***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: Objective : Due to high rates of undiagnosed and untreated HIV infection in Africa , we compared HIV counseling and testing ( VCT ) uptake among household members of patients receiving antiretroviral therapy . Methods : HIV-infected persons attending an AIDS clinic were r and omized to a home-based or clinic-based antiretroviral therapy program including VCT for household members . Clinic arm participants were given free VCT vouchers and encouraged to invite their household members to the clinic for VCT . Home arm participants were visited , and their household members offered VCT using a 3-test rapid finger-stick testing algorithm .  VCT uptake and HIV prevalence were compared . Findings : Of 7184 household members , 3974 ( 55.3 % ) were female and 4798 ( 66.8 % ) were in the home arm . Home arm household members were more likely to receive VCT  than those from the clinic arm ( 55.8 % vs. 10.9 % , odds ratio : 10.41 , 95 % confidence interval : 7.89 to 13.73 ; P < 0.001 ) , although the proportion of HIV-infected household members was higher in the clinic arm ( 17.3 % vs. 7.1 % , odds ratio : 2.76 , 95 % confidence interval : 1.97 to 3.86 , P < 0.001 ) . HIV prevalence among all household members tested in the home arm was 56 % compared with 27 % in the clinic arm . Of 148 spouses of HIV-infected patients , 69 ( 46.6 % ) were uninfected . Persons aged 15 - 24 were less likely to test than other age groups , and in the home arm , women were more likely to test than men . Conclusions : Home-based VCT for household members of HIV-infected persons was feasible , associated with lower prevalence , higher uptake , and increased identification of HIV-infected persons than clinic-based provision OBJECTIVE Patient satisfaction with HIV screening is crucial for sustainable implementation of the Centers for Disease Control and Prevention ( CDC ) HIV testing recommendations . This investigation assesses patient satisfaction with rapid HIV testing in the emergency department ( ED ) of an urban tertiary academic medical center . METHODS After receiving HIV test results , participants in the Universal Screening for HIV Infection in the Emergency Room ( USHER ) r and omized controlled trial were offered a patient satisfaction survey . Questions concerned overall satisfaction with ED visit , time spent on primary medical problem , time spent on HIV testing , and test provider 's ability to answer HIV-related questions . Responses were reported on a 4-point Likert scale , ranging from very dissatisfied to very satisfied ( defined as optimal satisfaction ) . RESULTS Of 4,860 USHER participants , 2,025 completed testing and were offered the survey : 1,616 ( 79.8 % ) completed the survey . Overall , 1,478 ( 91.5 % ) were very satisfied . Satisfaction was less than optimal for 34.5 % ( 10 of 29 ) of participants with reactive results and for 7.5 % ( 115 of 1,542 ) with nonreactive results . The independent factors associated with less than optimal satisfaction were reactive test result , aged 60 years or older , black race , Hispanic/Latino ethnicity , and testing by ED provider instead of HIV counselor . CONCLUSION Most participants were very satisfied with the ED-based rapid HIV testing program . Identification of independent factors that correlate with patient satisfaction will help guide best practice s as EDs implement CDC recommendations . It is critical to better underst and whether patients with reactive results were negatively affected by their results or truly had concerns about the testing process Background Routine  HIV screening  in emergency department ( ED ) setting s may require dedicated personnel . We evaluated the outcomes , costs and cost-effectiveness of  HIV screening  when offered by either a member of the ED staff or by an HIV counselor . Methods We employed a mathematical model to extend data obtained from a r and omized clinical trial of  provider- vs. counselor-based HIV screening in the ED . We compared the downstream survival , costs , and cost-effectiveness of three HIV screening modalities : 1 ) no screening program ; 2 ) an ED provider-based program ; and 3 ) an HIV counselor-based program . Trial arm-specific data were used for test offer and acceptance rates ( provider offer 36 % , acceptance 75 % ; counselor offer 80 % , acceptance 71 % ) . Undiagnosed HIV prevalence ( 0.4 % ) and linkage to care rates ( 80 % ) were assumed to be equal between the screening modalities . Personnel costs were derived from trial-based re source utilization data . We examined the generalizability of results by conducting