***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 Few data are available to guide programmatic solutions to the overlapping problems of undernutrition and HIV infection . We evaluated the impact of food assistance on patient outcomes in a comprehensive HIV program in central Haiti in a prospect i ve observational cohort study . Methods Adults with HIV infection were eligible for monthly food rations if they had any one of : tuberculosis , body mass index ( BMI ) < 18.5kg/m2 , CD4 cell count < 350/mm3 ( in the prior 3 months ) or severe socio-economic conditions . A total of 600 individuals ( 300 eligible and 300 ineligible for food assistance )  were interviewed before rations were distributed , at 6 months and at 12 months . Data collected included demographics , BMI and food insecurity score ( range 0 - 20 ) . Results At 6- and 12-month time-points , 488 and 340 subjects were eligible for analysis . Multivariable analysis demonstrated that at 6 months , food security significantly improved in those who received food assistance versus who did not ( -3.55 vs -0.16 ; P < 0.0001 ) ; BMI decreased significantly less in the food assistance group than in the non-food group ( -0.20 vs -0.66 ; P = 0.020 ) . At 12 months , food assistance was associated with improved food security ( -3.49 vs -1.89 , P = 0.011 ) and BMI ( 0.22 vs -0.67 , P = 0.036 ) . Food assistance was associated with improved adherence to monthly clinic visits at both 6 ( P < 0.001 ) and 12 months ( P = 0.033 ) . Conclusions Food assistance was associated with improved food security , increased BMI , and improved adherence to clinic visits at 6 and 12 months among people living with HIV in Haiti and should be part of routine care where HIV and food insecurity overlap 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 Objective : To explore the effects of four types of short message service ( SMS ) plus real-time adherence monitoring on antiretroviral therapy ( ART ) adherence : daily reminders , weekly reminders , reminders triggered after a late or missed dose ( delivered to patients ) , and notifications triggered by sustained adherence lapses ( delivered to patient-nominated social supporters ) . Design : Pilot r and omized controlled trial . Methods : Sixty-three individuals initiating ART received a real-time adherence monitor  and were r and omized ( 1 : 1 : 1 ) : ( 1 ) Scheduled SMS reminders ( daily for 1 month , weekly for 2 months ) , then SMS reminders triggered by a late or missed dose ( no monitoring signal within 2 h of expected dosing ) ; SMS notifications to social supporters for sustained adherence lapses ( no monitoring signal for > 48 h ) added after 3 months . ( 2 ) Triggered SMS reminders starting at enrolment ; SMS notifications to social supporters added after 3 months . ( 3 ) Control : No SMS .  HIV RNA was determined at 9 months . Percentage adherence and adherence lapses were compared by linear generalized estimating equations and Poisson regression , respectively . Results : Median age was 31 years , 65 % were women , and median enrolment CD4 + cell count was 322 cells/&mgr;l 97 % took once daily tenofovir/emtricitabine/efavirenz . Compared to control , adherence was 11.1 % higher ( P = 0.04 ) and more than 48-h lapses were less frequent ( IRR 0.6 , P = 0.02 ) in the scheduled SMS arm . Adherence and more than 48-h lapses were similar in the triggered SMS arm and control . No differences in HIV RNA were seen . Conclusion : Scheduled SMS reminders improved ART in the context of real-time monitoring . Larger studies are needed to determine the impact of triggered reminders and role of social supporters in improving adherence Abstract Good adherence is critical for antiretroviral therapy ( ART ) in sub-Saharan Africa . We report on the characteristics of medicine companions ( MCs ) chosen by Ug and an patients enrolling on ART , and on how MCs were chosen , and what roles they played . Baseline data on MCs of 1453 participants in a r and omized controlled trial comparing facility and home-based delivery of ART in Jinja , Ug and a were analyzed . Textual data on experience with MCs were collected through in-depth interviews among a sub sample of 40 trial participants equally divided by sex and trial arm . Significantly more women ( 71 % ) than men ( 29 % ) were recruited . The majority ( 75 % ) of women participants were either widowed ( 51 % ) or separated or divorced ( 24 % ) , whereas most of the men ( 66 % ) were married . Women were most likely to choose a child as their MC while men were most likely to choose their spouse ; 41 % of women chose an MC under 21 compared with only 14 % of men . Only 31 % of married women chose their husb and , compared with 66 % of married men who chose their wife . Qualitative interviews suggested MCs proved useful for reminding and other supportive tasks in the first three months but were generally less essential by six months and beyond . Convenience , reliability , and trust were key considerations in choosing an MC . Children provided the only alternative for many unmarried women , but even some married women felt children made more reliable MCs than husb and s. Participants who had disclosed their