***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 A better underst and ing of  pediatric antiretroviral therapy ( ART ) adherence in sub-Saharan Africa is necessary to develop interventions to sustain high levels of adherence . Methodology /Principal Findings Adherence among 96 HIV-infected Zambian children ( median age 6 , interquartile range [ IQR ] 2,9 ) initiating fixed-dose combination ART  was measured prospect ively ( median 23 months ; IQR 20,26 ) with caregiver report , clinic and unannounced home-based pill counts , and medication event monitoring systems ( MEMS ) . HIV-1 RNA was determined at 48 weeks . Child and caregiver characteristics , socio-demographic status , and treatment-related factors were assessed as predictors of adherence . Median adherence was 97.4 % ( IQR 96.1,98.4 % ) by visual analog scale , 94.8 % ( IQR 86,100 % ) by caregiver-reported last missed dose , 96.9 % ( IQR 94.5,98.2 % ) by clinic pill count , 93.4 % ( IQR 90.2,96.7 % ) by unannounced home-based pill count , and 94.8 % ( IQR 87.8,97.7 % ) by MEMS . At 48 weeks , 72.6 % of children had HIV-1 RNA < 50 copies/ml . Agreement among adherence measures was poor ; only MEMS was significantly associated with viral suppression ( p = 0.013 ) . Predictors of poor adherence included changing residence , school attendance , lack of HIV disclosure to children aged nine to 15 years , and increasing household income . Conclusions / Significance Adherence among children taking fixed-dose combination ART in sub-Saharan Africa is high and sustained over two years . However , certain groups are at risk for treatment failure , including children with disrupted routines , no knowledge of their HIV diagnosis among older children , and relatively high household income , possibly reflecting greater social support in the setting of greater poverty Background For youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome ( AIDS ) , nonadherence to antiretroviral therapy ( ART ) can lead to poor health outcomes and significantly decreased life expectancy . Objective To evaluate the feasability , acceptability , and preliminary efficacy of short message service ( SMS ) or text message reminders to improve adherence to ART for youth living with HIV/AIDS . Methods We conducted this prospect i ve pilot study using a pre – post design from 2009 to 2010 at a community-based health center providing clinical services to youth living with HIV/AIDS . Eligibility criteria included HIV-positive serostatus , age 14–29 years , use of a personal cell phone , English-speaking , and being on ART with documented poor adherence . During the 24-week study period , participants received personalized daily SMS reminders and a follow-up message 1 hour later assessing whether they took the medication , and asking participants to respond via text message with the number 1 if they took the medication and 2 if they did not . Outcome measures were feasibility , acceptability , and adherence . Self-reported adherence was determined using the visual analog scale ( VAS ) and AIDS Clinical Trial Group ( ACTG ) question naire 4-day recall . Viral load and CD4 cell count were followed as biomarkers of adherence and disease progression at 0 , 12 , and 24 weeks . Results Participants ( N = 25 ) were mean age 23 ( range 14–29 ) years , 92 % ( n = 23 ) male , 60 % ( n = 15 ) black , and 84 % ( n = 21 ) infected through unprotected sex . Mean VAS scores significantly increased at 12 and 24 weeks in comparison with baseline ( week 0 : 74.7 , week 12 : 93.3 , P < .001 ; week 24 : 93.1 , P < .001 ) . ACTG question naire 4-day recall also improved ( week 0 : 2.33 , week 12 : 3.24 , P = .002 ; week 24 : 3.19 , P = .005 ) . There was no significant difference in CD4 cell count or viral load between baseline and 12- or 24-week follow-up , although there was a trend toward improvement of these biomarkers and a small to moderate st and ardized effect size ( range of Cohen d : –0.51 to 0.22 ) . Of 25 participants , 21 ( 84 % ) were retained , and 20 of the 21 ( 95 % ) participants who completed the study found the intervention helpful to avoid missing doses . Conclusions In this pilot study , personalized , interactive , daily SMS reminders were feasible and acceptable , and they significantly improved self-reported adherence . Larger controlled studies are needed to determine the impact of this intervention on ART adherence and other related health outcomes for youth living with HIV/AIDS CONTEXT Physical activity has been shown to decrease the incidence of breast cancer , but the effect on recurrence or survival after a breast cancer diagnosis is not known . OBJECTIVE To determine whether physical activity among women with breast cancer decreases their risk of death from  breast cancer  compared with more sedentary women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational study based on responses from 2987 female registered nurses in the Nurses ' Health Study who were diagnosed with stage I , II , or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002 , whichever came first . MAIN OUTCOME MEASURE Breast cancer mortality risk according to  physical activity  category ( <3 , 3 - 8.9 , 9 - 14.9 , 15 - 23.9 , or > or = 24 metabolic equivalent task [ MET ] hours per week ) . RESULTS Compared with women who engaged in less than 3 MET-hours per week of physical activity , the adjusted relative risk ( RR ) of death from breast cancer was 0.80 ( 95 % confidence interval [ CI ] , 0.60 - 1.06 ) for 3 to 8.9 MET-hours per week ; 0.50 ( 95 % CI , 0.31 - 0.82 ) for 9 to 14.9 MET-hours per week ; 0.56 ( 95 % CI , 0.38 - 0.84 ) for 15 to 23.9 MET-hours per week ; and 0.60 ( 95 % CI , 0.40 - 0.89 ) for 24 or more MET-hours per week ( P for trend = .004 ) . Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour . The benefit of physical activity was particularly apparent among women with hormone-responsive tumors . The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more MET-hours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 ( 95 % CI , 0.34 - 0.74 ) . Compared with women who engaged in less than 3 MET-hours per week of activity , the absolute unadjusted mortality risk reduction was 6 % at 10 years for women who engaged in 9 or more MET-hours per week . CONCLUSIONS Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease . The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace , with little evidence of a correlation between increased benefit and greater energy expenditure . Women with breast cancer who follow US physical activity recommendations may improve their survival Background Mobile phone technology is a novel way of delivering health care and improving health outcomes . This trial investigates the use of motivational mobile phone text messages ( SMS ) to improve adherence to antiretroviral therapy ( ART ) over six months . Methodology /Principal Findings CAMPS was a single-site r and omized two-arm parallel design trial in Yaoundé , Cameroon . We enrolled and r and omized HIV-positive adults on ART , aged 21 years and above to receive a weekly  st and ardized motivational text message versus usual care alone . The primary outcome was adherence measured using a visual analogue scale ( VAS ) , number of doses missed ( in the week preceding the interview ) and pharmacy refill data . Outcomes were measured at 3 and 6 months . Service providers and outcome assessors were blinded to allocation . Analysis was by intention-to-treat . Between November and December 2010 , 200 participants were r and omized , with 101 in the intervention group and 99 in the control group . At 6 months , overall retention was 81.5 % . We found no significant effect on adherence by VAS>95 % ( risk ratio [ RR ] 1.06 , 95 % confidence interval [ CI ] 0.89 , 1.29 ; p = 0.542 ; reported missed doses ( RR 1.01 , 95 % CI 0.87 , 1.16 ; p>0.999 ) or number of pharmacy refills ( mean difference [ MD ] 0.1 , 95 % CI : 0.23 , 0.43 ; p = 0.617 . One participant in the intervention arm reported a possible disclosure of status . Conclusions / Significance St and ardized motivational mobile phone text messages did not significantly improve adherence to ART in this study . Other types of messaging or longer term studies are recommended . Registration 1 . Pan-African Clinical Trials Registry ; PACTR201011000261458 2 . Clinical trials.gov ; Background Many HIV-infected children in sub-Saharan Africa reside in rural areas , yet most research on treatment outcomes has been conducted in urban centers . Rural clinics and residents may face unique barriers to care and treatment . Methods A prospect i ve cohort study of HIV-infected children was conducted between September 2007 and September 2010 at the rural HIV clinic in Macha , Zambia . HIV-infected children younger than 16 years of age at study enrollment who received antiretroviral therapy ( ART ) during the study were eligible . Treatment outcomes during the first two years of ART , including mortality , immunologic status , and virologic suppression , were assessed and risk factors for mortality and virologic suppression were evaluated . Results A total of 69 children entered the study receiving ART and 198 initiated ART after study enrollment . The cumulative probabilities of death among children starting ART after study enrollment were 9.0 % and 14.4 % at 6 and 24 months after ART initiation . Younger age , higher viral load , lower CD4 + T-cell percentage and lower weight-for-age z-scores at ART initiation were associated with higher risk of mortality . The mean CD4 + T-cell percentage increased from 16.3 % at treatment initiation to 29.3 % and 35.0 % at 6 and 24 months . The proportion of children with undetectable viral load increased to 88.5 % and 77.8 % at 6 and 24 months . Children with longer travel times ( ≥5 hours ) and those taking nevirapine at ART initiation , as well as children who were non-adherent , were less likely to achieve virologic suppression after 6 months of ART . Conclusions HIV-infected children receiving treatment in a rural clinic experienced sustained immunologic and virologic improvements . Children with longer travel times were less likely to achieve virologic suppression , supporting the need for de central ized models of ART delivery Introduction With the availability of antiretroviral therapy ( ART ) and primary general care for people living with HIV ( PLHIV ) in re source limited setting s , PLHIV are living longer , and HIV has been transformed into a chronic illness . People are diagnosed and started on treatment when they are relatively well . Although ART results in clinical improvement , the ultimate goal of treatment is full physical functioning and general well-being , with a focus on quality of life rather than clinical outcomes . However , there has been little research on the relationship of specific factors to quality of life in PLHIV . The objective of this study was to investigate factors associated with quality of life among PLHIV in Ug and a receiving basic care and those on ART . Methods We enrolled 1274 patients attending an HIV outpatient clinic into a prospect i ve cohort study . Of these , 640 received ART . All were followed up at 3 and 6 months . Health related quality of life was assessed with the MOS-HIV Health Survey and the Global Person Generated Index ( GPGI ) . Multivariate linear regression and logistic regression with generalized estimating equations were used to examine the relationship of social behavioral and disease factors with Physical Health Summary ( PHS ) score , Mental Health Summary ( MHS ) score , and GPGI . Results Among PLHIV receiving basic care , PHS was associated with : sex ( p=0.045 ) - females had lower PHS ; age in years at enrollment ( p=0.0001 ) - older patients had lower PHS ; and depression ( p<0.001 ) - depressed patients had lower PHS . MHS was only associated with opportunistic infection ( p=0.01 ) - presence of an opportunistic infection was associated with lower MHS . For the GPG the associated variables were age ( p=0.03 ) - older patients had lower GPGI ; education ( p= 
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Conclusion YLWHA experience numerous challenges and support needs , some of which occur in schools and affect their QoL. The effects of these challenges are poor health and educational outcomes as well as school dropout .
The schools in which youths spend most of their formative years have not provided adequate support for YLWHA .