***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 Shame has long been seen as relevant to substance use disorders , but interventions have not been tested in r and omized trials . This study examined a group-based intervention for shame based on the principles of acceptance and commitment therapy ( ACT ) in patients ( N = 133 ; 61 % female ; M = 34 years old ; 86 % Caucasian ) in a 28-day residential addictions treatment program . METHOD Consecutive cohort pairs were assigned in a pairwise r and om fashion to receive treatment as usual ( TAU ) or the ACT intervention in place of 6 hr of treatment that would have occurred at that same time . The ACT intervention consisted of three 2-hr group sessions scheduled during a single week . RESULTS Intent-to-treat analyses demonstrated that the ACT intervention result ed in smaller immediate gains in shame , but larger reductions at 4-month follow-up . Those attending the ACT group also evidence d fewer days of substance use and higher treatment attendance at follow-up . Effects of the ACT intervention on treatment utilization at follow-up were statistically mediated by posttreatment levels of shame , in that those evidencing higher levels of shame at posttreatment were more likely to be attending treatment at follow-up . Intervention effects on substance use at follow-up were mediated by treatment utilization at follow-up , suggesting that the intervention may have had its effects , at least in part , through improving treatment attendance . CONCLUSIONS These results demonstrate that an approach to shame based on mindfulness and acceptance appears to produce better treatment attendance and reduced substance use Objective : Studies of the association between transportation barriers and HIV-related health outcomes have shown both positive and negative effects , possibly because a reliable , vali date d measure of transportation barriers has not been identified . Design : Prospect i ve cohort study of HIV-infected patients in rural Ug and a. Methods : Participants were enrolled from the HIV clinic at the regional referral hospital in Mbarara , Ug and a as part of the Ug and a AIDS Rural Treatment Outcomes ( UARTO ) Study . We collected the following measures of  transportation  barriers to HIV clinic : global positioning systems (GPS)-tracked distance  measured by driving participants to their homes along their typical route ; straight-line GPS distance  from clinic to home , calculated with the Great Circle Formula ; self-reported travel time ; and  self-reported travel cost .  We assessed inter-measure agreement using linear regression , correlation coefficients and & kgr ; statistics ( by measure quartile ) and vali date d measures by fitting linear regression models to estimate associations with days late for clinic visits . Results : One hundred and eighty-eight participants were tracked with GPS . Seventy-six percent were women , with a median age of 40 years and median CD4 cell count of 193 cells/&mgr;l . We found a high correlation between  GPS-based  distance measures ( & bgr ; = 0.74 , P < 0.001 , R2 = 0.92 , & kgr ; = 0.73 ) , but little correlation between GPS-based and self-reported measures ( all R2 ⩽ 0.4 ) . GPS-based measures were associated with days late to clinic ( P < 0.001 ) ; but neither self-reported measure was associated ( P > 0.85 ) . Conclusion : GPS-measured distance to clinic is associated with HIV clinic absenteeism and should be prioritized over self-reported measures to optimally risk-stratify patients accessing care in rural , re source -limited setting Background : As the numbers of HIV-positive diagnoses rise in South Africa , it is important to underst and the determinants and consequences of HIV disclosure . Methods : Cross-sectional survey from r and om community sample s of men and women in urban and rural South Africa ( n = 217 HIV-positive individuals , 89 % female ) . Results : Two thirds of all known HIV-infected adults in these communities had disclosed their status to sexual partner(s ) . On average , individuals who disclosed were 2 years older , higher in socioeconomic assets , and had known their HIV status 7 months longer than those who had not told their sexual partner(s ) . The “ need for privacy ” was the most cited reason ( 45 % ) for nondisclosure among those who had never disclosed . People who eventually disclosed their