***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 : The main aim of this study was to reduce breast-milk transmission of HIV-1 by treating HIV-1-infected women with highly active antiretroviral therapy ( HAART ) during breastfeeding . Methods : Mitra Plus was an open-label , nonr and omized , prospect i ve cohort study . HIV-1-infected pregnant women in Dar es Salaam were treated with zidovudine ( ZDV ) + lamivudine ( 3TC ) + nevirapine ( NVP ) . NVP was later replaced by nelfinavir for mothers with CD4 cell counts > 200 cells per microliter or with adverse reaction to NVP . HAART was initiated at 34 weeks of gestation . For women with symptomatic HIV infection or CD4 cell counts below 200 cells per microliter , HAART was started earlier if possible . Treatment of the mothers was stopped at 6 months except for those mothers who needed HAART for their own health . The infants received ZDV + 3TC for 1 week after birth . Mothers were advised to exclusively breastfeed and to wean abruptly between 5 and 6 months . Transmission of HIV-1 was analyzed using the Kaplan-Meier survival technique . Cox regression was used for comparison with the breastfeeding population of the Petra trial arm A. Results : There were 441 infants included in the analysis of HIV-1 transmission .  The cumulative transmission of HIV-1 was 4.1 % [ 95 % confidence interval ( CI ) : 2.2 to 6.0 ] at 6 weeks , 5.0 % ( 95 % CI : 2.9 to 7.1 ) at 6 months , and 6.0 % ( 95 % CI : 3.7 to 8.3 ) at 18 months after delivery . The cumulative risk of HIV transmission between 6 weeks and 6 months was 1.0 % and between 6 months and 18 months 1.1 % . The cumulative HIV infection or death rate was 8.6 % ( 95 % CI : 6.0 to 11.2 ) at 6 months and 13.6 % ( 95 % CI : 10.3 to 16.9 ) at 18 months after delivery . Viral load at enrollment and duration of HAART before delivery were significantly associated with transmission but CD4 cell count at enrollment was not . The median time of breastfeeding was 24 weeks . The transmission in the Mitra Plus study was about half of the transmission in the breastfeeding population in the Petra trial arm A at 6 months after delivery ( adjusted relative hazard = 0.49 , P < 0.001 ) . The combined outcome HIV infection or death was significantly lower in the Mitra Plus study than in the breastfeeding population in the Petra trial arm A at 18 months ( adjusted relative hazard = 0.61 , P = 0.007 ) . NVP-related mucocutaneous rash was demonstrated in 6.5 % of 429 NVP-exposed women . The incidence of NVP-related grade 3 or 4 hepatotoxicity was low ( 0.5 % ) . Conclusions : HAART given to HIV-infected mothers in late pregnancy and during breastfeeding result ed in a low postnatal HIV transmission similar to that previously demonstrated in the Mitra study in Dar es Salaam using infant prophylaxis with 3TC during breastfeeding . The extended maternal prophylaxis with HAART for prevention of mother-to-child transmission of HIV-1 for breastfeeding mothers who do not need HAART for their own health should be further evaluated and compared with the use of infant postnatal antiretroviral prophylaxis regarding safety and cost-effectiveness Background : Rates of retention in care of HIV-positive pregnant women in care programs in Nigeria remain generally poor with rates around 40 % reported for specific programs . Poor quality of services in health facilities and long waiting times are among the critical factors militating against retention of these women in care . The aim of the interventions in this study is to assess whether a continuous quality improvement intervention using a Breakthrough Series approach in local district hospitals and primary health care clinics will lead to improved retention of HIV-positive women and mothers . Methods / Design : A cluster r and omized controlled trial with 32 health facilities r and omized to receive a continuous quality improvement/Breakthrough Series intervention or not . The care protocol for HIV-infected pregnant women and mothers is the same in all sites . The quality improvement intervention started 4 months before enrollment of individual HIV-infected pregnant women and initially focused on reducing waiting times for women and also ensuring that antiretroviral drugs are dispensed on the same day as clinic attendance . The primary outcome measure is retention of HIV-positive mothers in care at 6 months postpartum . Discussion : Results of this trial will inform whether quality improvement interventions are an effective means of improving retention in prevention of mother-to-child transmission of HIV programs and will also guide where health system interventions should focus to improve the quality of care for HIV-positive women . This will benefit policymakers and program managers as they seek to improve retention rates in HIV care programs BACKGROUND We evaluated the efficacy of a maternal triple-drug antiretroviral regimen or infant nevirapine prophylaxis for 28 weeks during breast-feeding to reduce postnatal transmission of human immunodeficiency virus type 1 ( HIV-1 ) in Malawi . METHODS We r and omly assigned 2369 HIV-1-positive , breast-feeding mothers with a CD4 + lymphocyte count of at least 250 cells per cubic millimeter and their infants to receive a maternal antiretroviral regimen , infant nevirapine , or no extended postnatal antiretroviral regimen ( control group ) .  