***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 Prevention of mother to child HIV transmission ( PMTCT ) programmes have great potential to achieve virtual elimination of perinatal HIV transmission provided that PMTCT recommendations are properly followed . This study assessed mothers and infants adherence to medication regimen for PMTCT and the proportions of exposed infants who were followed up in the PMTCT programme . Methods A prospect i ve cohort study was conducted among 282 HIV-positive mothers attending 15 health facilities in Addis Ababa , Ethiopia . Descriptive statistics , bivariate and mulitivariate logistic regression analyses were done . Results Of 282 mothers enrolled in the cohort , 232 ( 82 % , 95 % CI 77 - 86 % ) initiated medication during pregnancy , 154 ( 64 % ) initiated combined zidovudine ( ZDV ) prophylaxis regimen while 78 ( 33 % ) were initiated lifelong antiretroviral treatment ( ART ) . In total , 171 ( 60 % , 95 % CI 55 - 66 % ) mothers ingested medication during labour . Of the 221 live born infants ( including two sets of twins ) , 191 ( 87 % , 95 % CI 81 - 90 % ) ingested ZDV and single-dose nevirapine ( sdNVP )  at birth . Of the 219 live births ( twin births were counted once ) , 148 ( 68 % , 95 % CI 61 - 73 % ) mother-infant pairs ingested their medication at birth . Medication ingested by mother-infant pairs at birth was significantly and independently associated with place of delivery . Mother-infant pairs attended in health facilities at birth were more likely ( OR 6.7 95 % CI 2.90 - 21.65 ) to ingest their medication than those who were attended at home . Overall , 189 ( 86 % , 95 % CI 80 - 90 % ) infants were brought for first pentavalent vaccine and 115 ( 52 % , 95 % CI 45 - 58 % ) for early infant diagnosis at six-weeks postpartum . Among the infants brought for early diagnosis , 71 ( 32 % , 95 % CI 26 - 39 % ) had documented HIV test results and six ( 8.4 % ) were HIV positive . Conclusions We found a progressive decline in medication adherence across the perinatal period . There is a big gap between mediation initiated during pregnancy and actually ingested by the mother-infant pairs at birth . Follow up for HIV-exposed infants seem not to be organized and is inconsistent . In order to maximize effectiveness of the PMTCT programme , the rate of institutional delivery should be increased , the quality of obstetric services should be improved and missed opportunities to exposed infant follow up should be minimized Background The aim of this study was to describe barriers to accessing and accepting highly active antiretroviral therapy ( HAART ) by HIV-positive mothers in the Ug and an Kabarole District 's Programme for the Prevention of Mother to Child Transmission-Plus ( PMTCT-Plus ) . Methods Our study was a qualitative descriptive exploratory study using thematic analysis . Individual in-depth interviews  ( n = 45 ) were conducted with r and omly selected HIV-positive mothers who attended this programme , and who : ( a ) never enrolled in HAART ( n = 17 ) ; ( b ) enrolled but did not come back to receive HAART ( n = 2 ) ; ( c ) defaulted/interrupted HAART ( n = 14 ) ; and ( d ) are currently adhering to HAART ( n = 12 ) . A focus group was also conducted to verify the results from the interviews . Results Results indicated that economic concerns , particularly transport costs from residences to the clinics , represented the greatest barrier to accessing treatment . In addition , HIV-related stigma and non-disclosure of HIV status to clients ' sexual partners , long waiting times at the clinic and suboptimal provider-patient interactions at the hospital emerged as significant barriers . Conclusions These barriers to antiretroviral treatment of pregnant and post-natal women need to be addressed in order to improve HAART uptake and adherence for this group of the population . This would improve their survival and , at the same time , drastically reduce HIV transmission from mother to child BACKGROUND The most effective highly active antiretroviral therapy ( HAART ) to prevent mother-to-child transmission of human immunodeficiency virus type 1 ( HIV-1 ) in pregnancy and its efficacy during breast-feeding are unknown . METHODS We r and omly assigned 560 HIV-1-infected pregnant women ( CD4 + count , > or = 200 cells per cubic millimeter ) to receive coformulated abacavir , zidovudine , and lamivudine ( the nucleoside reverse-transcriptase inhibitor [ NRTI ] group ) or lopinavir-ritonavir