***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 : Hazardous alcohol use by HIV-infected women is associated with poor HIV outcomes and HIV transmission risk behaviors . We examined the effectiveness of brief alcohol intervention ( BI ) among hazardous drinking women receiving care in an urban HIV clinic . Methods : Women were r and omized to a 2-session BI or usual care . Outcomes assessed at baseline , 3 , 6 , and 12 months included 90-day frequency of any alcohol use and heavy/binge drinking ( ≥4 drinks per occasion ) , and average drinks per drinking episode . Secondary outcomes included HIV medication and appointment adherence , HIV-1 RNA suppression , and days of unprotected vaginal sex . We examined intervention effectiveness using generalized mixed-effect models and quantile regression . Results : Of 148 eligible women , 74 were r and omized to each arm . In mixed-effects models , 90-day drinking frequency decreased among intervention group compared with control , with women in the intervention condition less likely to have a drinking day ( odds ratio : 0.42 ; 95 % confidence interval : 0.23 to 0.75 ) . Heavy/binge drinking days and drinks per drinking day did not differ significantly between groups . Quantile regression demonstrated a decrease in drinking frequency in the middle to upper ranges of the distribution of drinking days and heavy/binge drinking days that differed significantly between intervention and control conditions . At follow-up , the intervention group had significantly fewer episodes of unprotected vaginal sex . No intervention effects were observed for other outcomes . Conclusions : BI reduces frequency of alcohol use and unprotected vaginal sex among HIV-infected women . More intensive services may be needed to lower drinks per drinking day and enhance care for more severely affected drinkers This paper used qualitative methods to explore experiences of men who have sex with men and female sex workers in Nairobi and Mtwapa , Kenya , who used oral pre-exposure prophylaxis ( PrEP ) for HIV prevention as part of a four-month trial of safety , acceptability and adherence . Fifty-one of 72 volunteers who took part in a r and omized , placebo-controlled , blinded trial that compared daily and intermittent dosage of PrEP underwent qualitative assessment s after completing the trial . Analyses identified three themes : ( i ) acceptability of PrEP  was high , i.e. side effects were experienced early in the study but diminished over time , however characteristics of pills could improve comfort and use ; ( ii ) social impacts such as stigma , rumors , and relationship difficulties due to being perceived as HIV positive were prevalent ; ( iii ) adherence was challenged by complexities of daily life , in particular post-coital dosing adherence suffered from alcohol use around time of sex , mobile population s , and transactional sex work . These themes resonated across dosing regimens and gender , and while most participants favored the intermittent dosing schedule , those in the intermittent group noted particular challenges in adhering to the post-coital dose . Culturally appropriate and consistent counseling addressing these issues may be critical for PrEP effectiveness OBJECTIVE This article examines  client drinking and related psychosocial functioning during the course of alcoholism treatment .  It focuses on ( 1 ) the main effects of the three Project MATCH treatments , ( 2 ) the prognostic value of client attributes employed in the matching hypotheses , and ( 3 ) the attribute by treatment interaction effects . METHOD Clients recruited from outpatient setting s ( n = 952 ) or from aftercare setting s ( n = 774 ) were r and omized to one of the following treatments : Motivational Enhancement Therapy ( MET ) , Cognitive Behavioral Therapy ( CBT ) and Twelve-Step Facilitation ( TSF ) .  Alcohol consumption and psychosocial functioning during treatment were assessed at the end of the 12-week treatment phase . RESULTS During the treatment phase , small but statistically significant differences among treatments were found only in the outpatient arm on measures of alcohol consumption and alcohol-related negative consequences . Forty-one percent ( 41 % ) of CBT and TSF clients were abstinent or drank moderately without alcohol-related consequences , compared with 28 % of MET clients . Tests of 10 a priori primary client-treatment matching hypotheses failed to find any interaction effects that had an impact on drinking throughout the treatment phase . CONCLUSIONS In the outpatient setting there appears to be a temporary advantage to assigning individuals to CBT or TSF rather than MET . When there is a need to quickly reduce heavy drinking and alcohol-related consequences , it appears that CBT or TSF should be the treatment of choice In this article we review the important statistical properties of the urn r and omization ( design ) for assigning patients to treatment groups in a clinical trial . The urn design is the most widely studied member of the family of adaptive biased-coin design s. Such design s are a compromise between design s that yield perfect balance in treatment assignments and complete