***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: OBJECTIVES We assessed whether directly observed fluoxetine treatment reduced depression symptom severity and improved HIV outcomes  among homeless and marginally housed HIV-positive adults in San Francisco , California , from 2002 to 2008 . METHODS We conducted a nonblinded , r and omized controlled trial of once-weekly fluoxetine , directly observed for 24 weeks , then self-administered for 12 weeks ( n = 137 persons with major or minor depressive disorder or dysthymia ) .  Hamilton Depression Rating Scale score was the primary outcome . Response was a 50 % reduction from baseline and remission a score below 8 . Secondary measures were Beck Depression Inventory-II ( BDI-II ) score , antiretroviral uptake , antiretroviral adherence ( measured by unannounced pill count ) , and HIV-1 RNA viral suppression ( < 50 copies/mL ) . RESULTS The intervention reduced depression symptom severity ( b = -1.97 ; 95 % confidence interval [ CI ] = -0.85 , -3.08 ; P < .001 ) and increased response ( adjusted odds ratio [ AOR ] = 2.40 ; 95 % CI = 1.86 , 3.10 ; P < .001 ) and remission ( AOR = 2.97 ; 95 % CI = 1.29 , 3.87 ; P < .001 ) . BDI-II results were similar . We observed no statistically significant differences in secondary HIV outcomes . CONCLUSIONS Directly observed fluoxetine may be an effective depression treatment strategy for HIV-positive homeless and marginally housed adults , a vulnerable population with multiple barriers to adherence Spiritual models of illness causation are common in Africa . This article reports an investigation of some clinical correlates of patients who believe that their problem has a spiritual cause . A cross‐sectional survey of r and om attenders at primary health care clinics and traditional medical practitioners ( TMP ) in Harare ( n= 302 ) was performed . Interviews included eliciting of explanatory models , indigenous and etic psychiatric measures . Spiritual models of illness were held by half the subjects . Patients who hold this model had higher levels of mental disorder and were more likely to have a mental illness as judged by the patient , care provider and psychiatric measures . The symptoms of such patients resemble the construct of anxiety . Such patients are more likely to consult TMP and to have a chronic illness . Spiritual models of illness may represent an indigenous model to explain the distressing symptoms of nonpsychotic mental illness . Including them in training of primary health care providers may improve the recognition of mental illness CONTEXT Depression strongly predicts nonadherence to human immunodeficiency virus ( HIV ) antiretroviral therapy , and adherence is essential to maintaining viral suppression . This suggests that pharmacologic treatment of depression may improve virologic outcomes . However , previous longitudinal observational analyses have inadequately adjusted for time-varying confounding by depression severity , which could yield biased estimates of treatment effect . Application of marginal structural modeling to longitudinal observation data can , under certain assumptions , approximate the findings of a r and omized controlled trial . OBJECTIVE To determine whether antidepressant medication treatment increases the probability of HIV viral suppression . DESIGN Community-based prospect i ve cohort study with assessment s conducted every 3 months . SETTING Community-based research field site in San Francisco , California . PARTICIPANTS One hundred fifty-eight homeless and marginally housed persons with HIV who met baseline immunologic ( CD4 + T-lymphocyte count , < 350/μL ) and psychiatric ( Beck Depression Inventory II score , > 13 ) inclusion criteria , observed from April 2002 through August 2007 . MAIN OUTCOME MEASURES Probability of achieving viral suppression to less than 50 copies/mL. Secondary outcomes of interest were probability of being on an antiretroviral therapy regimen , 7-day self-reported percentage adherence to antiretroviral therapy , and probability of reporting complete ( 100 % ) adherence . RESULTS Marginal structural models estimated a 2.03 greater odds of achieving viral suppression ( 95 % confidence interval [ CI ] , 1.15 - 3.58 ; P = .02 ) result ing from antidepressant medication treatment . In addition , antidepressant medication use increased the probability of antiretroviral uptake ( weighted odds ratio , 3.87 ; 95 % CI , 1.98 - 7.58 ; P < .001 ) . Self-reported adherence to antiretroviral therapy increased by 25 percentage points ( 95 % CI , 14 - 36 ; P < .001 ) , and the odds of reporting