***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: Introduction There is growing evidence concerning the acceptability and feasibility of home-based HIV testing . However , less is known about the cost-effectiveness of the approach yet it is a critical component to guide decisions about scaling up access to HIV testing . This study examined the cost-effectiveness of a home-based HIV testing intervention in rural South Africa . Methods Two alternatives : clinic and home-based HIV counselling and testing were compared . Costs were analysed from a provider ’s perspective for the period of January to December 2010 . The outcome ,  HIV counselling and testing ( HCT ) uptake was obtained from the Good Start home-based HIV counselling and testing ( HBHCT ) cluster r and omised control trial undertaken in KwaZulu-Natal province .  Cost-effectiveness was estimated for a target population of 22,099 versus 23,864 people for intervention and control communities respectively .  Average costs were calculated as the cost per client tested , while cost-effectiveness was calculated as the cost per additional client tested through HBHCT . Results Based on effectiveness of 37 % in the intervention ( HBHCT ) arm compared to 16 % in control arm , home based testing costs US$ 29 compared to US$ 38 per person for clinic HCT . The incremental cost effectiveness per client tested using HBHCT was $ 19 . Conclusions HBHCT was less costly and more effective .  Home-based HCT could present a cost-effective alternative for rural ‘ hard to reach ’ population s depending on affordability by the health system , and should be considered as part of community outreach programs Introduction Linkage from HIV testing and counselling ( HTC ) to initiation of antiretroviral therapy ( ART ) is suboptimal in many national programmes in sub-Saharan Africa , leading to delayed initiation of ART and increased risk of death . Reasons for failure of linkage are poorly understood . Methods Semi-structured qualitative interviews were undertaken with health providers and HIV-positive primary care patients as part of a prospect i ve cohort study at primary health centres in Blantyre , Malawi . Patients successful and unsuccessful in linking to ART were included . Results Progression through the HIV care pathway was strongly influenced by socio-cultural norms , particularly around the perceived need to regain respect lost during a period of visibly declining health . Capacity to call upon the support of networks of families , friends and employers was a key determinant of successful progression . Over-busy clinics , non-functioning laboratories and unsuitable tools used for ART eligibility assessment ( WHO clinical staging system and central ized CD4 count measurement ) were important health systems determinants of drop-out . Conclusions Key interventions that could rapidly improve linkage include guarantee of same-day , same-clinic ART eligibility assessment s ; utilization of the support offered by peer-groups and community health workers ; and integration of HTC and ART programmes Background Antiretroviral therapy ( ART ) has been scaled-up rapidly in Africa . Programme reports typically focus on loss to follow-up and mortality among patients receiving ART . However , little is known about linkage and retention in care of individuals prior to starting ART . Methodology Data on adult residents from a periurban community in Cape Town were collected at a primary care clinic and hospital . HIV testing registers , CD4 count results provided by the National Health Laboratory System and ART registers were linked . A r and om sample ( n = 885 ) was drawn from adults testing HIV positive through antenatal care , sexual transmitted disease and voluntary testing and counseling services between January 2004 and March 2009 . All adults ( n = 103 ) testing HIV positive through TB services during the same time period were also included in the study . Linkage to HIV care was defined as attending for a CD4 count measurement within 6 months of HIV diagnosis . Linkage to ART care was defined as initiating ART within 6 months of HIV diagnosis in individuals with a CD4 count ≤200 cells/µl taken within 6 months of HIV diagnosis . Findings Only 62.6 % of individuals attended for a CD4 count measurement within 6 months of testing HIV positive . Individuals testing through sexually transmitted infection