plus zidovudine-lamivudine ( the protease-inhibitor group ) from 26 to 34 weeks ' gestation through planned weaning by 6 months post partum . A total of 170 women with CD4 + counts of less than 200 cells per cubic millimeter received nevirapine plus zidovudine-lamivudine ( the observational group ) . Infants received single-dose nevirapine and 4 weeks of zidovudine . RESULTS The rate of virologic suppression to less than 400 copies per milliliter was high and did not differ significantly among the three groups at delivery ( 96 % in the NRTI group , 93 % in the protease-inhibitor group , and 94 % in the observational group ) or throughout the breast-feeding period ( 92 % in the NRTI group , 93 % in the protease-inhibitor group , and 95 % in the observational group ) . By 6 months of age , 8 of 709 live-born infants ( 1.1 % ) were infected ( 95 % confidence interval [ CI ] , 0.5 to 2.2 ) : 6 were infected in utero ( 4 in the NRTI group , 1 in the protease-inhibitor group , and 1 in the observational group ) , and 2 were infected during the breast-feeding period ( in the NRTI group ) . Treatment-limiting adverse events occurred in 2 % of women in the NRTI group , 2 % of women in the protease-inhibitor group , and 11 % of women in the observational group . CONCLUSIONS All regimens of HAART from pregnancy through 6 months post partum result ed in high rates of virologic suppression , with an overall rate of mother-to-child transmission of 1.1 % . ( Clinical Trials.gov number , NCT00270296 . Background : Novel strategies are needed to increase retention in prevention of mother-to-child HIV transmission ( PMTCT ) services . We have recently shown that small , incremental cash transfers conditional on attending clinic result ed in increased retention along the PMTCT cascade . However , whether women who receive incentives to attend clinic visits are as adherent to antiretrovirals ( ARV ) as those who do not was unknown . Objective : To determine whether HIV-infected women who received incentives to remain in care were as adherent to antiretroviral treatment and achieved the same level of viral suppression at 6 weeks postpartum as those who did not receive incentives but also remained in care . Methods : Newly diagnosed HIV-infected women at ⩽32 weeks gestational age were recruited at antenatal care clinics in Kinshasa , Democratic Republic of Congo . Women were r and omized in a 1:1 ratio to an intervention or control group . The intervention group received compensation ( $ 5 , plus $ 1 increment at each subsequent visit ) conditional on attending scheduled clinic visits and accepting offered PMTCT services , whereas the control group received usual care . The proportion of participants who remained in care , were fully adherent ( took all their pills at each visit ) or with undetectable viral load at 6 weeks postpartum were compared across group . Results : Among 433 women r and omized ( 216 in intervention group and 217 in control group ) , 332 ( 76.7 % ) remained in care at 6 weeks postpartum , including 174 ( 80.6 % ) in the intervention group and 158 ( 72.8 % ) in the control group , ( P = 0.04 ) . Data on pill count were available for 297 participants ( 89.5 % ) , including 156 ( 89.7 % ) and 141 ( 89.2 % ) in the intervention and control groups , respectively ; 69.9 % ( 109/156 ) and 68.1 % ( 96/141 ) in the intervention and control groups had perfect adherence [ risk difference , 0.02 ; 95 % CI : −0.06 to 0.09 ] . Viral load results were available for 171 ( 98.3 % ) and 155 ( 98.7 % ) women in the intervention and control groups , respectively ; 66.1 % ( 113/171 ) in the intervention group and 69.7 % ( 108/155 ) in the control group had an undetectable viral load ( risk difference , −0.04 ; 95 % CI : −0.14 to 0.07 ) . Results were similar after adjusting for marital status , age , education , baseline CD4 count , viral load , gestational age , and initial ARV regimen . Conclusions : Although the provision of cash incentives to HIV-infected pregnant women led to higher retention in care at 6 weeks postpartum , among those retained in care , adherence to ARVs and virologic suppression did not differ by study group Causes for loss-to-follow-up , including early refusals of and stopping antiretroviral therapy ( ART ) , in Malawi ’s Option B+ program are poorly understood . This study examines the main barriers and facilitators to uptake and adherence to ART under Option B+ . In depth interviews were conducted with HIV-infected women