complete adherence nearly doubled ( weighted odds ratio , 1.94 ; 95 % CI , 1.20 - 3.13 ; P = .006 ) . CONCLUSIONS Antidepressant medication treatment  increases viral suppression among persons with HIV . This effect is likely attributable to improved adherence to a continuum of HIV care , including increased uptake and adherence to antiretroviral therapy Background This study was conducted to evaluate the diagnostic accuracy and determine the optimum cut-off scores for clinical use of the Center for Epidemiological Studies Depression scale ( CES-D  ) and  Alcohol Use Disorders Identification Test ( AUDIT ) against a reference psychiatric diagnostic interview , in TB and anti-retroviral therapy ( ART ) patients in primary care in Zambia . Methods This was a cross-sectional study in 16 primary level care clinics . Consecutive sampling was used to select 649 participants who started TB treatment or ART in the preceding month . Participants were first interviewed using the  CES-D and AUDIT , and subsequently with a psychiatric diagnostic interview  for current major depressive disorder ( MDD ) and alcohol use disorders ( AUDs ) using the Mini-International Neuropsychiatric Interview ( MINI ) . The diagnostic accuracy was calculated using the Area Under the Receiver Operating Characteristic curve ( AUROC ) . The optimum cut-off scores for clinical use were calculated using sensitivity and positive predictive value ( PPV ) . Results The CES-D and AUDIT had high internal consistency ( Cronbach 's alpha = 0.84 ; 0.98 respectively ) . Confirmatory factor analysis showed that the four-factor CES-D model was not a good fit for the data ( Tucker-Lewis Fit Index ( TLI ) = 0.86 ; st and ardized root-mean square residual ( SRMR ) = 0.06 ) while the two-factor AUDIT model fitted the data well ( TFI = 0.99 ; SRMR = 0.04 ) . Both the CES-D and AUDIT demonstrated good discriminatory ability in detecting MINI-defined current MDDs and AUDs ( AUROC for CES-D = 0.78 ; AUDIT = 0.98 for women and 0.75 for men ) . The optimum CES-D cut-off score in screening for current MDD was 22 ( sensitivity 73 % , PPV 76 % ) while that of the AUDIT in screening for AUD was 24 for women ( sensitivity 60 % , PPV 60 % ) , and 20 for men ( sensitivity 55 % , PPV 50 % ) . Conclusions The CES-D and AUDIT showed high discriminatory ability in measuring MINI-defined current MDD and AUD respectively . They are suitable mental health screening tools for use among TB and ART patients in primary care in Zambia OBJECTIVE To assess the feasibility of using community health workers to administer short or ultra-short screening instruments during routine community-based prenatal outreach for detecting probable depression at 12 weeks postpartum . METHODS During pregnancy and at 12 weeks postpartum , the 10-item  Edinburgh Postnatal Depression Scale ( EPDS-10 ) was administered to 249 Xhosa-speaking black African women living in Khayelitsha , South Africa . We compared the operating characteristics of the prenatal EPDS-10 , as well as 4 short and ultra-short subscales , with the criterion st and ard of probable postpartum depression . RESULTS Seventy-nine ( 31.7 % ) women were assessed as having probable postpartum depression . A prenatal EPDS-10 score of 13 or higher had 0.67 sensitivity and 0.67 specificity for detecting probable postpartum depression . Briefer subscales performed similarly . CONCLUSION Community health workers successfully conducted community-based screening for depression in a re source -limited setting using short or ultra-short screening instruments . However , overall feasibility was limited because prenatal screening failed to accurately predict probable depression during the postpartum period The authors ’ objective was to estimate the prevalence of major depressive disorder among Rw and ans 5 years after the 1994 genocidal civil war . They interviewed a  community-based r and om sample of adults in a rural part of Rw and a using the Hopkins Symptom Checklist and a locally developed functional impairment instrument . The authors estimated current rates of major depression using an algorithm based on the DSM-IV symptom criteria ( A ) , distress/functional impairment criteria ( C ) , and bereavement exclusionary criteria ( E ) . They also examined the degree to which depressive symptoms compromise social and occupational functioning .  