services had the best ( 84.1 % ) and individuals testing on their own initiative ( 53.5 % ) the worst linkage to HIV care . One third of individuals with timely CD4 counts were eligible for ART and 66.7 % of those were successfully linked to ART care . Linkage to ART care was highest among antenatal care clients . Among individuals not yet eligible for ART only 46.3 % had a repeat CD4 count . Linkage to HIV care improved in patients tested in more recent calendar period . Conclusion Linkage to HIV and ART care was low in this poor peri-urban community despite free services available within close proximity . More efforts are needed to link VCT scale-up to subsequent care Background The 2015 WHO recommendation of antiretroviral therapy ( ART ) for all immediately following HIV diagnosis is partially based on the anticipated impact on HIV incidence in the surrounding population . We investigated this approach in a cluster-r and omised trial in a high HIV prevalence setting in rural KwaZulu-Natal . We present findings from the first phase of the trial and report on uptake of  home-based HIV testing  , linkage to care , uptake of ART , and community attitudes about ART . Methods and Findings Between 9 March 2012 and 22 May 2014 , five clusters in the intervention arm ( immediate ART offered to all HIV-positive adults ) and five clusters in the control arm  ( ART offered according to national guidelines , i.e. , CD4 count ≤ 350 cells/μl ) contributed to the first phase of the trial . Households were visited every 6 mo . Following informed consent and administration of a study question naire , each resident adult ( ≥16 y ) was asked for a finger-prick blood sample , which was used to estimate HIV prevalence , and offered a rapid HIV test using a serial HIV testing algorithm . All HIV-positive adults were referred to the trial clinic in their cluster . Those not linked to care 3 mo after identification were contacted by a linkage-to-care team . Study procedures were not blinded . In all , 12,894 adults were registered as eligible for participation ( 5,790 in intervention arm ; 7,104 in control arm ) , of whom 9,927 ( 77.0 % ) were contacted at least once during household visits . HIV status was ever ascertained for a total of 8,233/9,927 ( 82.9 % ) , including 2,569 ascertained as HIV-positive ( 942 tested HIV-positive and 1,627 reported a known HIV-positive status ) . Of the 1,177 HIV-positive individuals not previously in care and followed for at least 6 mo in the trial , 559 ( 47.5 % ) visited their cluster trial clinic within 6 mo . In the intervention arm , 89 % ( 194/218 ) initiated ART within 3 mo of their first clinic visit . In the control arm , 42.3 % ( 83/196 ) had a CD4 count ≤ 350 cells/μl at first visit , of whom 92.8 % initiated ART within 3 mo . Regarding attitudes about ART , 93 % ( 8,802/9,460 ) of participants agreed with the statement that they would want to start ART as soon as possible if HIV-positive . Estimated baseline HIV prevalence was 30.5 % ( 2,028/6,656 ) ( 95 % CI 25.0 % , 37.0 % ) . HIV prevalence , uptake of home-based HIV testing , linkage to care within 6 mo , and initiation of ART within 3 mo in those with CD4 count ≤ 350 cells/μl did not differ significantly between the intervention and control clusters . Selection bias related to noncontact could not be entirely excluded . Conclusions Home-based HIV testing  was well received in this rural population , although men were less easily contactable at home ; immediate ART was acceptable , with good viral suppression and retention . However , only about half of HIV-positive people accessed care within 6 mo of being identified , with nearly two-thirds accessing care by 12 mo . The observed delay in linkage to care would limit the individual and public health ART benefits of universal testing and treatment in this population . Trial registration Clinical Trials.gov Introduction We aim ed to quantify and identify associated factors of linkage to HIV care following home-based HIV counselling and testing ( HBHCT ) in the ongoing ANRS 12249 treatment-as-prevention ( TasP ) cluster-r and omized trial in rural KwaZulu-Natal , South Africa . Methods Individuals ≥16 years were offered HBHCT ; those who were identified HIV positive were referred to cluster-based TasP clinics and offered antiretroviral treatment ( ART ) immediately ( five clusters ) or according to national guidelines ( five clusters ) . HIV care was also available in the local Department of Health ( DoH ) clinics . Linkage to HIV care was defined as TasP or DoH clinic attendance within three months of referral among adults not in HIV care at referral . Associated factors were identified using multivariable logistic regression adjusted for trial arm . Results Overall , 1323 HIV-positive adults ( 72.9 % women ) not in HIV care at referral were included , of whom 36.9 % ( n=488 ) linked to care <3 months of referral ( similar by sex ) . In adjusted analyses ( n=1222 ) , individuals who had never been in HIV care before referral were significantly less likely to link to care than those who had previously been in care ( <33 % vs. > 42 % , p<0.001 ) . Linkage to care was lower in students ( adjusted odds-ratio [aOR]=0.47 ; 95 % confidence interval [ CI ] 0.24–0.92 ) than in employed adults , in adults who completed secondary school ( aOR=0.68 ; CI 0.49–0.96 ) or at least some secondary school ( aOR=0.59 ; CI 0.41–0.84 ) versus ≤ primary school , in those who lived at 1 to 2 km ( aOR=0.58 ; CI 0.44–0.78 ) or 2–5 km from the nearest TasP clinic ( aOR=0.57 ; CI 0.41–0.77 ) versus < 1 km , and in those who were referred to clinic after ≥2 contacts ( aOR=0.75 ; CI 0.58–0.97 ) versus those referred at the first contact . Linkage to care was higher in adults who reported knowing an HIV-positive family member ( aOR=1.45 ; CI 1.12–1.86 ) versus not , and in those who said that they would take ART as soon as possible if they were diagnosed HIV positive ( aOR=2.16 ; CI 1.13–4.10 ) versus not . Conclusions Fewer than 40 % of HIV-positive adults not in care at referral were linked to HIV care within three months of HBHCT in the TasP trial . Achieving universal test and treat coverage will require innovative interventions to support linkage to HIV care Background In high HIV prevalence setting s , offering HIV testing may be a reasonable part of contact tracing of index tuberculosis ( TB ) patients . We evaluated the uptake of HIV counselling and testing ( HCT )  among household contacts of index TB patients and the proportion of newly diagnosed HIV-infected persons linked into care as part of a household TB contact tracing study . Methods We recruited index TB patients at public health clinics in two South African provinces to obtain consent for household contact tracing . During scheduled household visits we offered TB symptom screening to all household members and HCT to individuals ≥14years of age . Factors associated with  HCT uptake were investigated using a r and om effects logistic regression model . Results & Discussion Out of 1,887 listed household members ≥14 years old , 984 ( 52 % ) were available during a household visit and offered HCT of which 108 ( 11 % ) self-reported being HIV infected and did not undergo HCT . Of the remaining 876 , a total of 304 agreed to HCT  ( 35 % ) ; 26 ( 8.6 % ) were newly diagnosed as HIV positive . In multivariable analysis , factors associated with uptake of HCT were prior testing ( odds ratio 1.6 ; 95 % confidence interval [ CI ] : 1.1–2.3 ) and another member in the household testing ( odds ratio 2.4 ; 95 % CI : 1.7–3.4 ) . Within 3 months of testing HIV-positive , 35 % reported initiating HIV care . Conclusion HCT as a component of household TB contact tracing reached individuals without prior HIV testing , however uptake of HIV testing was poor . Strategies to improve HIV testing in household contacts should be evaluated OBJECTIVE Antiretroviral therapy ( ART ) significantly decreases HIV-associated morbidity , mortality , and HIV transmission through HIV viral load suppression . In high HIV prevalence setting s , outreach strategies are needed to find asymptomatic HIV positive persons , link them to HIV care and ART , and achieve viral suppression . METHODS We conducted a prospect i ve intervention study in two rural communities in KwaZulu-Natal , South Africa , and Mbabara district , Ug and a. The intervention included home HIV testing and counseling ( HTC ) , point-of-care CD4 count testing for HIV positive persons , referral to care , and one month then quarterly lay counselor follow-up visits . The outcomes at 12 months were linkage to care , and ART initiation and viral suppression among 
    Output:
    
Linkage was often low after routine referral but higher if additional interventions were used to facilitate it .