***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 Interventions are needed to reduce poor perinatal health . We trained community health workers ( CHWs ) as home visitors to address maternal/infant risks . Methods In a cluster r and omised controlled trial in Cape Town townships , neighbourhoods were r and omised within matched pairs to 1 ) the  control , healthcare at clinics ( n = 12 neighbourhoods ; n = 594 women ) , or 2 )  a home visiting intervention by CBW trained in cognitive-behavioural strategies to address health risks ( by the Philani Maternal , Child Health and Nutrition Programme )  , in addition to clinic care ( n = 12 neighbourhoods ; n = 644 women ) . Participants were assessed during pregnancy ( 2 % refusal ) and 92 % were reassessed at two weeks post-birth , 88 % at six months and 84 % at 18 months later . We analysed 32 measures of maternal/infant well-being over the 18 month follow-up period using longitudinal r and om effects regressions . A binomial test for correlated outcomes evaluated overall effectiveness over time . The 18 month post-birth assessment outcomes also were examined alone and as a function of the number of home visits received . Results Benefits were found on 7 of 32 measures of outcomes , result ing in significant overall benefits for the intervention compared to the control when using the binomial test ( p = 0.008 ) ; nevertheless , no effects were observed when only the 18 month outcomes were analyzed . Benefits on individual outcomes were related to the number of home visits received . Among women living with HIV , intervention mothers were more likely to implement the PMTCT regimens , use condoms during all sexual episodes ( OR = 1.25 ; p = 0.014 ) , have infants with healthy weight-for-age measurements ( OR = 1.42 ; p = 0.045 ) , height-for-age measurements ( OR = 1.13 , p<0.001 ) , breastfeed exclusively for six months ( OR = 3.59 ; p<0.001 ) , and breastfeed longer ( OR = 3.08 ; p<0.001 ) . Number of visits was positively associated with infant birth weight ≥2500 grams ( OR = 1.07 ; p = 0.012 ) , healthy head-circumference-for-age measurements at 6 months ( OR = 1.09 , p = 0.017 ) , and improved cognitive development at 18 months ( OR = 1.02 , p = 0.048 ) . Conclusions Home visits to neighbourhood mothers by CHWs may be a feasible strategy for enhancing maternal/child outcomes . However , visits likely must extend over several years for persistent benefits . Trial Registration Clinical Trials.gov Background Clinical evolution of HIV-infected children who have not yet initiated antiretroviral treatment ( ART ) is poorly understood in Africa . We describe severe morbidity and mortality of untreated HIV-infected children . Methods All HIV-infected children enrolled from 2004 - 2009 in a prospect i ve HIV programme in two health facilities in Abidjan , Côte d'Ivoire , were eligible from their time of inclusion . Risks of severe morbidity ( the first clinical event leading to death or hospitalisation ) and mortality were documented retrospectively and estimated using cumulative incidence functions . Associations with baseline characteristics were assessed by competing risk regression models between outcomes and antiretroviral initiation . Results 405 children were included at a median age of 4.5 years ; at baseline , 66.9 % were receiving cotrimoxazole prophylaxis , and 27.7 % met the 2006 WHO criteria for immunodeficiency by age . The risk of developing a severe morbid event was 14 % ( 95%CI : 10.7 - 17.8 ) at 18 months ; this risk was lower in children previously exposed to any prevention of mother-to-child-transmission ( PMTCT ) intervention ( adjusted subdistribution hazard ratio [ sHR ] : 0.16 , 95 % CI : 0.04 - 0.71 ) versus those without known exposure . Cumulative mortality reached 5.5 % ( 95%CI : 3.5 - 8.1 ) at 18 months . Mortality was associated with immunodeficiency ( sHR : 6.02 , 95 % CI : 1.28 - 28.42 ) . Conclusions Having benefited from early access to care minimizes the severe morbidity risk for children who acquire HIV . Despite the receipt of cotrimoxazole prophylaxis , the risk of severe morbidity and mortality remains high in untreated HIV-infected children . Such evidence adds arguments to promote earlier access to ART in HIV-infected children in Africa and improve care interventions in a context where treatment is still not available to all 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 : Retention in care is critical for improving HIV-infected maternal outcomes and reducing vertical transmission . Health systems ' interventions such as continuous quality improvement ( CQI ) may support health services to address factors that affect the delivery of HIV-related care and thereby influence rates of retention-in-care . Methodology : We evaluated the effect of a CQI intervention on retention-in-care at 6 months postpartum of pregnant women and mothers living with HIV who had been started on lifelong antiretroviral treatment . Thirty-two health care facilities were r and omized to either implement the intervention or not . We considered women fully retained in care when they attended the 6-month postpartum visit and did not miss any previous scheduled visit by more than 30 days . Results : Five hundred eleven women living with HIV attending antenatal clinics at 26 facilities were included in the analysis . Median age at enrolment was 27 years and gestational age was 20 weeks . Seventy-one percent of women were seen at 6-month postpartum irrespective of missing any scheduled visit . However , 43 % of women were fully retained at 6-month postpartum and did not miss any scheduled visit based on our stringent study definition of retention . There was no significant difference in retention at 6 months between the intervention and control arms [ 44 % vs. 41 % , relative risk : 1.08 ; 95 % confidence interval ( CI ) : 0.78 to 1.49 ] . Initiation of ARV prophylaxis among infants within 72 hours was not different by study arm ( 66.0 % vs. 74.7 % , relative risk = 0.95 ; 95 % CI : 0.84 to 1.07 ) but rates of early infant testing at 4–6 weeks were higher in intervention sites ( 48.8 % vs. 25.3 % , adjusted relative risk : 1.76 ; 95 % CI : 1.27 to 2.42 ) . Conclusions : CQI as implemented in this study did not differ across study arms in the rates of retention . Several intervention design or implementation issues or other context ual constraints may explain the absence of effect 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 Background In rural South Africa , only two-thirds of HIV-positive pregnant women seeking antenatal care at community health centers took full advantage of ‘ prevention of mother-to-child transmission ’ ( PMTCT ) services in 2010 . Studies generally support male involvement to promote PMTCT , but the nature and impact of that involvement is unclear and untested . Additionally , stigma , disclosure and intimate partner violence pose significant barriers to PMTCT uptake and retention in care , suggesting that male involvement may be ‘ necessary , but not sufficient ’ to reduce infant HIV incidence . This study exp and s on a successful United States President 's Emergency Plan for AIDS Relief (PEPFAR)-supported PMTCT couples intervention pilot study conducted in the Mpumalanga province , targeting HIV-positive pregnant women and their partners , the primary objective being to determine whether male partner involvement plus a behavioral intervention will significantly reduce infant HIV incidence . Methods / design The study follows a cluster r and omized controlled design enrolling two cohorts of HIV-positive pregnant women recruited from 12 r and omly assigned Community Health Centers ( CHC ) ( six experimental , six control ) . The two cohorts will consist of women attending without their male partners ( n = 720 ) and women attending with their male partners ( n = 720 couples ) , in order to determine whether the influence of male 
    Output:
    
Interventions including ANC/ART integration , family-centred approaches , and the use of lay healthcare providers are demonstrably effective in increasing service uptake and retention of HIV-positive mothers and their infants in PMTCT programmes .