sensitivity analyses on offer and acceptance rates , undetected HIV prevalence , and costs . Results Estimated HIV screening costs in the provider and counselor arms averaged $ 8.10 and $ 31.00 per result received . The Provider strategy ( compared to no screening ) had an incremental cost-effectiveness ratio of $ 58,700/ quality -adjusted life year ( QALY ) and the Counselor strategy ( compared to the Provider strategy ) had an incremental cost-effectiveness ratio of $ 64,500/QALY . Results were sensitive to the relative offer and acceptance rates by strategy and the capacity of providers to target-screen , but were robust to changes in undiagnosed HIV prevalence and programmatic costs . Conclusions The cost-effectiveness of provider-based HIV screening in an emergency department setting compares favorably to other US screening programs . Despite its additional cost , counselor-based screening delivers just as much return on investment as provider based-screening . Investment in dedicated HIV screening personnel is justified in situations where ED staff re sources may be insufficient to provide comprehensive , sustainable screening services Introduction Lack of universal , annual testing for human immunodeficiency virus ( HIV ) in health facilities suggests that expansion of HIV testing and counselling ( HTC ) to non- clinical setting s is critical to the achievement of national goals for prevention , care and treatment . Consideration should be given to the ability of lay counsellors to perform home-based HTC in community setting s. Methods We implemented a community cluster r and omized controlled trial of  home-based HTC in Sisonke District , South Africa . Trained lay counsellors conducted door-to-door HIV testing using the same rapid tests used by the local health department at the time of the study ( SD Bioline and Sensa ) . To monitor testing quality and counsellor skill , additional dry blood spots were taken and sent for laboratory-based enzyme-linked immunosorbent assay ( ELISA ) testing .  Sensitivity and specificity were calculated using the laboratory result as the gold st and ard . Results and discussion From 3986 sample s , the counsellor and laboratory results matched in all but 23 cases . In 18 cases , the counsellor judged the result as indeterminate , whereas the laboratory judged 10 positive , eight negative and three indeterminate , indicating that the counsellor may have erred on the side of caution . Sensitivity was 98.0 % ( 95 % CI : 96.3–98.9 % ) , and specificity 99.6 % ( 95 % CI : 99.4–99.7 % ) , for the lay counsellor field-based rapid tests . Both measures are high , and the lower confidence bound for specificity meets the international st and ard for assessing HIV rapid tests . Conclusions These findings indicate that adequately trained lay counsellors are capable of safely conducting high- quality rapid HIV tests and interpreting the results as per the kit guidelines . These findings are important given the likely expansion of community and home-based testing models and the shortage of clinical ly trained professional staff Home-based voluntary HIV counselling and testing ( HB-VCT ) has been reported to have a high uptake , but it has not been rigorously evaluated . We design ed a model for HB-VCT appropriate for wider scale-up , and investigated the acceptance of home-based counselling and testing , equity in uptake and negative life events with a cluster-r and omized trial . Thirty six rural clusters in southern Zambia were pair-matched based on baseline data and r and omly assigned to the intervention or the control arm . Both arms had access to st and ard HIV testing services . Adults in the intervention clusters were offered HB-VCT by local lay counsellors . Effects were first analysed among those participating in the baseline and post-intervention surveys and then as intention-to-treat analysis . The study was registered with www.controlled-trials.com , number IS RCT N53353725 . A total of 836 and 858 adults were assigned to the intervention and control clusters , respectively . In the intervention arm , counselling was accepted by 85 % and 66 % were tested ( n = 686 ) . Among counselled respondents who were cohabiting with the partner , 62 % were counselled together with the partner . At follow-up eight months later , the proportion of adults reporting to have been tested the year prior to follow-up was 82 % in the intervention arm and 52 % in the control arm ( Relative Risk ( RR ) 1.6 , 95 % CI 1.4 - 1.8 ) , whereas the RR was 1.7 ( 1.4 - 2.0 ) according to the intention-to-treat analysis . At baseline the likelihood of being tested