***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 : To investigate HIV incidence during a trial of two voluntary counselling and testing ( VCT ) strategies . Counselling may promote beneficial behavioural change , although knowledge of negative status does not appear to contribute further benefit . Design : The parent cluster-r and omized trial demonstrated much greater uptake of VCT when counselling and rapid testing were available on-site ( intensive VCT ) than through pre-paid vouchers to an external provider ( st and ard VCT ) . Anonymous HIV tests had been requested from all employees at enrolment and after 2 years intervention . Methods : The study setting was 22 businesses in Harare , Zimbabwe . Participants were 3146 HIV-negative individuals remaining in employment at the end of intervention , of whom 2966 ( 94.3 % ) consented to repeat testing . VCT linked to basic HIV care was provided and the main outcome measures were HIV incidence under each study arm , as a retrospective secondary analysis . Results : Mean VCT uptake in this cohort was 70.7 and 5.2 % , respectively , in the intensive and st and ard arms . Crude HIV incidence was 1.21 per 100 person-years , with non-significantly higher rates in the intensive VCT arm [ mean site incidence 1.37 and 0.95 per 100 person-years , respectively ; adjusted rate ratio 1.49 ( 95 % confidence interval 0.79–2.80 ) . Conclusions : Highly acceptable VCT did not reduce HIV incidence in this predominantly male cohort .  HIV incidence was highest in the high uptake VCT arm , lending support to a US trial in which rapid testing appeared to have adverse behavioural consequences in some HIV-negative clients . Careful comparison of outcomes under different counselling and testing strategies is needed to maximize HIV prevention from global scale-up of VCT OBJECTIVE To assess the possible impact of HIV infection on the management of general surgical patients at the Ga-Rankuwa Hospital . DESIGN A prospect i ve study . SETTING Ga-Rankuwa Hospital/Medical University of Southern Africa ( MEDUNSA ) Academic Complex , Pretoria , South Africa . SUBJECTS Nine hundred and forty one patients admitted to general surgical wards . MAIN OUTCOME MEASURES HIV infection and CD4 counts . RESULTS Nine hundred and forty one patients admitted to general surgical wards from January 1966 to December 1997 were tested for HIV infection . Twelve per cent tested positive . HIV positive patients were significantly younger [ 33 + /- 10 versus 41 + /- 7 ( men + /- SD ) years , Chi-square = 51 , p < 0.0001 ] . There was no correlation of HIV positivity to the patient 's sex ( p = 0.7 ) . In forty three HIV positive patients treated surgically , mortality was attributed to HIV/AIDS in only one patient with a CD4 count of 47/ul who died following laparotomy for peritonitis . CD4 counts done during follow up in thirty one HIV positive patients revealed a count of < 500/ul in eleven patients . CONCLUSION It is predicted that an increasing number of patients with HIV/AIDS will be admitted to general surgery wards of the Ga-Rankuwa Hospital . Surgeons are advised to take universal pre caution s to prevent HIV infection Background HIV counselling and testing is a key component of both HIV care and HIV prevention , but uptake is currently low . We investigated the impact of rapid HIV testing at the workplace on uptake of  voluntary counselling and testing ( VCT ) . Methods and Findings The study was a cluster-r and omised trial of two VCT strategies , with business occupational health clinics as the unit of r and omisation . VCT was directly offered to all employees , followed by 2 y of open access to VCT and basic HIV care .  