***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 Few data are available to guide programmatic solutions to the overlapping problems of undernutrition and HIV infection . We evaluated the impact of food assistance on patient outcomes in a comprehensive HIV program in central Haiti in a prospect i ve observational cohort study . Methods Adults with HIV infection were eligible for monthly food rations if they had any one of : tuberculosis , body mass index ( BMI ) < 18.5kg/m2 , CD4 cell count < 350/mm3 ( in the prior 3 months ) or severe socio-economic conditions . A total of 600 individuals ( 300 eligible and 300 ineligible for food assistance )  were interviewed before rations were distributed , at 6 months and at 12 months . Data collected included demographics , BMI and food insecurity score ( range 0 - 20 ) . Results At 6- and 12-month time-points , 488 and 340 subjects were eligible for analysis . Multivariable analysis demonstrated that at 6 months , food security significantly improved in those who received food assistance versus who did not ( -3.55 vs -0.16 ; P < 0.0001 ) ; BMI decreased significantly less in the food assistance group than in the non-food group ( -0.20 vs -0.66 ; P = 0.020 ) . At 12 months , food assistance was associated with improved food security ( -3.49 vs -1.89 , P = 0.011 ) and BMI ( 0.22 vs -0.67 , P = 0.036 ) . Food assistance was associated with improved adherence to monthly clinic visits at both 6 ( P < 0.001 ) and 12 months ( P = 0.033 ) . Conclusions Food assistance was associated with improved food security , increased BMI , and improved adherence to clinic visits at 6 and 12 months among people living with HIV in Haiti and should be part of routine care where HIV and food insecurity overlap Objectives To measure HIV prevalence and uptake of HIV counseling and testing ( HCT ) in a peri-urban South African community . To assess predictors for previous HIV testing and the association between the yield of previously undiagnosed HIV and time of last negative HIV test Methods A r and om sample of 10 % of the adult population ( ≥15 years ) were invited to attend a mobile HCT service . Study procedures included a question naire , HIV testing and CD4 counts . Predictors for previous testing were determined using a binominal model . Results 1,144 ( 88.0 % ) of 1,300 r and omly selected individuals participated in the study . 71.0 % ( 68.3–73.6 ) had previously had an HIV test and 37.5 % ( 34.6–40.5 ) had tested in the past 12 months . Men , migrants and older ( > 35 years ) and younger ( < 20 years ) individuals were less likely to have had a previous HIV test . Overall HIV prevalence was 22.7 ( 20.3–25.3 ) with peak prevalence of 41.8 % ( 35.8–47.8 ) in women aged 25.1–35 years and 37.5 % ( 26.7–48.3 ) in men aged 25.1–45 years . Prevalence of previously undiagnosed HIV was 10.3 % ( 8.5–12.1 ) overall and 4.5 % ( 2.3–6.6 ) , 8.0 % ( CI 3.9–12.0 ) and 20.0 % ( 13.2–26.8 ) in individuals who had their most recent HIV test within 1 , 1–2 and more than 2 years prior to the survey . Conclusion The high burden of undiagnosed HIV in individuals who had recently tested underscores the importance of frequent repeat testing at least annually . The high prevalence of previously undiagnosed HIV in individuals reporting a negative test in the 12 months preceding the survey indicates a very high incidence . Innovative prevention strategies are needed Background Human re source limitations are a challenge to the delivery of antiretroviral therapy ( ART ) in low-re source setting s. We conducted a cluster r and omized trial to assess the effect of community-based peer health workers ( PHW ) on AIDS care of adults in Rakai , Ug and a. Methodology /Principal Findings 15 AIDS clinics were r and omized 2∶1 to receive the PHW intervention ( n = 10 ) or control ( n = 5 ) . PHW tasks included clinic and home-based provision of counseling , clinical , adherence to ART , and social support . Primary outcomes were adherence and cumulative risk of virologic failure ( > 400 copies/mL ) . Secondary outcomes were virologic failure at each 24 week time point up to 192 weeks of ART . Analysis was by intention to treat . From May 2006 to July 2008 , 1336 patients were followed . 444 ( 33 % ) of these patients were already on ART at the start of the study . No significant differences were found in lack of adherence ( < 95 % pill count adherence risk ratio [ RR ] 0.55 , 95 % confidence interval [ CI ] 0.23–1.35 ; < 100 % adherence RR 1.10 , 95 % CI 0.94–1.30 ) , cumulative risk of virologic failure ( RR 0.81 , 95 % CI 0.61–1.08 ) or in shorter-term virologic outcomes ( 24 week virologic failure RR 0.93 , 95 % CI 0.65–1.32 ; 48 week , RR 0.83 , 95 % CI 0.47–1.48 ; 72 week , RR 0.81 , 95 % CI 0.44–1.49 ) . However , virologic failure rates ≥96 weeks into ART were significantly decreased in the intervention arm compared to the control arm ( 96 week failure RR 0.50 , 95 % CI 0.31–0.81 ; 120 week , RR 0.59 , 95 % CI 0.22–1.60 ; 144 week , RR 0.39 , 95 % CI 0.16–0.95 ; 168 week , RR 0.30 , 95 % CI 0.097–0.92 ; 192 week , RR 0.067 , 95 % CI 0.0065–0.71 ) . Conclusions / Significance A PHW intervention was associated with decreased virologic failure rates occurring 96 weeks and longer into ART , but did not affect cumulative risk of virologic failure , adherence measures , or shorter-term virologic outcomes . PHWs may be an effective intervention to sustain long-term ART in low-re source setting s. Trial Registration Clinical Trials.gov Background Routine ART programme statistics generally only provide information about individuals who start