***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: We evaluated the efficacy of LifeWindows , a theory-based , computer-administered antiretroviral ( ARV ) therapy adherence support intervention , delivered to HIV + patients at routine clinical care visits . 594 HIV + adults receiving HIV care at five clinics were r and omized to intervention or control arms . Intervention vs. control impact in the intent-to-treat sample ( including participants whose ARVs had been entirely discontinued , who infrequently attended care , or infrequently used LifeWindows ) did not reach significance . Intervention impact in the On Protocol sample ( 328 intervention and control arm participants whose ARVs were not discontinued , who attended care and were exposed to LifeWindows regularly ) was significant . On Protocol intervention vs. control participants achieved significantly higher levels of perfect 3-day ACTG-assessed adherence over time , with sensitivity analyses maintaining this effect down to 70 % adherence . This study supports the utility of LifeWindows and illustrates that patients on ARVs who persist in care at clinical care sites can benefit from adherence promotion software . ResumenEvaluamos la eficacia de LifeWindows , una intervención de apoyo para la adherencia a la terapia antirretroviral ( TAR ) basada en teoría y con administración informatizada para pacientes con VIH + en sus visitas clínicas rutinarias . 594 adultos de cinco clínicas con VIH + y bajo tratamiento fueron aleatoriamente asignados a un grupo de intervención o de control . No se alcanzó significación estadística al comparar ambos grupos bajo la estrategia de ‘ intención de tratar ’ ( incluyendo los participantes cuyos TAR se habían interrumpido por completo , habían asistido a la clínica en pocas ocasiones , o usaron LifeWindows con poca frecuencia ) . Sin embargo , la intervención obtuvo un impacto significativo cu and o se evaluó con la muestra bajo Protocol o ( un total de 328 participantes cuyos TAR no fueron interrumpidos , asistieron a sus visitas clínicas y se expusieron a LifeWindows regularmente ) . Los participantes bajo Protocol o de intervención obtuvieron niveles más altos de adherencia que el grupo control en tres días de Estudios de Grupos Clinicos con SIDA ( EGCS ) con repetidas evaluaciones y manteniendo como mínimo un 70 % de la adherencia . Este estudio apoya la utilidad de LifeWindows e indica que los pacientes con TAR que asisten a las visitas clínicas , pueden beneficiarse de este software de promoción de la adherencia Background Human re source limitations are a challenge to the delivery of antiretroviral therapy ( ART ) in low-re source setting s. We conducted a cluster r and omized trial to assess the effect of community-based peer health workers ( PHW ) on AIDS care of adults in Rakai , Ug and a. Methodology /Principal Findings 15 AIDS clinics were r and omized 2∶1 to receive the PHW intervention ( n = 10 ) or control ( n = 5 ) . PHW tasks included clinic and home-based provision of counseling , clinical , adherence to ART , and social support . Primary outcomes were adherence and cumulative risk of virologic failure ( > 400 copies/mL ) . Secondary outcomes were virologic failure at each 24 week time point up to 192 weeks of ART . Analysis was by intention to treat . From May 2006 to July 2008 , 1336 patients were followed . 444 ( 33 % ) of these patients were already on ART at the start of the study . No significant differences were found in lack of adherence ( < 95 % pill count adherence risk ratio [ RR ] 0.55 , 95 % confidence interval [ CI ] 0.23–1.35 ; < 100 % adherence RR 1.10 , 95 % CI 0.94–1.30 ) , cumulative risk of virologic failure ( RR 0.81 , 95 % CI 0.61–1.08 ) or in shorter-term virologic outcomes ( 24 week virologic failure RR 0.93 , 95 % CI 0.65–1.32 ; 48 week , RR 0.83 , 95 % CI 0.47–1.48 ; 72 week , RR 0.81 , 95 % CI 0.44–1.49 ) . However , virologic failure rates ≥96 weeks into ART were significantly decreased in the intervention arm compared to the control arm ( 96 week failure RR 0.50 , 95 % CI 0.31–0.81 ; 120 week , RR 0.59 , 95 % CI 0.22–1.60 ; 144 week , RR 0.39 , 95 % CI 0.16–0.95 ; 168 week , RR 0.30 , 95 % CI 0.097–0.92 ; 192 week , RR 0.067 , 95 % CI 0.0065–0.71 ) . Conclusions / Significance A PHW intervention was associated with decreased virologic failure rates occurring 96 weeks and longer