented . RESULTS The uptake of HTC of 5813 women with unknown HIV status was 98.5 % , 251 ( 4.4 % ) were newly diagnosed HIV positive , and ART uptake in women eligible to start Option B+ was 96.8 % . We enrolled 268 women initiating lifelong ART in the follow-up . Overall , 65 ( 24.3 % ) discontinued treatment , either defined by loss to follow-up ( 44.6 % ) or actively stopped treatment ( 55.8 % ) . Retention in care was 88.0 % and 81.1 % at 6 and 12 months , respectively . Discontinuation was significantly associated in multivariate analysis with small sites and high staff turnover [ aOR 2.5 ( 95 % CI 1.6 , 3.9 ) , P < 0.001 ] . Main reasons for stopping treatment were HIV status denial and stigma ( 52.8 % ) , religious reasons ( 25.0 % ) and lack of transport fare ( 11.1 % ) . CONCLUSION We observed good uptake of HTC , ART and retention in care , which declined over time . Discontinuation of Option B+ was highest at small sites with a high staff turnover . Improved staffing , adequate task shifting and community interventions to track defaulters including reducing stigma and religious beliefs may improve Option B+ retention OBJECTIVE The objective of this study was to assess the short-term effects of Gundo-So-a program aim ed at empowering Malian women living with HIV ( WLHIV ) regarding serostatus disclosure management . METHODS A pre-experimental study with two measures ( one week before and four weeks after Gundo-So ) was carried out . A 35-item question naire was administered to a convenience sample of 210 WLHIV . Six outcomes were considered : ability to decide whether or not to disclose HIV status , self-efficacy to keep HIV status a secret , self-efficacy to disclose HIV status , feeling crushed by the weight of secrecy , perceived physical health , and perceived psychological health . For each outcome , temporal changes associated with the intervention were assessed using linear regressions with r and om intercepts . RESULTS Statistically significant change was observed for all six outcomes between the pre- and post-intervention measures . Furthermore , several variables were associated with the baseline levels of the outcomes and the intervention effect . CONCLUSION The results suggest that Gundo-So empowers Malian WLHIV with regard to serostatus disclosure management , thus improving their perceived physical and psychological health . PRACTICAL IMPLICATION S These results highlight the need for programs to empower WLHIV regarding serostatus disclosure , so that WLHIV can make free and informed decisions regarding serostatus disclosure 
    Output:
    
The findings suggest that care engagement remains a concern in PMTCT programs , and must be addressed to realize the goals of PMTCT .