r and omization which eliminates experimental bias . The urn design forces a small-sized trial to be balanced but approaches complete r and omization as the size of the trial ( n ) increases . Thus , the urn design is not as vulnerable to experimental bias as are other restricted r and omization procedures . In a clinical trial it may be difficult to postulate that the study subjects constitute a r and om sample from a well-defined homogeneous population . In this case , a r and omization model provides a preferred basis for statistical inference . We describe the large- sample permutational null distributions of linear rank statistics for testing the e quality of treatment groups based on the urn design . In general , these permutation tests may be different from those based on the population model , which is equivalent to assuming complete r and omization . Poststratified subgroup analyses can also be performed on the basis of the urn design permutational distribution . This provides a basis for analyzing the subset of patients with observed responses when some patients ' responses can be assumed to be missing-at-r and om . For multiple mutually exclusive strata , these tests are correlated . For this case , a combined covariate-adjusted test of treatment effect is described . Finally , we show how to generalize the urn design to a prospect ively stratified trial with a fairly large number of strata Background Alcohol misuse is a significant international public health problem . Screening and brief intervention ( SBI ) in primary care reduces alcohol consumption by about 15 – 30 % , sustained over 12 months in hazardous or harmful drinkers but implementation has proved difficult leading to growing interest in exploring the effectiveness of SBI in other setting s , including the workplace . Computerised interventions for alcohol misuse can be as effective as traditional face-to-face interventions and may have advantages , including anonymity , convenience and availability . Methods / design Individually r and omised controlled trial to determine the effectiveness and cost-effectiveness of offering online screening and brief intervention for alcohol misuse in a workplace . Participants : adults ( aged 18 or over ) employed by participating employers scoring 5 or more on a three item screen for alcohol misuse ( the AUDIT-C ) indicating possible hazardous or harmful alcohol consumption , recruited through the offer of an online health check providing screening for a range of health behaviours with personalised feedback . Participants who accept the health check and score 5 or more on the alcohol screen will be r and omised to receiving immediate feedback on their alcohol consumption and access to an online intervention offering support in reducing alcohol consumption ( Down Your Drink ) or delayed feedback and access to Down Your Drink after completion of follow-up data at three months . All employees who take the online health check will receive personalised feedback on other screened health behaviours including diet , physical activity , smoking , and body mass index . The primary outcome is alcohol consumption in the past week at three months ; secondary outcomes are the AUDIT , EQ-5D , days off work , number and duration of hospital admissions , costs and use of the intervention . A sample size of 1,472 participants ( 736 in each arm ) provides 90 % power with 5 % significance to determine a 20 % reduction in alcohol consumption . Outcomes between groups at three months will be compared following the intention to treat principle and economic analyses will follow NICE guidance . Discussion This innovative design avoids recruitment bias by not mentioning alcohol in the invitation and avoids reactivity of assessment by not collecting baseline data on alcohol consumption The principal objective of these multisite studies ( Florida , New York , New Jersey : epicenters for human immunodeficiency virus [ HIV ] among women ) was to develop and implement effective combinations of behavioral interventions to optimize the health status of the most neglected and understudied population affected by the acquired immunodeficiency syndrome ( AIDS ) epidemic in the United States : poor women of color living with HIV . The two studies enrolled nearly 900 women r and omly assigned to “ high intensity ” ( cognitive – behavioral stress management training combined with expressive – supportive therapy [CBSM]+ group ) or “ low intensity ” ( individual psychoeducational program ) treatment conditions over a period of 9 years . The initial study of the stress management and relaxation training/expressive – supportive therapy ( SMART/EST ) Women ’s Project ( SWP I ) focused on reducing depression and anxiety , as well as improving self-efficacy and overall quality of life for women with case-defined AIDS . Findings from this study demonstrated the utility of CBSM+ in reducing distress ( depression , anxiety ) and denial , while improving social support , self-efficacy , coping skills , and quality of life . The second study ( SWP II ) , which included all women living with HIV , extended these findings by demonstrating that exposure to CBSM+ significantly