Businesses were r and omised to either on-site rapid HIV testing at their occupational clinic ( 11 businesses ) or to vouchers for off-site VCT at a chain of free-st and ing centres also using rapid tests ( 11 businesses ) . Baseline anonymised HIV serology was requested from all employees . HIV prevalence was 19.8 % and 18.4 % , respectively , at businesses r and omised to on-site and off-site VCT . In total , 1,957 of 3,950 employees at clinics r and omised to on-site testing had VCT ( mean uptake by site 51.1 % ) compared to 586 of 3,532 employees taking vouchers at clinics r and omised to off-site testing ( mean uptake by site 19.2 % ) . The risk ratio for on-site VCT compared to voucher uptake was 2.8 ( 95 % confidence interval 1.8 to 3.8 ) after adjustment for potential confounders . Only 125 employees ( mean uptake by site 4.3 % ) reported using their voucher , so that the true adjusted risk ratio for on-site compared to off-site VCT may have been as high as 12.5 ( 95 % confidence interval 8.2 to 16.8 ) . Conclusions High-impact VCT strategies are urgently needed to maximise HIV prevention and access to care in Africa . VCT at the workplace offers the potential for high uptake when offered on-site and linked to basic HIV care . Convenience and accessibility appear to have critical roles in the acceptability of community-based VCT Background Voluntary HIV counselling and testing ( VCT ) is one of the key strategies in the prevention and control of HIV/AIDS in Ug and a. However , the utilization of VCT services particularly among men is low in Kasese district . We therefore conducted a study to determine the prevalence and factors associated with  VCT  use among men in Bukonzo West health sub-district , Kasese district . Methods A population -based cross-sectional study employing both quantitative and qualitative techniques of data collection was conducted between January and April 2005 . Using cluster sampling , 780 men aged 18 years and above , residing in Bukonzo West health sub-district , were sample d from 38 r and omly selected clusters . Data was collected on VCT use and independent variables . Focus group discussion s ( 4 ) and key informant interviews ( 10 ) were also conducted . Binary logistic regression was performed to determine the predictors of VCT use among men . Results Overall VCT use among men was 23.3 % ( 95 % CI 17.2–29.4 ) . Forty six percent ( 95 % CI 40.8–51.2 ) had pre-test counselling and 25.9 % ( 95%CI 19.9–31.9 ) had HIV testing . Of those who tested , 96 % returned for post-test counselling and received HIV results . VCT use was higher among men aged 35 years and below ( OR = 2.69 , 95%CI 1.77–4.07 ) , the non-subsistence farmers ( OR = 2.37 , 95%CI 2.37 ) , the couple testing ( OR = 2.37 , 95%CI 1.02–8.83 ) and men with intention to disclose HIV test results to sexual partners ( OR = 1.64 , 95%CI 1.04–2.60 ) . The major barriers to VCT use among men were poor utilization of VCT services due to poor access , stigma and confidentiality of services . Conclusion  VCT use among men in Bukonzo West , Kasese district was low . In order to increase  VCT use among men , the VCT programme needs to address HIV stigma and improve access and confidentiality of VCT services . Among the more promising interventions are the use of routine counselling and testing for HIV of patients seeking health care in health units , home based VCT programmes , and mainstreaming of HIV counselling and testing services in community development programmes Objectives : To assess self‐ selection in a population ‐based voluntary HIV testing and counseling ( VTC ) program by comparing the HIV risk characteristics of users and nonusers of VTC in rural Ug and a. Design : A 1994 to 1995 community‐r and omized trial in the Rakai District of Ug and a enrolled adults aged 15 to 59 years and ascertained their HIV status , sociodemographic characteristics , risk behaviors , and AIDS‐associated symptoms . All subjects were offered confidential individual VTC at no cost . Methods : We compared users and nonusers of VTC among 10,950 participants ( 4764 male and 6186 female ) enrolled at baseline using multivariate logistic regression . Results : Women were significantly less likely to  receive VTC  than men ( 31.5 % vs. 34.8 % , p < .001 ) . In multivariate analysis , younger age , HIV‐positive status , and having no sexual partners in the past 5 years ( and , significant for women only , having 2 or more sexual partners ) were associated with lower VTC participation for both men and women . Among women ,  higher VTC participation was associated with symptoms suggestive of AIDS and other illnesses and shopkeeper occupations . Conclusions : During the initial phase of a population ‐based  free VTC program in rural Ug and a , certain high‐risk groups were underrepresented among VTC recipients . There is a need to target