***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 Data regarding the efficacy of directly administered antiretroviral therapy ( DAART ) are mixed . Opioid treatment programs ( OTPs ) provide a convenient framework for DAART . In a r and omized controlled trial , we compared DAART and self-administered therapy ( SAT ) among HIV-infected subjects attending five OTPs in Baltimore , MD . Methods HIV-infected individuals attending OTPs were eligible if they were not taking antiretroviral therapy ( ART ) or were virologically failing ART at last clinical assessment . In subjects assigned to DAART , we observed one ART dose per weekday at the OTP for up to 12 months . SAT subjects administered ART at home . The primary efficacy comparison was the between-arm difference in the average proportions with HIV RNA < 50 copies/mL during the intervention phase ( 3- , 6- , and 12-month study visits ) , using a logistic regression model accounting for intra-person correlation due to repeated observations . Adherence was measured with electronic monitors in both arms . Results We r and omized 55 and 52 subjects from five Baltimore OTPs to DAART and SAT , respectively . The average proportions with HIV RNA < 50 copies/mL during the intervention phase were 0.51 in DAART and 0.40 in SAT ( difference 0.11 , 95 % CI : −0.020 to 0.24 ) . There were no significant differences between arms in electronically-measured adherence , average CD4 cell increase from baseline , average change in log10 HIV RNA from baseline , opportunistic conditions , hospitalizations , mortality , or the development of new drug resistance mutations . Conclusions In this r and omized trial , we found little evidence that DAART provided clinical benefits compared to SAT among HIV-infected subjects attending OTPs . Trial Registration Clinical Trails.gov NCT00279110 NCT00279110?term = NCT00279110&rank = Background There are conflicting reports of antiretroviral therapy ( ART ) effectiveness comparisons between primary healthcare ( PHC ) facilities and hospitals in low-income setting s. This comparison has not been evaluated on a broad scale in South Africa . Methodology /Principal Findings A retrospective cohort study was conducted including ART-naïve adults from 59 facilities in four provinces in South Africa , enrolled between 2004 and 2007 . Kaplan-Meier estimates , competing-risks Cox regression , generalised estimating equation population -averaged models and logistic regression were used to compare death , loss to follow-up ( LTFU ) and virological suppression ( VS ) between PHC , district and regional hospitals . 29 203 adults from 47 PHC facilities , nine district hospitals and three regional hospitals were included . Patients at PHC facilities had more advanced WHO stage disease when starting ART . Retention in care was 80.1 % ( 95 % CI : 79.3%–80.8 % ) , 71.5 % ( 95 % CI : 69.1%–73.8 % ) and 68.7 % ( 95 % CI : 67.0%–69.7 % ) at PHC , district and regional hospitals respectively , after 24 months of treatment ( P<0.0001 ) . In adjusted regression analyses , LTFU was independently increased at regional hospitals ( aHR 2.19 ; 95 % CI : 1.94−2.47 ) and mortality was independently elevated at district hospitals ( aHR 1.60 ; 95 % CI : 1.30−1.99 ) compared to PHC facilities after 12 months of ART . District and regional hospital patients had independently reduced probabilities of VS , aOR 0.76 ( 95 % CI : 0.59−0.97 ) and 0.64 ( 95 % CI : 0.56−0.75 ) respectively compared to PHC facilities over 24 months of treatment . Conclusions / Significance ART outcomes were superior at PHC facilities , despite PHC patients having more advanced clinical stage disease when starting ART , suggesting that ART can be adequately provided at this level and supporting the South African government 's call for rapid up-scaling of ART at the primary level of care . Further prospect i ve research is required to determine the degree to which outcome differences are attributable to either facility level characteristics or patient co-morbidity at hospital level Summary Background Robust evidence of the effectiveness of task shifting of antiretroviral therapy ( ART ) from doctors to other health workers is scarce . We aim ed to