improved the ability of the participants to take advantage of a health behavior change program encouraging the adoption and maintenance of healthier lifestyle behaviors ( high levels of medication adherence , appropriate nutritional intake and physical activity , safer sexual practice s , and reduced alcohol use/abuse ) essential for optimal health in the context of living with HIV . SWP II also determined that the intervention program was equally beneficial to less-acculturated segments of the affected population ( ie , non-English speaking HIV+ women ) through the creation of culturally and linguistically sensitive Spanish and Creole versions of the program . A third study ( SWP III ) is currently underway to “ translate ” this evidence -based treatment program into Community Health Centers in Miami , New York City , and metropolitan New Jersey Background : Alcohol consumption has frequently been purported as a driver of condomless sex and HIV transmission , but to date , experimental evidence for the causal risk-taking impact of alcohol among HIV-positive population s is lacking . The present experiment sought to determine whether acute alcohol consumption has a direct causal impact on condomless sex intentions among HIV-positive men-who-have-sex-with-men ( MSM ) , and to assess whether alcohol 's impact differs between MSM who are HIV-positive versus HIV-negative . Methods : In a r and omized controlled alcohol administration experiment , HIV-positive and HIV-negative MSM were brought into a specialized barroom laboratory and r and omly assigned to beverage consumption condition : alcohol ( target blood alcohol concentration = 0.080 % ) , placebo alcohol ( target blood alcohol concentration = 0.000 % ) , or water ( control ) . Participants then underwent a video-based sexual arousal manipulation ( sexually aroused/nonaroused ) and indicated their intentions to engage in condom-protected and condomless sexual  acts in a st and ardized paradigm . The primary outcome entailed intentions to engage in condomless receptive and condomless insertive anal sex . Results : A total of 282 MSM ( 141 HIV-positive ; 141 HIV-negative ) completed experimental procedures . MSM who received alcohol reported significantly stronger intentions to engage in condomless sex than those who received placebo alcohol or water ( F(1,274 ) = 9.43 , P = 0.002 ) . The impact of alcohol did not differ between HIV-positive and HIV-negative MSM ( F(1,274 ) = 1.86 , P = 0.174 ) . Conclusions : The present investigation entailed the first risk-focused alcohol administration experiment to involve an HIV-positive sample , and results demonstrated that consuming alcohol had an independent , causal impact on intentions to engage in sexual behaviors that can result in HIV transmission . Findings strongly suggest that alcohol-focused initiatives should be incorporated into HIV prevention efforts We evaluated the efficacy of a brief motivational intervention ( MI ) counseling in reducing alcohol consumption among persons living with HIV/AIDS in Kampala , Ug and a. Persons living with HIV/AIDS with Alcohol Use Disorders Identification Tool ( AUDIT ) score ≥3 points were r and omized to either st and ardized positive prevention counseling alone or in combination with alcohol brief MI counseling . The mean change in AUDIT-C scores over 6 months was compared by treatment arm . The mean ( st and ard deviation [ SD ] ) AUDIT-C scores were 6.3 ( 2.3 ) and 6.8 ( 2.3 ) for control and MI arms ( P = .1 ) at baseline , respectively , and change in mean AUDIT-C score was not statistically different between arms over the 6 months ( P = .8 ) . However , there was a statistically significant decrease in mean AUDIT-C score ( −1.10 ; 95 % confidence interval : −2.19 to −0.02 , P = .046 ) among women in the MI arm . There was a nondifferential reduction in alcohol consumption overall , but MI appeared effective among women only . Studies with more than 1 counseling session and evaluation of gender differences in treatment response are needed AIMS Co-occurrence of drug and alcohol use among people living with HIV is linked to poor medication adherence and lack of viral suppression . HealthCall , a technological enhancement of brief Motivational Interviewing ( MI ) , involves brief daily self-monitoring , positive reinforcement , and personalized feedback . This r and omized pilot study among people living with HIV investigated the feasibility and efficacy of reducing non-injection drug and alcohol 
    Output:
    
However , a 2017 review that examined multiple HIV prevention and treatment outcomes suggested that behavioural interventions were effective in reducing alcohol use .
There was a lack of evidence for significant intervention effects in the included studies .
Isolated effects of motivational interviewing , cognitive behavioural therapy and group therapy were noted .
However for some of the studies that found significant effects , the effect sizes were small and not sustained over time .
Conclusion This systematic review did not reveal large or sustained intervention effects of psychological interventions for either primary alcohol use or secondary HIV-related outcomes .