was higher for women vs. men and for more educated people . At follow-up these differences were found only in the control communities . Measured negative life events following HIV testing were similar in both groups . In conclusion , this HB-VCT model was found to be feasible , with a very high acceptance and to have important equity effects . The high couple counselling acceptance suggests that the home-based approach has a particularly high HIV prevention potential HIV-related stigma continues to be a prominent barrier to testing , treatment and care . However , few studies have investigated changes in stigma over time and the factors contributing to these changes , and there is no evidence of the impact of HIV testing and counselling on stigma . This study was nested within a pair-matched cluster-r and omized trial on the acceptance of home-based voluntary HIV counselling and testing conducted in a rural district in Zambia between 2009 and 2011 , and investigated changes in stigma over time and the impact of HIV testing and counselling on stigma . Data from a baseline survey ( n = 1500 ) and a follow-up survey ( n = 1107 ) were used to evaluate changes in stigma . There was an overall reduction of seven per cent in stigma from baseline to follow-up . This was mainly due to a reduction in individual stigmatizing attitudes but not in perceived stigma . The reduction did not differ between the trial arms ( β = -0.22 , p = 0.423 ) . Being tested for HIV was associated with a reduction in stigma ( β = -0.57 , p = 0.030 ) , and there was a trend towards home-based Voluntary Counselling and Testing having a larger impact on stigma than other testing approaches ( β = -0.78 , p = 0.080 vs. β = -0.37 , p = 0.551 ) , possibly explained by a strong focus on counselling and the safe environment of the home . The reduction observed in both arms may give reason to be optimistic as it may have consequences for disclosure , treatment access and adherence . Yet , the change in stigma may have been affected by social desirability bias , as extensive community mobilization was carried out in both arms . The study underscores the challenges in measuring and monitoring HIV-related stigma . Adjustment for social desirability bias and inclusion of qualitative methods are recommended for further studies on the impact of HIV testing on stigma HIV testing and counselling is a critical gateway to prevention and treatment . Yet , coverage remains insufficient , few couples are tested together and gender differences in access exist . We used an embedded mixed methods approach to investigate possible explanations for the high acceptance of home-based voluntary HIV counselling and testing ( HB-VCT ) in a pair-matched cluster-r and omized trial in Zambia . A baseline survey included 1694 individuals in 36 clusters . Adults in 18 intervention clusters were offered HB-VCT by lay counsellors . St and ard testing services were available in both trial arms . After the completion of the intervention , a follow-up survey was conducted in all trial clusters . In addition , 21 in-depth interviews and one focus group discussion were conducted with home-based VCT clients in the intervention arm . Informants favoured the convenience , confidentiality and credibility of HB-VCT . Counsellors were perceived as trustworthy owing to their closeness and conduct , and the consent process was experienced as convincing . Couple testing was selected by 70 % of cohabiting couples and was experienced as beneficial by both genders . Levels of first-time testing ( 68 % vs. 29 % , p < 0.0001 ) and re-testing ( 94 % vs. 74 % , p < 0.0001 ) were higher in the intervention than in the control arm . Acceptance of HIV testing and counselling is dependent on stigma , trust and gender . The confidentiality of home-based VCT was essential for overcoming stigma-related barriers , and the selection of local counsellors was important to ensure trust in the services . The high level of couple counselling  within HB-VCT may contribute to closing the gender gap in HIV testing , and has benefits for both genders and potentially for prevention of HIV transmission . The study demonstrates the feasibility of achieving high test coverage with an opt-in consent approach . The embedded qualitative component confirmed the high satisfaction with HB-VCT reported in the quantitative survey and was crucial to fully under 
    Output:
    
Values and preferences studies generally found support for lay providers conducting HTS , particularly in non-hypothetical scenarios .
Uptake of this recommendation could exp and HIV testing to more people globally