assess the effects on mortality , viral suppression , and other health outcomes and quality indicators of the Streamlining Tasks and Roles to Exp and Treatment and Care for HIV ( STRETCH ) programme , which provides educational outreach training of nurses to initiate and represcribe ART , and to de central ise care . Methods We undertook a pragmatic , parallel , cluster-r and omised trial in South Africa between Jan 28 , 2008 , and June 30 , 2010 . We r and omly assigned 31 primary -care ART clinics to implement the STRETCH programme ( intervention group ) or to continue with st and ard care ( control group ) . The ratio of r and omisation depended on how many clinics were in each of nine strata . Two cohorts were enrolled : eligible patients in cohort 1 were adults ( aged ≥16 years ) with CD4 counts of 350 cells per μL or less who were not receiving ART ; those in cohort 2 were adults who had already received ART for at least 6 months and were being treated at enrolment . The primary outcome in cohort 1 was time to death ( superiority analysis ) . The primary outcome in cohort 2 was the proportion with undetectable viral loads ( < 400 copies per mL ) 12 months after enrolment ( equivalence analysis , prespecified difference < 6 % ) . Patients and clinicians could not be masked to group assignment . The interim analysis was blind , but data analysts were not masked after the data base was locked for final analysis . Analyses were done by intention to treat . This trial is registered , number IS RCT N46836853 . Findings 5390 patients in cohort 1 and 3029 in cohort 2 were in the intervention group , and 3862 in cohort 1 and 3202 in cohort 2 were in the control group . Median follow-up was 16·3 months ( IQR 12·2–18·0 ) in cohort 1 and 18·0 months ( 18·0–18·0 ) in cohort 2 . In cohort 1 , 997 ( 20 % ) of 4943 patients analysed in the intervention group and 747 ( 19 % ) of 3862 in the control group with known vital status at the end of the trial had died . Time to death did not differ ( hazard ratio [ HR ] 0·94 , 95 % CI 0·76–1·15 ) . In a preplanned subgroup analysis of patients with baseline  CD4 counts of 201–350 cells per μL , mortality was slightly lower in the intervention group than in the control group ( 0·73 , 0·54–1.00 ; p=0·052 ) , but it did not differ between groups in patients with baseline CD4 of 200 cells per μL or less ( 0·94 , 0·76–1·15 ; p=0·577 ) . In cohort 2 , viral load suppression 12 months after enrolment was equivalent in intervention ( 2156 [ 71 % ] of 3029 patients ) and control groups ( 2230 [ 70 % ] of 3202 ; risk difference 1·1 % , 95 % CI −2·4 to 4·6 ) . Interpretation Expansion of primary -care nurses ' roles to include ART initiation and represcription can be done safely , and improve health outcomes and quality of care , but might not reduce time to ART or mortality . Funding UK Medical Research Council , Development Cooperation Irel and , and Canadian International Development Agency BACKGROUND Untreated opioid dependence adversely affects the care of human immunodeficiency virus (HIV)-positive patients .  Buprenorphine , a partial opioid agonist , is available for maintenance treatment of opioid dependence in HIV specialty setting s. We investigated the feasibility and efficacy of integrating buprenorphine , along with 2 levels of counseling , into HIV clinical care . METHODS HIV-positive , opioid-dependent patients were enrolled in a 12-week pilot study and r and omized to receive daily buprenorphine/naloxone treatment along with either brief physician management or physician management combined with nurse-administered drug counseling and adherence management . Primary outcomes included treatment retention ; illicit drug use , assessed by urine toxicology test and self-report ; CD4 lymphocyte counts ; and log(10 ) HIV type 1 ( HIV-1 ) RNA levels . RESULTS Of the 16 patients who received at least 1 dose of buprenorphine , 13 ( 81 % ) completed 12 weeks of treatment . The proportion of opioid-positive weekly urine test results decreased from 100 % at baseline to 32 % ( month 1 ) , 20 % ( month 2 ) , and 16 % ( month 3 ) . Only 4 patients reported any opioid use ( in the prior 7 days ) during the 12-week study . CD4 lymphocyte counts