treatment . We aim ed to investigate the outcome of those who are eligible but do not start ART in the Malawi programme , factors associated with this dropout , and reasons for not starting treatment , in a prospect i ve cohort study . Methods Individuals having a first screening visit at the ART clinic at Karonga District Hospital , northern Malawi , between September 2005 and July 2006 were interviewed . Study follow-up to identify treatment outcomes was conducted at the clinic and in the community . Logistic regression models were used to identify factors associated with dropout before ART initiation among participants identified as clinical ly eligible for ART . Results 88 participants eligible for ART at their first screening visit ( out of 633 , 13.9 % ) defaulted before starting ART . Participants with less education ,  difficulties in dressing , a more delayed ART initiation appointment , and mid-upper arm circumference ( MUAC ) < 22 cm were significantly less likely to have visited the clinic subsequently . Thirty-five ( 58 % ) of the 60 participants who defaulted and were tracked at home had died , 21 before their ART initiation appointment . Conclusions MUAC and reported difficulties in dressing may provide useful screening indicators to identify sicker ART-eligible individuals at high risk of dropping out of the programme who might benefit from being brought back quickly or admitted to hospital for observation . Individuals with less education may need adapted health information at screening . Deaths of ART-eligible individuals occurring prior to ART initiation are not included in routine programme statistics . Considering all those who are eligible for ART as a denominator for programme indicators would help to highlight this vulnerable group , in order to identify new opportunities for further improving ART programmes OBJECTIVE Few articles have examined specific counseling tools used to increase  antiretroviral therapy ( ART ) adherence . We present communication tools used in the context of Project MOTIV8 , a r and omized clinical trial . METHODS We developed , piloted , and evaluated pictorial images to communicate the importance of consistent dose timing and the concept of drug resistance . Electronic drug monitoring ( EDM ) review was also used to provide visual feedback and facilitate problem solving discussion s. Adherence knowledge of all participants ( n=204 ) was assessed at baseline and 48 weeks . Participant satisfaction with counseling was also assessed . RESULTS Adherence knowledge did not differ at baseline , however , at 48 weeks , intervention participants demonstrated significantly increased knowledge compared to controls F(1 , 172)=10.76 , p=0.001 ( 12.4 % increase among intervention participants and 1.8 % decrease among controls ) . Counselors reported that the tools were well-received , and 80 % of participants felt the counseling helped them adhere to their medications . CONCLUSIONS Counseling tools were both positively received and effective in increasing ART adherence knowledge among a diverse population . PRACTICE IMPLICATION S While developed for research , these counseling tools can be implemented into clinical practice to help patients ; particularly those with lower levels of education or limited abstract thinking skills to underst and medical concepts related to ART adherence BACKGROUND Minimizing death and ensuring high retention and good adherence remain ongoing challenges for human immunodeficiency virus ( HIV ) treatment programs . We examined whether the addition of community-based accompaniment ( characterized by daily home visits from a community health worker , directly observed treatment , nutritional support , transportation stipends , and other support as needed ) to the Rw and a national model for antiretroviral therapy ( ART ) delivery would improve retention in care , viral load suppression , and change in CD4 count , relative to the national model alone . METHODS We conducted a prospect i ve observational cohort study among 610 HIV-infected adults initiating ART in 1 of 2 programs in rural Rw and a. Psychosocial and clinical characteristics were recorded at ART initiation . Death , treatment retention , and plasma viral load were assessed at 1 year . CD4 count was evaluated at 6-month intervals . Multivariable regression models were used to adjust for baseline differences between the 2 population s. RESULTS Eighty-five percent and 79 % of participants in the community-based and clinic-based programs , respectively , were retained with viral load suppression at 1 year . After adjusting for CD4 count , depression , physical health quality of life , and food insecurity , community-based accompaniment was protective against death or loss to follow-up during the first year of ART ( hazard ratio , 0.17 ; 95 % confidence interval [ CI ] , .09-.35 ; P < .0001 ) . In a second multivariable analysis , individuals receiving accompaniment were more likely to be retained with a suppressed viral load at 1 year ( risk ratio : 1.15 ; 95 % CI , 1.03 - 1.27 ; P = .01 ) . CONCLUSIONS These findings indicate that community-based accompaniment is effective in improving retention , when added to a clinic-based program with fewer patient support mechanisms 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 
    Output:
    
Several interventions showed favourable outcomes :  integration of care and peer supporters increased enrolment into HIV care , medical incentives increased pre-ART retention , POC CD4 testing and food incentives increased completion of ART eligibility screening and ART initiation .