into ART , but did not affect cumulative risk of virologic failure , adherence measures , or shorter-term virologic outcomes . PHWs may be an effective intervention to sustain long-term ART in low-re source setting s. Trial Registration Clinical Trials.gov Background As highly active antiretroviral therapy ( HAART ) becomes increasingly available to African children , it is important to evaluate simple and feasible methods of improving adherence in order to maximize benefits of therapy . Methods HIV-1-infected children initiating World Health Organization non-nucleoside reverse transcriptase-inhibitor-containing first-line HAART regimens were r and omized to use medication diaries plus counselling , or counselling only ( the control arm of the study ) . The diaries were completed daily by caregivers of children r and omized to the diary and counselling arm for nine months . HIV-1 RNA , CD4 + T cell count , and z-scores for weight-for-age , height-for-age and weight-for-height were measured at a baseline and every three to six months . Self-reported adherence was assessed by question naires for nine months . Results Ninety HIV-1-infected children initiated HAART , and were followed for a median of 15 months ( interquartile range : 2–21 ) . Mean CD4 percentage was 17.2 % in the diary arm versus 16.3 % in the control arm at six months ( p = 0.92 ) , and 17.6 % versus 18.9 % at 15 months ( p = 0.36 ) . Virologic response with HIV-1 RNA of < 100 copies/ml at nine months was similar between the two arms ( 50 % for the diary arm and 36 % for the control , p = 0.83 ) . The weight-for-age , height-for-age and weight-for-height at three , nine and 15 months after HAART initiation were similar between arms . A trend towards lower self-reported adherence was observed in the diary versus the control arm ( 85 % versus 92 % , p = 0.08 ) . Conclusion Medication diaries did not improve clinical and virologic response to HAART over a 15-month period . Children had good adherence and clinical response without additional interventions . This suggests that paediatric HAART with conventional counselling can be a successful approach . Further studies on targeted approaches for non-adherent children will be important OBJECTIVES To describe health-care use by persons with HIV in an urban area of Switzerl and ( Zurich ) . Further , to compare the different health-care setting s. DESIGN A 1-year prospect i ve cohort study recruiting 60 patients at general practice s and 60 patients at a specialized university outpatient clinic . METHODS Patients and their treating physicians were interviewed or answered question naires , respectively , at baseline , month 6 and 12 . RESULTS During the study period , five patient groups were identified among the 106 enrolled patients , of whom ( i ) 42 % saw a general practitioner exclusively , ( ii ) 31 % were treated at the specialized outpatient clinic , ( iii ) 8 % were in shared care , ( iv ) 10 % changed health-care model , and ( v ) 9 % were lost to follow-up . Baseline demographic , psychosocial and clinical data were similar among patient groups . At study end , the proportion of patients with HIV-1 RNA < 400 copies/mL was 72 % , 74 % , 88 % , 55 % among groups ( i ) to ( iv ) , respectively ( ns ) , and 22 % at month 6 among those lost to follow-up . Indicators for quality of care were similarly good among all patient groups . CONCLUSIONS A well-working system offers high- quality healthcare to persons living with HIV , where existing teams of specialty and primary health-care professionals efficiently and effectively co-operate Adherence to antiretroviral therapy ( ART ) represents one of the strongest predictors of progression to AIDS , yet it is difficult for most patients to sustain high levels of adherence . This study compares the efficacy of a personalized cell phone reminder system ( ARemind ) in enhancing adherence to ART versus a beeper .  