remained stable over the course of the study . The mean log(10 ) HIV-1 RNA level ( + /- st and ard deviation ) declined significantly , from 3.66+/-1.06 log(10 ) HIV-1 RNA copies/mL at baseline to 3.0+/-0.57 log(10 ) HIV-1 RNA copies/mL at month 3 ( P<.05 ) . No significant differences based on counseling intervention were detected . All 13 patients who completed the study continued to receive treatment in an extension phase of at least 0 - 15 months ' duration . CONCLUSIONS We conclude that it is feasible to integrate buprenorphine into HIV clinical care for the treatment of opioid dependence . Patients experienced good treatment retention and reductions in their opioid use . HIV biological markers remained stable or improved during buprenorphine/naloxone treatment BACKGROUND Exp and ed access to combination antiretroviral therapy ( ART ) in re source -poor setting s is dependent on task shifting from doctors to other health-care providers . We compared outcomes of nurse versus doctor management of ART care for HIV-infected patients . METHODS This r and omised non-inferiority trial was undertaken at two South African primary -care clinics . HIV-positive individuals with a CD4 cell count of less than 350 cells per microL or WHO stage 3 or 4 disease were r and omly assigned to nurse-monitored or doctor-monitored ART care . Patients were r and omly assigned by stratified permuted block r and omisation , and neither the patients nor those analysing the data were masked to assignment . The primary objective was a composite endpoint of treatment-limiting events , incorporating mortality , viral failure , treatment-limiting toxic effects , and adherence to visit schedule . Analysis was by intention to treat . Non-inferiority of the nurse versus doctor group for cumulative treatment failure was prespecified as an upper 95 % CI for the hazard ratio that was less than 1.40 . This study is registered with Clinical Trials.gov , number NCT00255840 . FINDINGS 408 patients were assigned to doctor-monitored ART care and 404 to nurse-monitored ART care ;  all participants were analysed . 371 ( 46 % ) patients reached an endpoint of treatment failure : 192 ( 48 % ) in the nurse group and 179 ( 44 % ) in the doctor group . The hazard ratio for composite failure was 1.09 ( 95 % CI 0.89 - 1.33 ) , which was within the limits for non-inferiority . After a median follow-up of 120 weeks ( IQR 60 - 144 ) , deaths ( ten vs 11 ) , virological failures ( 44 vs 39 ) , toxicity failures ( 68 vs 66 ) , and programme losses ( 70 vs 63 ) were similar in nurse and doctor groups , respectively . INTERPRETATION Nurse-monitored ART is non-inferior to doctor-monitored therapy . Findings from this study lend support to task shifting to appropriately trained nurses for monitoring of ART . FUNDING National Institutes of Health ; United States Agency for International Development ; National Institute of Allergy and Infectious Diseases Objectives : To assess whether community-based care delivered by people living with HIV/AIDS ( PLWAs ) could replace clinic-based HIV care . Design : Prospect i ve cluster r and omized controlled clinical trial . Setting : Villages surrounding 1 rural clinic in western Kenya . Subjects : HIV-infected adults clinical ly stable on antiretroviral therapy ( ART ) . Intervention : The intervention group received monthly Personal Digital Assistant supported home assessment s by PLWAs with clinic appointments every 3 months . The control group received st and ard of care monthly clinic visits . Main Outcomes Measured : Viral load , CD4 count , Karnofsky score , stability of ART regimen , opportunistic infections , pregnancies , and number of clinic visits . Results : After 1 year , 
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The limited data on ART integration into OST services indicated comparable rates of ART coverage , retention , and mortality .
CONCLUSION Integrating ART into MNCH , TB , and OST services was often associated with improvements in ART coverage , and de central ization of ART into primary health facilities and communities was often associated with improved retention .
Neither integration nor de central ization was associated with adverse outcomes .