Three hundred sixty-eight adults were interviewed , of whom 15.5 % met Criteria A , C , and E for current major depression . Depressive symptoms were strongly associated with functional impairment in most major roles for men and women . The authors conclude that a significant part of this population has seriously disabling depression . Work on appropriate , feasible , safe , and effective mental health interventions should be a priority for this population Depressed mood has been associated with HIV transmission risk behavior . To determine whether effective depression treatment could reduce the frequency of sexual risk behavior , we analyzed secondary outcome data from a 36-week , two-arm , parallel- design , r and omized controlled trial , in which homeless and marginally housed , HIV-infected persons with comorbid depressive disorders were r and omized to receive either : ( a ) directly observed treatment with the antidepressant medication fluoxetine , or ( b ) referral to a local public mental health clinic .  Self-reported sexual risk outcomes , which were measured at 3 , 6 , and 9 months , included : total number of sexual partners , unprotected sexual intercourse , unprotected sexual intercourse with an HIV-uninfected partner or a partner of unknown serostatus , and transactional sex . Estimates from generalized estimating equations regression models did not suggest consistent reductions in sexual risk behaviors result ing from treatment . Mental health interventions may need to combine depression treatment with specific skills training in order to achieve durable impacts on HIV prevention outcomes The purpose of this study is to evaluate empirical criticism of the psychometric properties of the Hamilton Depression Rating Scale ( HDRS ) by undertaking an " internal construct validity " evaluation . Individual symptom responses for the HDRS were obtained from 370 patients meeting Research Diagnostic Criteria for major depression . A multidimensional normal item response theory ( IRT ) model was used to assess the dimensionality of the HDRS and estimate corresponding item parameters which were then expressed as factor loadings and item thresholds . The analysis yielded a five-dimensional solution . The first dimension ( depressed mood , guilt , suicide , work and interests , agitation , psychic anxiety , somatic anxiety , and loss of libido ) appeared to define global depression severity . These results are consistent with other published factor analytic studies and provide further justification for thinking that the  HDRS total score is a weak index of depressive syndrome severity . The findings provide a benchmark by which the adequacy of future results may be judged , because the multidimensional IRT model does not suffer from the statistical limitations that arise when applying traditional factor analytic methods to discrete symptom ratings The objective of this study was to develop an indigenous measure of common mental disorders ( CMD ) in the Shona language in Zimbabwe . Ethnographic and qualitative studies elicited idioms of distress of mental disorder leading to the preliminary Shona Symptom Question naire ( SSQ ) , and items from the Self‐Report Question naire ( SRQ ) were added to it . The 56‐item Preliminary Shona Symptom Question naire ( PSSQ ) was administered to 302 r and omly selected primary care attenders , of whom 100 were classified as cases on the basis of agreement between care provider assessment and a psychiatric interview . Discriminant analysis identified 14 items that were the strongest predictors of mental disorder . The 14‐item  SSQ has a high level of internal consistency ( Cronbach 's alpha=0.85 ) . The items are a mixture of emic and etic phenomena . The total score correlates strongly with patients ' self‐ assessment of the emotional nature of their illness . Satisfactory specificity and sensitivity occurred at a cut‐off point of 7/8 . The SSQ is the first indigenous measure of mental disorder developed in sub‐Saharan Africa to have included idioms of distress of primary care attenders and involved patients consulting traditional medical practitioners . It promises to be a useful instrument for epidemiological and clinical research . The methodology used is an innovative way of combining etic and emic methods in the evaluation of CMD Objective : To determine whether earlier initiation of  antiretroviral therapy ( ART ) is associated with better economic outcomes . Design : Prospect i ve cohort study of HIV-positive patients on ART in rural Ug and a. Methods : Patients initiating ART at a regional referral clinic in Ug and a were enrolled in the Ug 
    Output:
    
Depression-screening instruments yielded relatively high false positive rates .
Overall , few studies described the reliability and /or validity of depression instruments in sub-Saharan Africa