All mothers and infants received perinatal prophylaxis with single-dose nevirapine and 1 week of zidovudine plus lamivudine . We used the Kaplan-Meier method to estimate the cumulative risk of HIV-1 transmission or death by 28 weeks among infants who were HIV-1-negative 2 weeks after birth . Rates were compared with the use of the log-rank test . RESULTS Among mother-infant pairs , 5.0 % of infants were HIV-1-positive at 2 weeks of life . The estimated risk of HIV-1 transmission between 2 and 28 weeks was higher in the control group ( 5.7 % ) than in either the maternal-regimen group ( 2.9 % , P=0.009 ) or the infant-regimen group ( 1.7 % , P<0.001 ) . The estimated risk of infant HIV-1 infection or death between 2 and 28 weeks was 7.0 % in the control group , 4.1 % in the maternal-regimen group ( P=0.02 ) , and 2.6 % in the infant-regimen group ( P<0.001 ) . The proportion of women with neutropenia was higher among those receiving the antiretroviral regimen ( 6.2 % ) than among those in either the nevirapine group ( 2.6 % ) or the control group ( 2.3 % ) . Among infants receiving nevirapine , 1.9 % had a hypersensitivity reaction . CONCLUSIONS The use of either a maternal antiretroviral regimen or infant nevirapine for 28 weeks was effective in reducing HIV-1 transmission during breast-feeding . ( Clinical Trials.gov number , NCT00164736 . Abstract : UNAIDS has set a goal of achieving the elimination of mother-to-child transmission ( eMTCT ) of HIV by 2015 and keeping HIV-positive ( HIV+ ) mothers alive . In pursuit of this goal , in 2011 , the Malawi Ministry of Health ( MoH ) adopted the Option B+ strategy , which entails lifelong antiretroviral treatment for all HIV+ mothers , irrespective of severity of HIV infection . Poor mother – child pair retention is one of the major challenges against achieving this goal . To improve retention of mother – infant pairs in the eMTCT continuum of care , the Promoting Retention among Infants and Mothers Effectively ( PRIME ) study is evaluating the effectiveness of 3 models of health care delivery namely , mother – infant pair clinics , which deliver integrated HIV and non-HIV services , mother – infant pair clinics plus electronic text message ( SMS ) reminders for mother – infant pairs who miss scheduled eMTCT follow-up clinics , and current st and ard of care . The primary outcome is “ the proportion of HIV+ mothers and /or HIV-exposed infants ( HEI ) retained in eMTCT care at 12 months postpartum and received recommended HIV and non-HIV services during preceding scheduled visits . ” This 3-arm cluster r and omized intervention study is being implemented in 30 primary health facilities ( 10 facilities per arm ) in Mangochi and Salima districts , Malawi . At each clinic , a total of 41 HIV+ mothers attending maternal and child health services are being recruited and followed up for 18 months postpartum . This article describes the study methodology and interventions , successes and challenges experienced during the first 12 months of study implementation and relevance of study results to Malawi and other countries adopting the Option B+ strategy Background Pregnant women living with HIV ( WLH ) face daily challenges maintaining their own and their babies ' health and mental health . St and ard Prevention of Maternal to Child Transmission ( PMTCT ) programs are not design ed to address these challenges . Methods / Design As part of a cluster r and omized controlled trial , WLH are invited to attend four antenatal and four postnatal small group sessions led by a peer WLH ( a Peer Mentor ) . The WLH and their babies are assessed during pregnancy and at one week , six months , and twelve months post-birth . Mobile phones are used to collect routine information , complete question naires and remain in contact with participants over time . Pregnant WLH ( N = 1200 ) are r and omly assigned by clinic ( N = 8 clinics ) to an intervention program , called Masihambisane ( n = 4 clinics , n = 600 WLH ) or a st and ard care PMTCT control condition ( n = 4 clinics ; n = 600 WLH ) . Discussion Data collection with cellular phones are innovative and effective in low-re source setting s. St and ard PMTCT programs are not design ed to address the daily challenges faced by WLH ; Peer Mentors may be useful in supporting WLH to cope with these challenges . Trial registration Clinical Trials.gov registration # Background : Nigeria is a key target country in the global effort toward elimination of mother-to-child transmission of HIV . Low coverage of prevention of mother-to-child transmission ( PMTCT ) interventions , adherence , and retention-in-care rates in HIV-positive pregnant women are contributing factors to high mother-to-child transmission of HIV ( MTCT ) rates . In Nigeria , rural areas , served largely by primary health care facilities , have particularly poor indicators of PMTCT coverage . Mentor Mothers are HIV-positive women who serve as peer counselors for PMTCT clients , provide guidance , and support in keeping appointments and promoting antiretroviral adherence and retention-in-care . The Mother Mentor ( MoMent ) study aims to investigate the impact of structured Mentor Mother programs on PMTCT outcomes in rural Nigeria . Design and Methods : A prospect i ve cohort study will compare rates of retention-in-care among PMTCT clients who are supported by formally-trained supervised Mentor Mothers versus clients who receive st and ard-of-care , informal peer support . Study sites are 20 primary health care centers ( 10 intervention , 10 control ) in rural North- Central Nigeria . The study population is HIV-positive mothers and exposed infant pairs ( MIPs ) ( N = 480 ; 240 MIPs per study arm ) . Primary outcome measures are the proportion of exposed infants receiving early HIV testing by age 2 months , and the proportion of MIPs retained in care at 6 months postpartum . Secondary outcome measures examine antiretroviral adherence , 12-month postpartum MIP retention , and MTCT rates . This article presents details of the study design , the structured Mentor Mother programs , and how their impact on PMTCT outcomes will be assessed 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 participation itself , or combined with a behavioral PMTCT intervention , can significantly reduce infant HIV infection ante- , peri- and postnatally . Disc 
    Output:
    
Overall , the evidence base for interventions to improve postpartum retention in HIV care is weak .
Nevertheless , there is some evidence that phone-based interventions can improve retention in PMTCT in the first one to three months postpartum