HIV status to sexual partner(s ) were significantly more likely to report always or more frequently using condoms , reducing their number of sexual partners , and /or becoming monogamous . Among individuals who disclosed their HIV status , 77 % reported increases in social support , with families providing the most support . Conclusions : Disclosure is associated with reports of consequent safer sexual behavior and greater social support . Interventions might be informed by the costs and benefits of disclosure and differences in disclosure to sexual partner vs. to one 's social network Background A large , district-wide , home-based HIV counselling and testing ( HBHCT ) programme was implemented in Bushenyi district of Ug and a from 2004 to 2007 . This programme provided free HBHCT services to all consenting adults of Bushenyi district and had a very high uptake and acceptability . We measured population -level changes in knowledge of HIV status , stigma and HIV-risk behaviours before and after HBHCT to assess whether widespread HBHCT had an effect on trends of risky sexual behaviours and on stigma and discrimination towards HIV . Methods Serial cross-sectional surveys were carried out before and after the implementation of  HBHCT programme in Bushenyi district of Ug and a. A total of 1402 r and omly selected adults ( 18 to 49 years ) were interviewed in the baseline survey . After the implementation , a different set of r and omly selected 1562 adults was interviewed using the same question naire . Data was collected on socio-demographic characteristics , sexual behaviour , whether respondents had ever tested for HIV and stigma and discrimination towards HIV/AIDS . Results The proportion of people who had ever tested for HIV increased from 18.6 % to 62 % ( p<0.001 ) . Among people who had ever tested , the proportion of people who shared HIV test result with a sexual partner increased from 41 % to 57 % ( p<0.001 ) . The proportion of persons who wanted infection status of a family member not to be revealed decreased from 68 % to 57 % ( p<0.001 ) . Indicators of risk behaviour also improved ; the proportion of people who exchanged money for sex reduced from 12 % to 4 % ( p<0.001 ) , who used a condom when money was exchanged during a sexual act increased from 39 % to 80 % ( p<0.001 ) and who reported genital ulcer/discharge decreased from 22 % to 10 % ( p<0.001 ) . Conclusion These data suggest that HBHCT rapidly increased the uptake of HCT and may have led to reduction in high-risk behaviours at population level as well as reduction in stigma and discrimination . Because HBCT programmes are cost-effective , they should be considered for implementation in delivery of HIV services especially in areas where access to HCT is low Background Whether scale-up of HIV prevention and care will reduce negative attitudes and discriminatory practice s towards persons living with HIV/AIDS ( PLWH ) is uncertain . An HIV knowledge and attitude survey was conducted in a rural Ethiopian community where HIV prevention and treatment was being rapidly scaled up . Data were analyzed to identify prevalence of and factors associated with stigma-associated attitudes towards PLWH . Methods We surveyed 561 adults from 250 r and omly selected households in the rural town of Arba Minch and surrounding villages about positive or negative attitudes towards PLWH , as well as demographic characteristics , and knowledge about HIV transmission and treatment . Results Eighty percent of respondents agreed with ≥ 1 negative statements indicating blame or shame towards PLWH and 41 % agreed with ≥ 1 negative statements associated with distancing themselves from PLWH . However , only 14 % expressed negative responses about whether PLWH should receive support from their communities . In multivariate analysis , a greater number of negative attitudes towards PLWH was significantly ( p < 0.05 ) associated with : female gender ( Odds Ratio [ OR ] = 1.51 ) , living in a rural village ( vs. town neighborhood ) ( OR = 3.44 ) , not knowing PLWH can appear healthy ( OR = 1.78 ) , lack of knowledge about perinatal transmission ( OR = 1.49 ) , lack of knowledge about how HIV is not transmitted ( e.g. casual contact ) ( OR = 2.05 ) , lack of knowledge about HIV treatment ( OR = 1.80 ) , and not personally knowing a PLWH ( OR = 1.41 ) . Conclusions In a rural Ethiopian setting