VTC to ensure participation by high‐risk individuals most in need of services Introduction According to the 2011–2012 HIV and Malaria Indicator Survey , the prevalence of HIV infection in Tanzania is 5.1 % , with limited information on its magnitude among older people , as the community believes that the elderly are not at risk . Consequently , little attention is given to the fight against HIV and AIDS in this group . The present study investigated the magnitude of HIV and AIDS infection among older people in rural and urban areas of the Tanzania mainl and . Subjects and methods The study was conducted in Mufindi and Babati districts of Iringa and Manyara regions , respectively , through  multistage sampling procedures . Dried blood spot cards were used to collect blood sample s for HIV testing among consenting participants . HIV testing was done and retested using different enzyme-linked immunosorbent assay kits . Results A total of 720 individuals , 340 ( 47.2 % ) males and 380 ( 52.8 % ) females , were r and omly selected , of whom 714 ( 99.2 % ) consented to HIV testing while six ( 0.8 % ) refused to donate blood . The age ranged from 50 to 98 years , with a mean age of 64.2 years . Overall , a total of 56 ( 7.8 % ) participants were HIV-positive .  Females had a higher prevalence ( 8.3 % ) than males ( 7.4 % ) , with Mufindi district recording the higher rate ( 11.3 % ) compared to the 3.7 % of Babati district . The prevalence was higher in the rural population ( 9.4 % ) compared to 6.4 % of their urban counterparts . Conclusion Although HIV/AIDS is considered a disease of individuals aged 15–49 years , the overall prevalence among the older people aged 50 years and above for Mufindi and Babati districts was higher than the national prevalence in the general population . These findings point to the need to consider strengthening interventions targeting older population s against HIV/AIDS in these districts while establishing evidence countrywide to inform policy decisions BACKGROUND Access to HIV-1 voluntary counselling and testing ( VCT ) is severely limited in less-developed countries . We undertook a multisite trial of HIV-1 VCT to assess its impact , cost , and cost-effectiveness in less-developed country setting s. METHODS The cost-effectiveness of HIV-1 VCT was estimated for a hypothetical cohort of 10000 people seeking VCT in urban east Africa . Outcomes were modelled based on results from a r and omised controlled trial of  HIV-1 VCT in Tanzania and Kenya . Our main outcome measures included programme cost , number of HIV-1 infections averted , cost per HIV-1 infection averted , and cost per disability-adjusted life-year ( DALY ) saved . We also modelled the impact of targeting VCT by HIV-1 prevalence of the client population , and the proportion of clients who receive  VCT  as a couple compared with as individuals . Sensitivity analysis was done on all model parameters . FINDINGS HIV-1 VCT was estimated to avert 1104 HIV-1 infections in Kenya and 895 in Tanzania during the subsequent year . The cost per HIV-1 infection averted was US$ 249 and $ 346 , respectively , and the cost per DALY saved was $ 12.77 and $ 17.78 . The intervention was most cost-effective for HIV-1-infected people and those who received VCT as a couple . The cost-effectiveness of VCT was robust , with a range for the average cost per DALY saved of $ 5.16 - 27.36 in Kenya , and $ 6.58 - 45.03 in Tanzania . Analysis of targeting showed that increasing the proportion of couples to 70 % reduces the cost per DALY saved to $ 10.71 in Kenya and $ 13.39 in Tanzania , and that targeting a population with HIV-1 prevalence of 45 % decreased the cost per DALY saved to $ 8.36 in Kenya and $ 11.74 in Tanzania . INTERPRETATION HIV-1 VCT is highly cost-effective in urban east African setting s , but slightly less so than interventions such as improvement of sexually transmitted disease services and universal provision of nevirapine to pregnant women in high-prevalence setting s. With the 
    Output:
    
Exp and ing home and mobile testing , self-testing and outreach to key population s with facilitated linkage can increase the proportion of men , young adults and high-risk individuals linked to HIV treatment and prevention , and decrease HIV burden .