Twenty-three HIV-infected subjects on ART with self-reported adherence less than 85 % were r and omized to a cellular phone ( CP ) or beeper ( BP ) . CP subjects received personalized text messages daily ; in contrast , BP subjects received a reminder beep at the time of dosing . Interviews were scheduled at weeks 3 and 6 . Adherence to ART was measured by self-report ( SR , 7-day recall ) , pill count ( PC , past 30 days at baseline , then past 3 weeks ) , Medication Event Monitoring System ( MEMS ; cumulatively at 3 and 6 weeks ) , and via a composite adherence score constructed by combining MEMS , pill count , and self report . A mixed effects model adjusting for baseline adherence was used to compare adherence rates between the intervention groups at 3 and 6 weeks . Nineteen subjects completed all visits , 10 men and 9 females . The mean age was 42.7 ± 6.5 years , 37 % of subjects were Caucasian and 89 % acquired HIV heterosexually .  The average adherence to ART was 79 % by SR and 65 % by PC at baseline in both arms ; over 6 weeks adherence increased and remained significantly higher in the ARemind group using multiple measures of adherence . A larger and longer prospect i ve study is needed to confirm these findings and to better underst and optimal reminder messages and user fatigue We evaluated a nurse-delivered adherence intervention in a preliminary r and omized controlled trial among 70 HIV-positive out patients initiating antiretroviral therapy ( ART ) in Beijing , China . In both arms , participants received a 30-min educational session , a pillbox , and a referral to a peer support group . In the enhanced arm , participants could choose an electronic reminder device , three sessions of counseling either alone or with a treatment adherence partner , or both reminder and counseling .  Survey assessment s and blood draws occurred at baseline , post-intervention ( 13 weeks ) , and follow-up ( 25 weeks ) . Primary outcomes were 7-day and 30-day adherence assessed by self-report and electronic drug monitoring ( EDM ) , and secondary outcomes were HIV-1 RNA viral load and CD4 count . The intervention was feasible and well received . It led to some improvement in self-reported and EDM-assessed adherence but not the biological outcomes . Providing counseling and facilitating the use of electronic reminders to patients initiating ART merits further investigation as a culturally viable means of promoting adherence in China Background : There is a lack of effective behavioral interventions for HIV-positive injection drug users ( IDUs ) . We sought to evaluate the efficacy of an intervention to reduce sexual and injection transmission risk behaviors and to increase utilization of medical care and adherence to HIV medications among this population . Methods : HIV-positive IDUs ( n = 966 ) recruited in 4 US cities were r and omly assigned to a 10-session peer mentoring intervention or to an 8-session video discussion intervention ( control condition ) . Participants completed audio computer-assisted self-interviews and had their blood drawn to measure CD4 cell count and viral load at baseline and at 3-month ( no blood ) , 6-month , and 12-month follow-ups . Results : Overall retention rates for r and omized participants were 87 % , 83 % , and 85 % at 3 , 6 , and 12 months , respectively . Participants in both conditions reported significant reductions from baseline in injection and sexual transmission risk behaviors , but there were no significant differences between conditions . Participants in both conditions reported no change in medical care and adherence , and there were no significant differences between conditions . Conclusions : Both interventions led to decreases in risk behaviors but no changes in medical outcomes . The characteristics of the trial that may have contributed to these results are examined , and directions for future research are identified The principal objective of these multisite studies ( Florida , New York , New Jersey : epicenters for human immunodeficiency virus [ HIV ] among women ) was to develop and implement effective combinations of behavioral interventions to optimize the health status of the most neglected and understudied population affected by the acquired immunodeficiency syndrome ( AIDS ) epidemic in the United States : poor women of color living with HIV . The 
    Output:
    
Although there is strong evidence that all five of these interventions can significantly increase ART adherence in some setting s , each intervention has also been found not to produce significant effects in several studies .
Combination interventions tended to have effects that were similar to those of single interventions .
The evidence base on interventions in key population s was weak , with the exception of interventions for people who inject drugs .