who were pregnant or postpartum in Lilongwe , Malawi ( N = 65 ) . Study participants included women who refused ART initiation ( N = 10 ) , initiated ART and then stopped ( N = 26 ) , and those who initiated ART and remained on treatment ( N = 29 ) . The barriers to ART initiation were varied and included concerns about partner support , feeling healthy , and needing time to think . The main reasons for stopping ART included side effects and lack of partner support . A substantial number of women started ART after initially refusing or stopping ART . There were several facilitators for re-starting ART , including encouragement from community health workers , side effects subsiding , decline in health , change in partner , and fear of future sickness . Amongst those who remained on ART , desire to prevent transmission and improve health were the most influential facilitators . Reasons for refusing and stopping ART were varied . ART-related side effects and feeling healthy were common barriers to ART initiation and adherence . Providing consistent pre-ART counseling , early support for patients experiencing side effects , and targeted efforts to bring women who stop treatment back into care may improve long term health outcomes Introduction To prevent mother-to-child transmission ( MTCT ) of HIV in developing countries , new World Health Organization ( WHO ) guidelines recommend maternal combination antiretroviral therapy ( cART ) during pregnancy , throughout breastfeeding for 1 year and then cessation of breastfeeding ( COB ) . The efficacy of this approach during the first six months of exclusive breastfeeding has been demonstrated , but the efficacy of this approach beyond six months is not well documented . Methods A prospect i ve observational cohort study of 279 HIV-positive mothers was started on zidovudine/3TC and lopinavir/ritonavir tablets between 14 and 30 weeks gestation and continued indefinitely thereafter . Women were encouraged to exclusively breastfeed for six months , complementary feed for the next six months and then cease breastfeeding between 12 and 13 months . Infants were followed for transmission to 18 months and for survival to 24 months . Text message reminders and stipends for food and transport were utilized to encourage adherence and follow-up . Results Total MTCT was 9 of 219 live born infants ( 4.1 % ; confidence interval ( CI ) 2.2–7.6 % ) . All breastfeeding transmissions that could be timed ( 5/5 ) occurred after six months of age . All mothers who transmitted after six months had a six-month plasma viral load > 1,000 copies/ml ( p<0.001 ) . Poor adherence to cART as noted by missed dispensary visits was associated with transmission ( p=0.04 ) . Infant mortality was lower after six months of age than during the first six months of life ( p=0.02 ) . The cumulative rate of infant HIV infection or death at 18 months was 29/226 ( 12.8 % 95 CI : 7.5–20.8 % ) . Conclusions Maternal cART may limit MTCT of HIV to the UNAIDS target of < 5 % for eradication of paediatric HIV within the context of a clinical study , but poor adherence to cART and follow-up can limit the benefit . Continued breastfeeding can prevent the rise in infant mortality after six months seen in previous studies , which encouraged early COB Background Adherence to antiretroviral ( ARV ) drugs is essential for eliminating new pediatric infections of human immunodeficiency virus ( HIV ) 
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Results The review demonstrated that stigma , cost of transportation , food deprivation and a woman ’s disclosure or non-disclosure of her HIV status to a partner , family and the community , could limit or define the extent of her adherence to prescribed antiretroviral drugs during pregnancy .
Furthermore , the review indicated that knowledge of HIV status , either before or during pregnancy , was significantly associated with medication adherence .
Women who knew their HIV status before pregnancy demonstrated good adherence while women who found out their HIV infection status during pregnancy were linked with non-adherence to ART .
Conclusion This review revealed several barriers and enablers of adherence among pregnant women taking ART in sub-Saharan Africa .
Major barriers included the fear of HIV infection status disclosure to partners and family members , stigma and discrimination .
A major enabler of adherence in women taking ART was women ’s knowledge of their HIV status prior to becoming pregnant .