serostatus usually received drug-taking reminders from multiple household members . One participant in the qualitative sample with poor family relations delayed starting treatment due to unwillingness to identify an MC . MCs were generally welcome and useful in supporting early adherence . However , disclosure to an MC should not be a condition of obtaining treatment Food insecurity and malnutrition negatively affect adherence to antiretroviral therapy ( ART ) and are associated with poor HIV clinical outcomes . We examined the effect of providing household food assistance and nutrition education on ART adherence . A 12-month prospect i ve clinical trial compared the effect of a monthly household food basket ( FB ) plus nutrition education ( NE ) versus NE alone on ART adherence on 400 HIV patients at four clinics in Honduras . Participants had been receiving ART for an average of 3.7 years and were selected because they had suboptimal adherence . Primary outcome measures were missed clinic appointments , delayed prescription refills , and self-reported missed doses of ART . These three adherence measures improved for both groups over 12 months ( p < 0.01 ) , mostly within 6 months . On-time prescription refills improved for the FB plus NE group by 19.6 % more than the group receiving NE alone after 6 months ( p < 0.01 ) , with no further change at 12 months . Change in missed appointments and self-reported missed ART doses did not significantly differ by intervention group . ResumenLa inseguridad alimentaria y la malnutrición afectan en forma negativa la adherencia a la terapia antiretroviral ( TAR ) , y se asocian con malos result ados clínicos relacionados con el VIH . En este estudio examinamos el efecto de ofrecer una canasta de ayuda alimentaria ( CA ) y educación nutricional ( EN ) sobre la adherencia a la TAR . Mediante un ensayo clínico prospect ivo a nivel de conglomerados , comparamos el efecto de una CA para la familia ofrecida en forma mensual adicional a EN en contraste con EN por sí sola sobre la adherencia a la TAR en 400 pacientes infectados con VIH , en cuatro clínicas en Honduras . Los participantes habían estado recibiendo TAR por un promedio de 3.7 años , y fueron elegidos con base en mostrar adherencia sub-óptima a la misma . Las medidas de impacto incluyeron número de citas clínicas perdidas , retraso en surtir los medicamentos , y el auto-reporte de dosis faltantes de TAR . Las tres medidas mejoraron en ambos grupos a lo largo de 12 meses de seguimiento ( p < 0.01 ) , con la mayor parte del efecto observado en los primeros 6 meses . El surtimiento de medicamentos en la farmacia mejoró 19.6 % más en el grupo que recibió CA más EN en comparación con el grupo que recibió sólo EN , a los 6 meses de seguimiento ( p < 0.01 ) , sin mayor cambio a los 12 meses de seguimiento . En cuanto a citas clínicas perdidas y el auto-reporte de dosis faltantes de TAR , no hubo una diferencia significativa al comparar entre ambos grupos Introduction : Direct measurement of antiretroviral treatment ( ART ) program indicators essential for evidence -based planning and evaluation – especially HIV incidence , population viral load , and ART eligibility – is rare in sub-Saharan Africa . Design / methods : To measure key indicators in rural western Kenya , an area with high HIV burden , we conducted a population survey in September to November 2012 via multistage cluster sampling , recruiting everyone aged 15–59 years living in 3330 r and omly selected households . Consenting individuals were interviewed and tested for HIV at home . Participants testing positive were assessed for CD4 + cell count and viral load , and their infections classified as either recent or long term based on Limiting Antigen Avidity assays . HIV-negative participants were tested by nucleic acid amplification to detect acute infections . Results : Of 6833 household members eligible for the study , 6076 ( 94.7 % of all women and 81.0 % of men ) agreed to participate . HIV prevalence and incidence were 24.1 % [ 95 % confidence interval [ CI ] 23.0–25.2 ] and 1.9 new cases/100 person-years ( 95 % CI 1.1–2.7 ) , respectively . Among HIV-positive participants , 59.4 % ( 95 % CI 56.8–61.9 ) were previously diagnosed , 53.1 % ( 95 % CI 50.5–55.7 ) were receiving care , and 39.7 % ( 95 % CI 37.1–42.4 ) had viral load less than 1000 copies/ml . Applying 2013 WHO recommendations for ART initiation increased the proportion of ART-eligible people from 60.0 % ( based on national guidelines in place during the survey ; 95 % CI 57.3–62.7 ) to 82.0 % ( 95 % CI 79.5–84.5 ) . 
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RESULTS AND DISCUSSION The evidence base is promising for currently available , effective , and scalable ART adherence interventions for re source -limited setting s. Numerous interventions build on existing health care infrastructure and leverage available re sources .
Many additional interventions could have an important impact on ART adherence with further development , including st and ardized counselling through multi-media technology , electronic dose monitoring , de central ized and differentiated models of care , and livelihood interventions .