in which rapid scale-up of HIV treatment occurred , many respondents still characterized HIV as associated with shame or blame , or indicated PLWH would be isolated or discriminated against . HIV stigma can hamper both prevention and treatment programs . We identified multiple issues which , if addressed , can help promote a more positive cycle in which PLWH are appreciated as members of one ’s own community who are affirmatively interacted with and supported . Stigma reduction programs should address knowledge gaps such as fears of casual contact contagion , and lack of awareness of medical interventions to help prevent HIV disease , as well as building upon community-based attitudes of the importance of supporting and showing compassion for PLWH BACKGROUND Little is known about the effect of combination antiretroviral therapy ( cART ) on life expectancy  in sub-Saharan Africa . OBJECTIVE To estimate life expectancy of patients once they initiate cART in Ug and a. DESIGN Prospect i ve cohort study . SETTING Public sector HIV and AIDS disease-management program in Ug and a. PATIENTS 22 315 eligible patients initiated cART during the study period , of whom 1943 were considered to have died . MEASUREMENTS All-cause mortality rates were calculated and abridged life tables were constructed and stratified by sex and baseline CD4 cell count status to estimate life expectancies for patients receiving cART . The average number of years remaining to be lived by patients who received cART at varying age categories was estimated . RESULTS After adjustment for loss to follow-up , crude mortality rates ( deaths per 1000 person-years ) ranged from 26.9 ( 95 % CI , 25.4 to 28.5 ) in women to 43.9 ( CI , 40.7 to 47.0 ) in men . For patients with a baseline CD4 cell count less than 0.050 × 10(9 ) cells/L , the mortality rate was 67.3 ( CI , 62.1 to 72.9 ) deaths per 1000 person-years , whereas among persons with a baseline CD4 cell count of 0.250 × 10(9 ) cells/L or more , the mortality rate was 19.1 ( CI , 16.0 to 22.7 ) deaths per 1000 person-years . Life expectancy at age 20 years for the overall cohort was 26.7 ( CI , 25.0 to 28.4 ) additional years and at age 35 years was 27.9 ( CI , 26.7 to 29.1 ) additional years . Life expectancy increased substantially with increasing baseline CD4 cell count . Similar trends are observed for older age groups . LIMITATIONS A small ( 6.4 % ) proportion of patients were lost to follow-up , and it was imputed that 30 % of these patients had died . Few patients with a CD4 cell count greater than 0.250 × 10(9 ) cells/L initiated cART . CONCLUSION Ug and an patients receiving cART can expect an almost normal life expectancy , although there is considerable variability among subgroups of patients . PRIMARY FUNDING SOURCE Canadian Institutes of Health Research Objective : To determine the efficacy of patient-selected treatment partners on virologic and adherence outcomes during first-line antiretroviral therapy .  Design : R and omized controlled trial . Setting and Analytical Approach : Between June 2006 and December 2007 , 499 HIV-infected adults in Jos , Nigeria , were r and omized to st and ard of care ( SOC ) or patient-selected treatment partner-assisted therapy ( TPA ) .  Each patient was followed for 48 weeks . Virologic outcomes , adherence to drug pick-up , CD4 cell counts , and mortality are reported . Results : At week 24 , undetectable viral load was achieved by 61.7 % of patients in the TPA arm versus 50.2 % of those receiving SOC [ odds ratio ( OR ) = 1.58 , 95 % CI : 1.11 to 2.26 , P < 0.05 ] . There was no significant difference at week 48 : 65.3 % versus 59.4 % for TPA and SOC , respectively ( OR = 1.28 , 95 % CI : 0.89 to 1.84 , P > 0.05 ) . The TPA group had more than 3 times the odds of at least 95 % drug pickup adherence through week 24 ( OR = 3.06 , 95 % CI : 1.89 to 4.94 , P < 0.01 ) and almost twice the odds through week 48 ( OR = 1.95 , 95 % CI : 1.29 to 2.93 , P < 0.01 ) . At week 48 , there were no significant differences in CD4 cell count increases ( t = −0.09 , df = 404 , P > 0.05 ) or mortality ( 10.6 % vs. 6.1 % ) between TPA vs. SOC , respectively . Residence-to-clinic distance was significantly associated with virologic and adherence outcomes . Conclusions : Use of patient-selected 
    Output:
    
Our review revealed considerable progress in the stigma-reduction field .